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.