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Ministers ban practices' full-list ploy

Ministers are demanding tough action to stop GPs claiming their list is 'full' in order to refuse new patients.

The crackdown means GPs who have followed GPC advice and adopted the 'full list' policy to control their list size now face sanctions from their PCT.

Practices that cannot handle new patients will be forced to go through the complex closed list procedure and risk losing enhanced service deals.

The hardline Department of Health stance was revealed by NHS Confederation contract negotiator Dr Tony Snell in a clash with GPC deputy-chair Dr Hamish Meldrum last week.

Dr Carol Restell, a GP in Hatfield, Hertfordshire, asked the two negotiators at the Primary Care 2004 conference whether her PCT was correct in telling GPs they had to take everyone except violent patients unless they formally closed their list.

Dr Meldrum said the trust, Welwyn and Hatfield PCT, was wrong. 'You can refuse patients as long as you're not discriminating,' he said. 'The GPC has taken strong legal advice on this.'

But Dr Snell, medical director of Birmingham and the Black Country strategic health authority, said the PCT was following department policy.

He said: 'The department's view is that if the list is open, you have to take the patients unless there's evidence of violence. And PCTs will take action to ensure this happens.'

A department spokesman said it would be up to PCTs to choose what sanctions to take.

Dr Meldrum predicted a series of test cases would follow. 'We must protect GPs if they are threatened,' he said.

Welwyn and Hatfield PCT confirmed it had adopted the policy, but said it would be flexible if practices had temporary problems.

GPs said they would continue to use the full list policy.

Birmingham LMC secretary Dr Charles Zuckerman said: 'Tony Snell and the

department are wrong. The contract is clear.'

Opposing views on list closure

BMA: 'No matter whether or not it has gone through the list closure procedure...a GMS contractor retains its freedom under the new contract not to register new patients, provided it has reasonable and non-discriminatory grounds for doing so.'

DoH: 'A practice must go through the formal closed list procedure with the PCT before it can refuse anyone other than a violent patient.'

GMS contract, part 2, section 6, paragraph 17: The contractor shall only refuse an application...if it has reasonable grounds for doing so which do not relate to the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

By Rob Finch

and Joe Lepper

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