How do I formally close my list?
According to BMA guidance, practices can formally apply to close their list if ‘their workload is jeopardising their ability to provide safe care for their registered patients’.If you are struggling with workload and want to formally close your list, you need to apply to the area team in writing, as explained in clause 13.18 of part three of the GMS regulations.
NHS England provides a sample template for the application which should include: the options you have ‘considered, rejected or implemented’ to try to overcome your difficulties and how successful they were; a summary of discussions with your patients (and their opinions on list closure); a summary of discussions between you and other practices in the area (and their opinions on list closure); how long you want to close your list for (must be three to 12 months); what support the area team could give you that would enable the list to stay open or shorten the duration of closure; and the plans you have to resolve your difficulties during list closure so that the list can reopen as normal.
If your list is closed, you can still register ‘immediate family members of registered patients’, according to GMS regulations.
What if I need to take immediate action?
According to the GPC, you have the contractual right to decline to register new patients as long as you have ‘reasonable and non-discriminatory grounds for doing so’, for example to ensure service quality. This is addressed in clause 13.7.12 of the GMS regulations, which states that a contractor can only refuse a new-patient application ‘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.’
You therefore can’t refuse to register only a certain group of patients, for example care home residents. As with a closed list you can register immediate family members of registered patients.
Note that you cannot refer to your list as ‘closed’ (or ‘informally closed’) as under the regulations the list is still open – you are simply taking legitimate action to continue to provide safe care to current patients.
You don’t need to make an official declaration saying you intend to stop taking on new patients, but you do need to notify patients wanting to join the practice in writing that you can’t take them on within 14 days of their application.
However, you should discuss the issues you are facing with the area team or CCG (if it has co-commissioning responsibility) to try to resolve the problem. The area team may ask you to justify your reason for not taking on more patients, and a written acceptance policy will help to show them that you are not declining patients incorrectly.
You should also get advice from your LMC before taking action on your list.
Could I be found in breach of my contract if I stop registering new patients?
Although NHS England threatened to issue a breach of contract notice to a GP who followed GPC guidance on halting registration of new patients, it does now allow for urgent action before going through formal list closure processes. According to a statement last year from NHS England: ‘If there is a sudden impact on a practice’s ability to provide patient services, we accept that a temporary halt to new patient registration is appropriate, but this should be followed quickly by a discussion with the commissioner to identify an action plan to address the issues’, with a formal closure application to follow if you cannot solve the problems ‘imminently’.
However, NHS England warns that ‘Where a practice is opting to restrict patient registration without discussing the implications and appropriate actions with NHS England, we would consider whether contractual action ought to be taken’, although if the practice is following GMS regulations as stated above, there would be no grounds for contractual action.
What are the benefits of formal list closure?
Formal list closure makes it much harder for the area team to allocate new patients to the practice list.
Written with advice from Dr Robert Morley, GPC contracts and regulation subcommittee chair