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Patient registration and controlling workload

It is clear that the workload of very many practices is stretched beyond limits. Practices overriding obligation is to provide safe care to their registered patients and I have received numerous queries from practices on how they can safely control workload whilst continuing to meet their professional and contractual obligations./p>

GMS and PMS contracts do allow, of course, for practices to apply for formal list closure and it would be appropriate to do soif a practice feelsthat itsworkload is such that it are no longer able to safely care for its registered list of patients and meet contractual obligations in respect of meeting patients’ reasonable needs. I have attached the relevant regulations,( all nine pages!)though you will see that this requires Area Team consent and it is an extremely complex, bureaucratic process. /p>

Practices do, however, maintain the contractual right to decline to register any new patients without having to go through the formal closure process and without needing to obtain Area Team permission, though formal closure does make it far more difficult for the Area Team to be able to allocate any new patients to the list, and it is extremely unlikely it would do so. However the key point about declining to register any new patients is that it must be applied by practices in a completely non- discriminatory way, in line with the regulations which are copied below./p>

Refusal of applications for inclusion in the list of patients or for acceptance as a temporary resident

  1. The contractor shall only refuse an application made under paragraph 15 or 16 if it has reasonable grounds for doing so which do not relate to the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
  2. The reasonable grounds referred to in paragraph (1) may, in the case of an application made under paragraph 15, include the ground that the applicant
    1. does not live in the contractor's practice area; or
    2. lives in the outer boundary area (the area referred to in regulation 18(1A))
  3. A contractor which refuses an application made under paragraph 15 or 16 shall, within 14 days of its decision, notify the applicant (or, in the case of a child [an adult who lacks capacity], the person making the application on their behalf) in writing of the refusal and the reason for it.
  4. The contractor shall keep a written record of refusals of applications made under paragraph 15 and of the reasons for them and shall make this record available to [the Board] on request.

So a practice may decide, without needinggoing through the formal closure process, thatits workload is such that it has reasonable grounds to decline to register allnew patients. Practices may not pick and choose which patients they decline to register in these circumstances- eg refusing nursing home or care home residents, as that would clearly be discriminatory and breach the contractual regulations. The only exceptionswhich could be reasonably argued would be new babies of registered mothers and perhaps other first degree relatives in the same household if it could be demonstratedthat it would be in the patients’ best interests to be registered withthe same practice. Patients may still be allocated to the practice, in the usual way, as the list is not formally closed.

It would always be helpful, of course, if homes fairly distributed their requests to register new patients amongst local practices, though the bottom line remains that it should be patient choice which dictates the practice and in reality achievinga fair allocation is generally very difficult. It would be very helpful however if local practices with particularly difficult homes in their area did perhaps liaise with each other and with the home to see whether this might be possible. The LMC could be involved in the process if the parties wished. It might also be a matter which practices would wish discuss within their locality networks.

Please click here for Application for closure of list of patients.pdf.

Dr. Robert Morley
Executive Secretary
Birmingham Local Medical Committee

36 Harborne Road, Edgbaston, Birmingham B15 3AF

Tel. 0121-454 5008, Fax. 0121-455 0758
Office email:
Birmingham Local Medical Committee
Supporting the Business of General Practice


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