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Independents' Day

GP threatened with breach-of-contract notice after following BMA workload advice

A row over list closures has broken out between the GPC and NHS England after a GP following the BMA’s advice to informally close his list has been threatened with a breach-of-contract notice.

The guide, published by the BMA last month in a bid to help GPs reduce unnecessary workload while still meeting their contractual requirements, said that practices under pressure could ‘informally’ close their lists to new patients without seeking NHS England’s approval as long as there were ‘reasonable grounds’, did not discriminate against any patient and they informed patients within 14 days.

But Dr Hadrian Moss, a GP in Kettering in Northamptonshire, said that after taking this advice and informally closing his list he has received an email from the local area team warning that the practice has breached the contract.

Dr Moss, who first wrote about his decision in his Pulse blog last month and encouraged other GPs to follow his lead, has said the practice faces a situation where it has been unable to replace a partner who retired in January, with the remaining doctors putting in 10-hour days just to care for existing patients.

Explaining what happened after that, Dr Moss told Pulse: ‘NHS England contacted us by email saying they’d heard something in the media, saying that we had closed our lists, and could we confirm whether this had happened or not. And if we had closed it, we had broken our contract.’

He added: ‘The partner that retired left on 1 January, we’ve been advertising since July of last year, and we’ve not had a single applicant. Not one.’

When approached by Pulse, a spokesperson for NHS England in the central Midlands said that although it had not yet issued a breach notice to Dr Moss’ practice it stood by its reading that ‘contractual arrangements do not allow GPs to informally close their lists to new patients’.

The spokesperson said: ‘The terms… include the processes which must be followed in the event that a practice believes they need to close their register.

‘NHS England and the [CCG] are planning to meet with the practice to discuss their current position. To date, NHS England [has] not received a written pplication from Drylands GP practice to close their patient lists.’

But GPC contracts and regulation subcommittee chair Dr Robert Morley said that it is ‘perfectly legitimate’ for a practice to not take on new patients without going through the formal process with NHS England.

He said: ‘There are several reasons why practices must take action to safely manage their workload. They have a contractual obligation to meet the reasonable needs of their patients. There is legislation that the CQC judge them on.’

He added: ‘The real shame is that the NHS England area seem to be taking a typically heavy-handed and bullying approach to these practices, threatened them totally incorrectly with breach-of-contract notices. Rather than doing what they can to support these practice, they’re doing the opposite.’

Who is right?

NHS England guidance on temporary list closures says: ‘Sometimes a contractor may wish to close its list to new registrations e.g.internal capacity issues or premises refurbishments. The contractor must seek approval from the AT by a written application (the application) before this may happen.’

The GPC’s guide to managing workload says: ‘In addition to the formal list closure procedure all practices have the contractual right to decline to register any new patients without having to go through the formal processes and without needing to obtain area team permission. However the formal closure does make it far more difficult for the area team to be able to allocate any new patients to the practice list. A practice can decide not to register new patients, provided it has “reasonable and non-discriminatory grounds for doing so”, (such as protecting the quality of patient services.) In such cases, the regulations allow practice to refuse to register new patients.’

Sources: NHS England; BMA

Pulse warned in November last year that one in 20 GPs was considering closing the practice by springtime because workload pressures meant they were unable to safely sign up new patients. This followed news in September that the number of formal requests to area teams had risen by 160% in three years. Pulse also reported last March that one in three practice requests to their area team for a temporary list closure was denied by NHS England.

Dr Moss said the practice had had an outpouring of support from its patients and GP colleagues who understood what it was going through.

The GPC has advised Dr Moss that having gone down the route of informal list closure he should now follow that up with a formal request to NHS England, which Dr Moss said the partnership would discuss next week.


Related images

  • Hadrian Moss Duo 330x330

Readers' comments (49)

  • The time has come for GPs to exercise our muscle in the long term interests of our patients. If Dr Moss is held in breach of contract ALL of us should announce informal list closures forthwith
    I've had enough

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  • Yes, the time has come to copy Dr Moss if he is found in breach

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  • Russell Thorpe

    The GPC has advised Dr Moss that having gone down the route of informal list closure he should now follow that up with a formal request to NHS England. So push come to shove BMA guidance as robust as a chocolate firegaurd.

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  • Vinci Ho

    Hero rises at a time of absolute chaos.
    Hadrian , full admiration to your audacity.
    Happy Chinese New Year to all....,,

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  • Took Early Retirement


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  • GPs should take the case for corporate manslaughter against NHSE if they are arm-twisted into taking on dangerous workloads and things go wrong. This is mafia type behaviour and not acceptable in any civilized society. NHSE seems to be above the law in all circumstances and some of those at the top seem to feel that they are 'Untouchables'. This misconception needs to be rooted out and the government should look at these incidents as an urgent matter. GPs are being bullied into putting themselves and their patients at risk.

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  • The year of the sheep (or goat, depending who you believe), so with an election, we'll be blindly doing as we're told.
    The NHS has finally got my goat. Time we got a little gruff with this nanny state.

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  • "The GPC has advised Dr Moss that having gone down the route of informal list closure he should now follow that up with a formal request to NHS England"

    Wow, stand up and fight for your members GPC! What craven cowardice by a union.

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  • I find it very strange that practices cant close their lists when they perceive their workload to be sufficient. I cant understand why anyone wants to sign up to this contract. I bet in any other country you can register as few or as many patients as you feel suits you, that was certainly the case when I worked in canada. you could also just see walk ins if you wanted to.
    Why does anyone sign up to this autocratic contract. Were supposed to be independant professionals yet we are forced to do exactly what the government wants even if it leads us to burnout and puts patients at risk.

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  • Secure environments GP

    It is unhelpful to contractors and a risk to patient to safety for NHS England not to recognise an unsustainable workload and permit a solution in a practice unable to recruit.

    Whether this will work in mitigation with the GMC, Ombudsman, CQC and the Courts for a life-threatening mistake made under pressure is a moot point....

    General practice is in a dangerous state...mortally wounded...

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