The following guidance is provided to help GPs decide whether they should formally apply to close their practice list, or if informal list measures would be better suited to their situation.
Formal list closure
GMS practices can apply formally to close the practice list if their workload is jeopardising their ability to provide safe care for their registered patients. This is permitted by The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018.
Practices that do not wish to have patients assigned to their list by their NHS board must go through the list closure procedures set out in the regulations (paragraphs 26-28 of Part 2 of Schedule 6).
Read the regulations
If the NHS board or the assessment panel approves the closure notice, the contractor’s list is officially closed to assignments. The closure period will be either for a maximum of 12 months, or if a range was specified in the closure notice, until an earlier point in time when the number of patients falls below the bottom figure of the range.
If a practice’s list is closed, the only applications for inclusion on a practice list that practice may accept are those from immediate family members of existing patients (paragraph 12 of part 2 of schedule 6).
You should note that formal list closure requires NHS board consent (or assessment panel approval) and the following should be taken into account:
- Instead of list closure, is there an opportunity to negotiate with the NHS board team for staffing support with other services
- There will be a responsibility on both the practice and the NHS board to ensure that all options other than closure have been considered
- Document what options you have considered in trying to address the problems being faced and the outcomes of those considerations
- Discuss your individual practice problems at the earliest opportunity with your LMC who will provide you with confidential help and support in line with the rules and regulations
- Consider the possible impact on neighbouring practices and any help they can provide
- Meet neighbouring practices including LMC representation to discuss the problems that the practice is facing
- Request a meeting with the NHS board and let them know you will be accompanied by an LMC representative
- Discuss with your patient liaison group to explain how and why you have come to this decision and to listen to any suggestions they may have to ease the pressures
Informal list measures
In addition to the formal list closure procedure, and subject to paragraph 2 below, 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 NHS board permission. However the formal closure route makes it far more difficult for the NHS board to be able to allocate any new patients to the practice list.
Key points to consider
Refusing new patients
A practice can decide not to register new patients, provided 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’, (such as protecting the quality of patient services.) In such cases, the regulations allow practice to refuse to register new patients (paragraph 14 of part 2 of schedule 6).
Registering relatives of existing patients
A practice cannot pick and choose which patients it declines to register in these circumstances e.g. refusing nursing home or care home residents, as that would clearly be discriminatory and breach the contractual regulations. Exceptions which 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 demonstrated that it would be in the patients’ best interests to be registered with the same practice.
Support from the NHS board
Should a practice be unable to accept patients routinely, a discussion between the practice and the NHS board could take place in an attempt to resolve the situation. This could involve, for example, additional support being provided by the NHS board and would normally lead to an application for formal closure.
Declaring your intention
The contractor does not need to make an official declaration of its intention to refuse to register new patients. However, the regulations state they must provide the patient with a written notice. In addition it is good practice to put up notices, provide patient leaflets and post on its website that it is temporarily unable to accept any new registrations, and explain the reasons why.
Justifying your decision
The NHS board may still assign patients to the contractor’s list (paragraph 29 of part 2 of schedule 6) as its list is open to assignments within the meaning of the regulations. Practices should bear in mind that the NHS board may ask them to justify the decision not to register a patient. Practices must ensure that their actions do not discriminate between patients on the grounds of the applicant’s race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
A written acceptance policy will enable practices to refute any suggestion of improper rejection of applications. There are equivalent procedures in the regulations for the other devolved nations.
Referring to your list as 'closed'
Practices should not refer to their list as ‘closed’ when it has not been formally closed and should state only that they have concluded that they cannot at present take on further patients.
Concerns about quality of care
If the practice is unable to take on additional patients on the basis of safety/quality of care then the practice should enter into discussions with their NHS board and LMC leading to an application for formal list closure.