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The waiting game

One in three GP requests to close practice lists blocked by NHS England

Exclusive GP practices are facing uncontrollable ‘severe workload pressures’ as area team managers have refused 23 out of 78 requests for a temporary list closure in 2013, a rise of ten percentage points on the proportion refused permission the year before.

Pulse has learnt that the 27 area teams rejected 30% of GP practice requests for temporary list closure in 2013, compared with 20% of requests in 2012.

NHS England said the rise in refusals was due to area teams applying a ‘single approach’, compared with the variable approach taken by PCTs in 2012. But the GPC said that rising numbers of applications should be an ‘alarm bell’ for NHS England and that huge variations in rejection rates in different areas of the country showed that a more ‘consistent approach’ was needed.

The figures - obtained under the Freedom of Information Act - show that in the London and south of England region over half (53%) of list closure requests were denied in 2013, compared with 30% in the north of England and 16% in the Midlands and east.

The statistics also indicated an increasing number of applications from GP practices to close their lists, with figures from the 14 area teams able to provide comparative statistics showing the number of applications rose from 40 to 48 from 2013 to 2012.

NHS England said the rise in refusals was due to a national policy it introduced in July last year. The Government abolished a previous system where GPs could say their list was ‘open but full’ from April 2012, and since then approval by the local commissioning body is necessary for a practice to close its list.

A spokesperson said: ‘Whilst the circumstance for a practice wishing to close its list will be local for each case, the policy describes a single approach for all 27 area team, compared to 152 PCT operating models that existed prior to establishing NHS England.

‘Together these two changes provide a clearer, more detailed process to ensure applications for list closure are applied more consistently and this is likely to be the key driver for any change in the outcome of applications between 2012 and 2013.’

How rising numbers of list closure request are being knocked back


2013 applications

Of which refused

Refusal percentage

London and the South17953%
Midlands and East31516%
North of England30930%

2012 applications

Of which refused

Refusal percentage

London and the South1218%
Midlands and East4250%
North of England24521%

Source: FOI request to NHS England

But GPC deputy chair Dr Richard Vautrey said rising applications should set off ‘alarm bells ringing’ at NHS England about rising practice workload.

He said: ‘Practices do not do this lightly and it is often a sign of severe workload pressures often created by a workforce crisis in the practice. Area teams should be taking a consistent approach and if there is regional variation NHS England should be taking steps to resolve this and ensure practices across England are dealt with in a fair way and in line with national standards.’

He added: ‘Whilst the numbers are small these figures show in increase in the number of practices seeking to close their list. This is very worrying and could be another alarm bell ringing which provides further evidence that practice workload pressures have reached crisis point.’

RCGP council member Dr Una Coales said she had heard of practices where doctors now covered more than twice as many patients as they typically had. She added: ‘This is dangerous as a sick child or adult may not get a timely appointment.’

A spokesperson for NHS England London region said: ‘There is an NHS England national policy covering the temporary closure of practice lists, and the London region follows this. There is a requirement to set up a local panel to make these decisions, which again makes decision based on the national policy.’

How to apply to close your list

The application must include:
- options the practice has considered, rejected or implemented in an attempt to relieve the difficulties encountered about its open list and, if any of the options were implemented, the level of success in reducing or extinguishing such difficulties;
- any discussions between the practice and its patients and a summary of them, including whether those patients believe the list of patients should or should not be closed;
- any discussions between the practice and other contractors in the practice area and a summary of the opinion of the other practices as to whether the list of patients should or should not be closed;
- the period of time during which the practice wishes its list of patients to be closed must be more than three months and up to 12 months;
- any reasonable support from the area team that the practice considers would enable its list of patients to remain open or for the period of proposed closure to be minimised;
- any plans the practice has to alleviate the difficulties mentioned in that application while the list of patients is closed so the list can reopen at the end of the proposed closure period without such any other information the practice considers ought to be drawn to the attention of the area team.

Source: NHS England


Readers' comments (17)

  • Don't others think that it is totally ridiculous that a practice can be prevented from closing it's list? This is a sign that both staff and patients are at risk, the system is not coping, and that they are prepared to tolerate a loss in income to be able to continue working. Why should someone else be able to stop them?

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  • The GPC should be working on a policy to increase NHS England's accountability for the safety implications of denying list closure. It would also be helpful to work up maximum tolerance of patient/doctor ratios perhaps campaigning to put this into health and safety legislation?

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  • It's a bizarre situation when practices are penalised (sometimes financially) for lack of access and yet they can't do anything about it by restricting their list size or hiring another doctor due to the recruitment crisis. Bonkers.

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  • The calculation must be done on disease type prevalence rather than number of patients . It is the demographic that is killing us .

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  • We need to ensure thre is a legal framework where the practice makes it clear that it is no longer safe to manage that increased number of patients and inform NHS England via a legal statement. Silly question to ask, but BMA needs to be involved here. There is far too much legal liability sitting on the shoulders of these practices

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  • It is very interesting that in a working era defined by health and safety culture, so little of it has protected General Practice patients and staff. Instead we have continual nonsense demands from an ever expanding collection of regulatory empires such as the CQC and GMC without anyone being prepared to look at fundamental questions such as how much work is it reasonable to expect a doctor or nurse to do safely and what is reasonable demand. Other industries such as aviation and haulage have these constraints on their activity levels but in the very high risk area of medicine, the safety legislation simply isn't there.

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  • Very odd.
    When I was in practice, all local lists were open - but we regularly had patients registering who had been told their first choice practice "wasn't registering patients this week".
    Was the local situation ("open but not accepting patients") official, legal or just practices ignoring the rules - and getting away with it?

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  • Closing a practice list puts an intolerable burden of those practices in the same catchment area

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  • >Closing a practice list puts an intolerable burden of those practices in the same catchment area

    If they also can't accept patients, they should close also. Why should currently registered patients and staff be put at risk?

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  • If I was so busy that I wanted to close my list and was told by NHSE that I was not allowed to, I would take big steps to reduce my workload.

    I would on mass refer an entire chronic disease to secondary care each week.

    Week 1 COPD
    Week 2 IHD
    Week 3 T2DM
    Week 4 Asthma etc etc

    I wonder how many weeks I would get through before they found a cheaper way to help.

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