Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

We're 'informally' closing our list - and here's how

  • Print
  • Comments (11)
  • Rate
  • Save

Firstly, I’d like to say a big thank you to the General Practice Committee of the BMA for publishing a comprehensive 42-page document to help GPs manage their workload - GPC launches 42-page guide to help GPs manage workload pressures. This publication comes at a time when we are going through a period of unprecedented workload with a backdrop of both retention and recruitment difficulties for GPs across the country.

I was intrigued to find a little gem buried inside the document on pages 20 and 21 about informal list measures.

I always thought there was only one way for a practice to close its list if it felt unable to provide a safe level of patient care due to lack of capacity (for example, GPs leaving and being unable to replace them). This was to seek formal permission from the local NHS area team who can refuse it if they wish. But, it turns out there is an alternative choice - to informally close your list - and apparently you don’t need anyone’s permission to do this.

According to the BMA: ‘GMS and PMS practices can apply to close the practice list, and may choose to do so if they find their level of workload is jeopardising their ability to provide safe care for their registered patients, or to carry out their contractual obligations to meet their patients’ core clinical needs. This process requires area team consent.’

It also states: ‘In addition to the formal list closure procedure all practices have the contractual right to decline to register any new patients without having to go through the formal processes and without needing to obtain area team permission. However the formal closure does make it far more difficult for the area team to be able to allocate any new patients to the practice list.  A practice can decide not to register new patients, provided it has “reasonable and non-discriminatory grounds for doing so”, (such as protecting the quality of patient services.) In such cases, the regulations allow practice to refuse to register new patients. The contractor does not need to make an official declaration of its intention to refuse to register new patients. It must, however, provide the patient with a written notice (within 14 days).’

Clearly it was buried on page 20 of the booklet for a reason.

As I can make out, it refers to a situation where you’re putting in a 10-hour day just to meet current patient demand because you’re struggling to replace an ex-senior partner who decided to retire at 65. You can’t recruit anyone to replace him and you’ve divided his list between the remaining partners.

According to the guidance, you can refuse to register new patients (provided you do it in a non discrimatory way and give them a letter stating why you are refusing) without seeking anyone’s permission (though the GPC goes on to say it would be wise to discuss this policy with your local LMC and neighbouring practices first).

Imagine the scenario where every practice in a small market town informally closed their lists after feeling unable to provide a safe level of care due to struggles to recruitment struggles. A political hot potato indeed.

Despite the flack we might get for this, my practice has decided to take the guidance on board. We are going to ‘informally’ close our list.

And given that the possibility to do this has now been pointed out, I doubt we’ll be the only ones.

Dr Hadrian Moss is a GP in Kettering, Northamptonshire. You can tweet him at @DrHMoss.

 

 

Rate this blog  (4.36 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (11)

  • Unfortunately this is not as obvious a solution as it seems.From personal experience of this all that will happen is if all the practices follow suit then new patients will be allocated which is not something that can be influenced unless your list is FORMALLY closed in agreement with you guessed it...NHS England.So ultimately you end up with the patients anyway ... believe me. Sorry to disappoint but Catch 22 recurs as it always does in GP world.

    Unsuitable or offensive? Report this comment

  • this can work if all the local practices go to the LAT, however there will always be a practice in the area that will take on new patients!

    Unsuitable or offensive? Report this comment

  • Hadrian Moss

    2.09 I can't see this being a problem if what 8.30 says will happen. If other practices have capacity then good luck to them.

    Unsuitable or offensive? Report this comment

  • Good luck.I hope you are right Hadrian and look forward to your hopeful success. If so can you do a blog to update us so we can follow your lead?

    Unsuitable or offensive? Report this comment

  • what can a practice do if for example the patient's last practice refused to let the patient book appointments due to excessive levels of DNA (eg told them they had to come and wait for a DNA or to the end of the list, no scheduled appointment)?
    How about if the patient has a history of "complain, ask for money, move practice once they have it"?

    Unsuitable or offensive? Report this comment

  • I think this is one single thing the GPC should sort out. If we are Independent Contractors and we feel safety is compromised by taking on more patients we should be able, must be able to close lists.
    That is an imperative, not a wish. Otherwise we have to walk away from the NHS, because we cannot compromise safety at any cost.

    Unsuitable or offensive? Report this comment

  • Nice article - futile though. We did discover the 'gem' but try explaining that to the bullies in NHSE and LMCs. The level of arrogance in this institution is of mobsters with connections going straight up to the government and hence, they are untouchables. Go on, best of luck, maybe, because you don't live in the Southeast, the level of intelligence and understanding of your peers in LMCs and NHSE maybe more human and helpful.

    Unsuitable or offensive? Report this comment

  • good luck, i think the LAT needs to challenged especially if they try to bully you

    Unsuitable or offensive? Report this comment

  • Hadrian Moss

    I just had an email from my local LMC fully supporting us

    Unsuitable or offensive? Report this comment

  • I think this inability to determine a safe workload ourselves is a sig contributor to pc under funding as it has enabled gov to maintain the fiction that there are enough of us by preventing a significant number of 'I can't get a GP stories'. Its bonkers: I have absolute discretion about saying whether a pt with chest pain is safe to go home but no discretion at all about whether I'm seeing too many pts with chest pain to be safe.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say

  • Print
  • Comments (11)
  • Rate
  • Save