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Position on list closure is crystal clear

There is no uncertainty about the ability of practices to refuse applications from new patients when their lists are 'full' (Comment, May 17).

They can do so. As long as there is no discrimination involved, a practice can say no to applicants without having to go through the formal procedure to close its list.

In this case the practice does have to continue to accept allocated patients. If practices have completed the formal procedure to close their list, they no longer have to accept allocations. We have sound legal advice which confirms this view.

The GPC guidance that spells this out was cleared with both the Department of Health and the NHS Confederation, and reflects the wording in the contract regulations – paragraph 17 (1) of schedule 6.

On the department's website, the May issue of the GP Bulletin states that as there is no maximum list size in the new contract, the list is either open or officially closed. It then says: 'A practice with an open list can decide to refuse an application from an individual.' Any PCOs claiming this is not the case are wrong.

Under the old Red Book contract there was no definition of a closed list and no mechanism by which GPs could refuse the allocation of patients. Yet day-to-day terminology referred to practices having 'closed their lists'. In much the same way people now talk about 'full lists'.

Although there is no legal definition of a 'full list' it is clear under the regulations that a practice that wishes to limit new patient registration, without formally closing its list, can do so.

Contrary to your front-page claim, we are not planning to meet ministers to thrash things out as the position is clear. The BMA will support any practices that find themselves under pressure and have been unable to resolve the issue locally through the dispute resolution procedures.

Dr John Chisholm

Chair, GPC

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