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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)

  • we had this very issue, due to our much better pt access we were swamped and despite having a greater list per FTE GP and and even greater list size per clinician and no room for any more records the "9-5 ers" said no. The choice was let standards slip endure tremendous mental strain for me and my staff or take the sensible option. I was shown no duty of care.

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  • What did you do ?

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  • Once you have requested closure for patient safety - then life is easy. Any problem which occurs can be levelled at the FPC.

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  • We took contact details and said we would call when the list had fallen to a more manageable level which we did and all were then offered the opportunity to join. Problem sorted and no one at the then PCT had to stand up and make a positive decision. By the way all local practices contacted re this only 2 bothered to respond and they were happy for our list to temp close.

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  • the gmc clearly states that you should work within your limits whatever that may be,and not put patients at can any organization stop you from closing your list.

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  • It is the GPC that needs to sort this. We have currently a bunch of ninnies who actually said of this abominable Contract - It could have been worse. Like giving up a kidney or something.
    Hamish Meldrum did ask for mass resignation and got it. These current GPC types keep pointing out the problems we all know about and do absolutely nothing.
    As Independent Contractors we should be able to tell NHSE where to get lost so easily if only the GPC would stipulate something as simple as doctor/ patient safety. I wish the whole useless lot would resign, because of them there is not going to any GPs left. No one wants this absolutely awful job where we are constantly brow beaten to work way beyond our capacity in numbers and competence dealing with stuff that really belongs to Secondary care which has waiting lists.

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  • And carry the can if something goes wrong even when it is forced on you. Imposed Contracts and patients. Some Independent Contractor !! Dear God please give us some proper negotiators with some backbone and teeth. GPC - if you cannot stand the heat, get out of the kitchen.
    I say this as 2 neighboring solicitor practices get over 2 million in legal aid. Perhaps we could ask the legal society to negotiate. Note Judges have no increase in 3% pension while ours has gone up from 8 to 14%.
    The UK so disregards its doctors it does not deserve the NHS.

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