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CAMHS won't see you now

Row brewing over Department of Health's hard line on full lists

The first row of the new contract has been sparked by the overruling of GPC guidance on closing lists – by Joe Lepper

The Department of Health's decision to overrule GPC guidance that practices can refuse to accept new patients because their list is 'full' has left GPs in a state of confusion.

It has also sparked the first major row of the new contract era – one that looks set to rumble on through the summer and possibly into the courts.

Until the department's intervention last week, GPs were able to use the 'full' list ploy as a way of controlling their list without going through the complex and bureaucratic list-closure process.

The policy also staved off the threat of being excluded from taking on enhanced


GPC advice states practices are able to refuse new patients if they give a fair and non-

discriminatory reason.

Many GPs have been given sample letters by LMCs including tick-boxes stating the reasons for their refusal –

such as that the patient lives outside the catchment area or the practice is suffering staff


Now, if the Government's view prevails, GPs either have to go through the formal

closure process or accept all-comers.

GPC deputy-chair Dr Hamish Meldrum is adamant its guidance is correct and says the BMA will support any practice challenged by its primary care organisation for adopting the 'full' list policy.

The GPC is working with practices in at least one PCO that have been accused of breaching their contract over the issue.

'With the case of this one PCT we have a policy agreed on all sides not to name and shame but to see if it can be resolved locally,' he said. 'If that doesn't happen then there is a possibility that it may go

further legally.'

Dr Meldrum said he is confident, based on the BMA's legal advice, GPs would win any court action, although he concedes the 'law is all about detail' and nothing is 100 per cent certain until it is tested.

Birmingham LMC is taking a bullish stance against any PCOs that take issue with GPs' 'full' lists. It has forced two trusts in the region to back down after they confronted GPs over the issue.

LMC secretary Dr Charles Zuckerman said GPs should follow the contract, but avoid describing their lists as 'full'. He added: 'It is clear in the contract that a GP has every right to refuse to take patients as long as it is not discriminatory,' he said. 'Having to officially close your list to do that shouldn't come into it.'

But many trusts are implementing the department's hardline stance.

A spokeswoman for North Tyneside PCT said it had

told practices they must go through the closed list procedure if they are saying their list is full.

Of the area's 32 practices, seven have done so.

North Tyneside LMC secretary Dr George Rae is calling on the trust to adopt a softer stance, particularly as GPs

fear missing out on enhanced services.

'There's an implicit threat that if your list is closed then you won't get enhanced funding as you can't cope. That is unfair,' he said.

He added: 'If what we in the NHS are trying to do is get rid of unnecessary bureaucracy it makes no sense to make GPs go through a bur-eaucratic procedure like closing their list.'

Avon LMC chief executive Steve Mercer called for a 'middle way' to enable practices to refuse patients when they are faced with short-term problems such as staff losses without having to close their list formally.

He said: 'It must be stressed this is for a temporary period of time and must not be used for GPs to cherry-pick patients.'

Many GPs told Pulse they simply wanted clarity over the issue.

Dr David Henderson, a GP in Hove, Sussex, said he thought the contract was clear. 'Now I'm not sure as there seems to be misunderstanding already,' he added.

'I'd like to see more clarity on this to say once and for all that a list is full if you reach X amount and you don't have to take any more patients.'

Dr Barbara Allen's practice in central Manchester has closed its list, but does not want to have to take all-

comers. She said: 'We want to reopen the list but in a managed way so that we are not overburdened.'

(1)The contractor shall only refuse an application made under paragraph 15 or 16 if it has reasonable grounds for doing so that do not relate to the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

(2)The reasonable grounds referred to in paragraph (1) shall, in the case of applications made under paragraph 15, include the ground that the applicant does not live in the contractor's practice area.

(3)A contractor which refuses an application made under paragraph 15 or 16 shall, within 14 days of its decision, notify the applicant (or, in the case of a child or incapable adult, the person making the application on their behalf) in writing of the refusal and the reason for it.

(4)The contractor shall keep a written record of refusals of applications made under paragraph 15 and of the reasons for them and shall make this record available to the PCT on request.

Dr Steven Nimmo says he is reluctantly taking anyone who wants to register with his Plymouth practice, even though he considers his list to be full.

Before April 1, the two-and-one-third partner practice would only take on patients to replace those leaving its 4,200-strong list.

However, the GPs were told by their PCO this was no longer possible under the new contract without closing the list. Dr Nimmo said: 'The previous way worked as we could properly manage our workload. Now we can't and have to take all-comers.'

He said the row between the GPC and the Government had created confusion among GPs and a legal test case would be welcome.

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