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CAMHS won't see you now

List row: who'll blink first?

GPC negotiators are to hold a crunch meeting with ministers to thrash out whether GPs can refuse new patients by claiming their list is 'full'.

The move comes amid escalating concern among GPs over the Department of Health's apparent U-turn on the issue.

LMCs told Pulse they were braced for disputes with primary care organisations after the department said GPs could not refuse new patients unless they had gone through the formal list closure procedure.

South Staffordshire LMC has already brought in the GPC after a circular from East Staffordshire PCT warned GPs it would close their list and deny them enhanced services if they continued to use the full list policy.

Dr David Dickson, secretary of the LMC, said the PCT's approach had been 'heavy-handed and not in the spirit of the contract'.

GPC deputy-chair Dr Hamish Meldrum said negotiations over the issue were 'about who blinks first'.

He said: 'We have sound legal advice and we are not going to blink. If a PCT does take this down to the wire then we will deal with it.'

GPC negotiator Dr Laurence Buckman said the department had signed off on the GPC's guidance – which states practices can use the 'full' list policy – but was now 'starting to get nervous'.

The department's line, stated in its May GP Bulletin, is 'there is no such thing as a ''full'' list'. The bulletin adds that GPs can refuse individual patients if their list is open, but must apply to close it if they want to refuse all patients.

Some LMCs said they would 'seek common ground' with PCOs.

But Dr Ken Megson, secretary of Gateshead and South Tyneside LMC, said practices in the region would close their list en masse if they were stripped of their contract right.

He added: 'It's the allocations problem under a different heading and we never sorted it out before.'

Dr Gareth Hayes, medical secretary of Bro Taf LMC, said several GPs in Wales had come under pressure from local health boards. He said: '[They] didn't realise they were going to have to recognise the ''full'' concept. We need to get common ground.'

lRow over hardline stance, page 20; Tell us what you think, page 22; Comment, page 24

'I want to keep right to refuse mischief makers'

Dr Carol Restell has branded the NHS Confederation a 'slippery customer' after one of its contract negotiators said GPs with open lists can no longer turn away new patients.

Dr Restell, a GP in Hatfield, Hertfordshire, told Pulse her list was not full, but she wanted to keep the power to turn away 'mischief makers'.

She said: 'Now the NHS Confederation negotiators are saying we can't do that. I think they are a slippery customer.'

Dr Restell added: 'What if they have not been violent but are still threatening? It's a real worry.'

Dr Restell sparked the row over whether GPs can refuse patients by saying their list is 'full' in a question at a recent conference.

NHS Confederation negotiator Dr Tony Snell said GPC guidance that they could was wrong. The Department of Health later supported his view.

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