An LMC has advised its GP practices that they can ‘informally’ close their lists to new patients without informing the ICB.
Leicester, Leicestershire and Rutland LMC said it has recently received questions from practices about how to informally close their practice list to deal with capacity issues.
In an update to practices, LMC chair Dr Grant Ingrams explained that all practices have a contractual right to decline to register any new patients without having to go through any formal processes and without needing to obtain commissioner permission.
He said: ‘There is no contractual requirement for a practice to inform the ICB. However, the LMC would encourage practices to consider an OPEL report if due to a problem with capacity, or if the arrangement is likely to be ongoing to discuss it with the ICB and what support they may be able to give.’
According to the guidance, practices can decide to refuse to register all new patients or devise a policy to only register particular patients, including:
- Children born to registered patients
- First degree relatives or partners of registered patients
- New residents in a care or nursing home that the practice already has registered patients
- Other people living in the same residence as already registered patients
The LMC said that when declining a patient’s application to register, the practice must give notice in writing to the applicant with the grounds for the refusal within 14 days of the decision, and must keep a written record of the refusals and the grounds, and make these available to the ICB if requested.
Reasonable grounds to refuse patients’ applications could include a patient not living in the practice area or living in the outer boundary; that the practice is ‘unable to provide a safe service’ due to a GP leaving or inability to recruit staff; part of the practice premises being temporarily unusable; a sudden influx of patients due to a new development or a neighbouring practice closing.
Dr Ingrams added: ‘Practices must ensure that whatever policy they adopt is non-discriminatory as per the regulations. Please note that the practice would have to accept any patient assigned to the practice by the ICB.’
The LMC also said that as this is an informal process using a practice’s contractual rights there is no minimum or maximum time for closing a practice’s list.
BMA guidance also confirmed that practices have the contractual right to decline to register any new patients without having to go through the formal processes and without needing to get permission from the board.
However, the union advised that the formal closure route makes it ‘far more difficult’ for the ICB to be able to add any new patients to the list.
It added: ‘Should a practice be unable to accept patients routinely, a discussion between the practice and the board (NHS board in Scotland) could take place.
‘This could involve, for example, additional support being provided by the area team or board or a formal closure of the list.
‘The board may still assign patients to your list as it’s open to assignments within the regulations. They may ask you to justify the decision not to register a patient.’
Last month, research from the BMA found that GP patient lists are formally closed to new registrants at almost one in ten Scottish practices.