This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

GPs go forth

'Significant rise' in informal GP list closures prompts crackdown

GP practices run the risk of being served with breach notices if they follow BMA advice to informally close their lists to new patients, Pulse has learned.

In surprise new guidance, issued to area teams and CCGs earlier this month, NHS England said it does ‘not sanction the term “open but full”' with regards to GP patient lists, potentially putting scores of practices in danger.

Contradicting BMA guidance issued last year, NHS England said that practices must request approval before even temporarily closing their list and that 'protecting the quality of patient services' was not a valid reason to suspend patient registrations.

A recent Pulse GP survey showed that more than one in 10 GPs (12%) had closed their list to new patients at some point over the past year, including both formal and informal temporary list closures.

In the new policy, NHS England said it had 'seen a significant rise in the number of practices suspending registration on a temporary basis causing a significant problem for patients, neighbouring practices and commissioners in some areas’.

It added: ‘Where a practice is failing to engage with the commissioner, and unilaterally seeking to determine its own restrictions on patient access, without consideration of the impact on patient access generally or the implications for neighbouring practices, then contractual action may need to be considered.’

NHS England appeared to soften its stance on temporary list closures last year, following a furore involving former Pulse columnist Dr Hadrian Moss, who was threatened with a breach of contract notice after following BMA advice and informally closing his list.

Following this, the BMA released specific advice that says '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'.

It says this stems from Schedule 6, Part 2, paragraph 17 of the GMS contract, which says that 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).

But NHS England's new guidance says they 'do not consider [this section] to be appropriate in these circumstances’. 

It adds: 'Because of the potential impact of “temporary suspension” NHS England encourages practices to open a dialogue with their commissioner as early as possible when considering temporary suspension.'

GPC deputy chair Dr Richard Vautrey told Pulse that there 'are a number of issues [with NHS England's new policy], but they include whether or not the practice has to seek permission from the commissioner to take this action and once done how long they can remain closed to new registrations'.

He said: 'We've been clear with NHS England that the guidance which we produced... is legally robust and we would recommend that practices should follow this if they need to take this action.

'A practice's primary duty is to deliver safe care and that is why some practices feel that they are left with no alternative but to close their list to further registrations in order to maintain safe care provision to their existing patients.'

Newcastle and North Tyneside LMC said in a bulletin to practices: 'Some of the information in this guidance contradicts the BMA’s guidance and the LMC would like to assure practices that we believe the BMA guidance is within the regulations.'

NHS England figures have showed that more than double the number of GP practices were forced to formally (approved by NHS England) close their list to new patients in 2015/16 as the year before, up from 77 to 175.

What is the new advice?

The new NHS England guidance says that 'the GMS and PMS contracts do not allow for a "temporary" or "informal" list closure', because there is a distinction between 'a patient refusal on a case by case basis, based on the patient circumstances, from a refusal to allow a patient to join the list because of the circumstances surrounding the provider'.

The guidance adds: 'These guidelines have been drafted in recognition of the immediate pressures facing some practices; they do not however sanction the term "open but full".

'Where a practice is failing to engage with the commissioner, and unilaterally seeking to determine its own restrictions on patient access, without consideration of the impact on patient access generally or the implications for neighbouring practices, then contractual action may need to be considered.'

Source:NHS England

IMPORTANT:

On Wednesday 7 December 2016, we implemented a new log in system, and if you have not updated your details you may experience difficulties logging in. Update your details here. Only GMC-registered doctors are able to comment on this site.

Readers' comments (15)

  • Mr Mephisto

    I feel like I’m living in a real life version of “Blackadder Goes Forth” ( the one set in World War One).

    The “General Melchett” types have obviously decided that shooting “shell shocked” deserters is a good policy – it will obviously bolster resolve and “keep the men at the front”.

    I’m just waiting for the sound of the whistle when we all go “over the top” and march slowly into the machine guns.

    Unsuitable or offensive? Report this comment

  • Wouldn't it be interesting if we all closed our lists!BMA

    Unsuitable or offensive? Report this comment

  • Bye and thanks for all the fish

    "Pulse columnist Dr Hadrian Moss, who was served with a breach of contract notice after following BMA advice and informally closing his list" - oh no we didn't! We were never served with s breach notice.

    Unsuitable or offensive? Report this comment

  • Apologies for this - it has been changed

  • BMA advice looks good to me.
    All we need now is a test case against NHSE breach notice.
    Or against any CCG foolish enough to serve such a notice on one of their own members

    Unsuitable or offensive? Report this comment

  • Fundamentally it is about patient safety and quality of care. Demand for access is increasing and the workforce is struggling to cope. Primary Care commissioning is so varied there are great differences in what is expected to be provided. Interpretation of the guidance is dependant on how much funding is available. Buy cheap buy twice!

    Unsuitable or offensive? Report this comment

  • excuse ignorance, what sanctions or threat does a breach notice contain if you don't comply? 'we'll take your contract off you and give the work to someone else ' is probably not a very frightening threat these days is it?

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Going to watch Rogue One : A Star Wars Story (3D IMAX) tomorrow.
    Dedicate these quotes to those Jedi of us who want to do what you believe is the 'right thing':

    ''I fear nothing. All is as the Force wills it.''

    ''Our Rebellion is all that remains to push back the Empirem''

    Unsuitable or offensive? Report this comment

  • "But NHS England's new guidance says they 'do not consider [this section] to be appropriate in these circumstances’."

    so what other bits of the contract do they not consider to be appropriate? This is attempting to change the contract uinilaterally and they can't do it

    Unsuitable or offensive? Report this comment

  • IT IS GP WHO should decide what is correct list size for men power they have.we can't do this at present.if a patient changes gp but still registered locally then it commonsense to ask reason. you may not be able to provide what is expected. if you want to limit list size but don't want to close list then redefine practice boundary to minimum and let ccg know.

    Unsuitable or offensive? Report this comment

  • doctordog.

    So those on PMS contracts are really up s--t creek.

    Unsuitable or offensive? Report this comment

  • Am more and more pleased that off PMS contract and on nationally negotiated GMS contract- unless of course commissioners decide to unilaterally change it!

    Unsuitable or offensive? Report this comment

  • There are ways to reduce workload without closing lists.

    If your practice is being prevented from closing a list, make sure you pick out the ways to reduce workload that will cost the CCG/ NHSE the most - and do those first.

    All emergency visit requests go to ambulance.
    All extras go to A+E.
    Stop agreeing to pre-referral guidance (and stick to your CONTRACTED right to refer in whatever way you think is appropriate when you cannot meet the needs of the patient) - if they will not accept referral - to A+E with a note explaining why.
    Stop any work related to reducing prescribing costs.

    After someone complains about your referral rate/ prescribing costs etc just tell them it is because of the workload/ difficulties in keeping things safe with so many patients.

    If you are willing to follow through your feelings with actions - then people will start to actually listen to you. If you are not willing to take action then please do not complain about the consequences.

    Unsuitable or offensive? Report this comment

  • Hear hear Obi.

    Unsuitable or offensive? Report this comment

  • Spuds

    The phrase "...without consideration of the impact on patient access generally" is very inflammatory.

    It is not for individual practices to consider the wider problems of inadeqaute healthcare provision. We must consider our own pratcice's patients, our staff morale and mental health and so on. Whetehr there is adequate provision of GP is a POLITICAL question and should be answered by the health boards.

    Listen to BMA, not these bully-boys.

    Unsuitable or offensive? Report this comment

  • We should decide what a safe size should be and then close the list.
    The Government then would be forced to change the system .
    In what other profession would you be forced to work at an unsafe level and under such pressure and scrutiny.
    At one time patients would give you some slack but in many areas you are a government employee .
    Also in the 24 hour society everyone expects an instant service just like McDonalds!Perhaps we should ask them to provide a health service but it would not be cheap.
    I sometimes ask patients would they choose a bank that used a different computer system in every branch or town.They usually answer no but this is how the NHS operates!

    Unsuitable or offensive? Report this comment

Have your say