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What can we do to prepare for an influx of new patients?

Chris Locke

Chris Locke: Make the case for one-off funding

Your area team (or health board) is responsible for what happens to patients when a practice closes and in determining whether to put the practice contract out to tender or disperse the list. In doing this they are supposed to consider the impact on neighbouring practices.

If NHS England or your PCO takes the decision to close a practice, it is unlikely to simply allow you to close the list. The rules on list closures are vague but restrictive and, anecdotally, many requests are refused.

If you expect a large influx of new patients you could, with your LMC, make a case to managers for one-off funding as short-term financial relief to cover the cost of undertaking an exceptional number of new patient health checks, for example, or urgent note summarisation that may be required. Your CCG (in England) may support that request, especially if several practices are involved. There is no requirement for managers to provide such relief, but they may use discretion, especially if you can demonstrate a potential financial detriment (for example, on QOF targets).

You should aim to maximise income from DESs or locally commissioned services by identifying relevant patients as soon as they register. Where care home patients are involved, it would be sensible to discuss with the area team or PCO, CCG, neighbouring practices and the homes itself what registration arrangements should apply.

Chris Locke is chief executive of Nottinghamshire LMC


Dr Eleanor Scott

Dr Eleanor Scott: Think carefully before complaining about workload

Being under-resourced is not considered a valid reason to refuse to register new patients. Area teams or PCOs can override even justifiable refusals and allocate patients to a bulging list. Adopting an ‘open but closed’ list status is not possible any more.

Consider carefully before informing managers that you would struggle to provide essential services. They may advise list closure which could bar you from participating in extra-contractual work. If you’re facing destabilising forced allocations, closing your list temporarily may be the most reasonable option but it’s a procedural minefield. Present a convincing case for closure to the LAT or PCO (over 50% of London applications failed in 2013). Managers can appeal and overturn a ‘successful’ closure application. Practices can counter-appeal under the NHS dispute resolution process. Ask your LMC for advice.

Dr Eleanor Scott is a medical director for Londonwide LMCs