Informal List Closure
All practices have the contractual right to decline to register any new patients in certain circumstances without having to go through formal processes and without needing to obtain commissioner permission.  This is sometimes referred to as an informal list closure.

A practice can decide not to register new patients, provided it has reasonable and nondiscriminatory grounds for doing so, (such as protecting the quality of patient services). In such cases, the regulations allow practices to refuse to register new patients (Schedule 6, Part 2, paragraph 17).

Paragraph 17 of Part 2 of Schedule 6:
“(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) shall, in the case of applications
made under paragraph 15, include the ground that the applicant –
(a) does not live in the contractor’s practice area; or
(b) 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 or 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”.

Should a practice be unable to accept patients routinely, a discussion between the practice and the area team could take place in an attempt to resolve the situation. This could involve, for example, additional support being provided by the area team or a formal closure of the list.

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 as in paragraph 3 of the extract above.

The area team may still assign patients to the contractor’s list (paragraph 32 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 area team 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.

All patients who are refused registration must be provided with written notification and reason within 14 days.

Patient names and reason for refusal must be kept on a list for review by NHS England on request.

Formal List Closure
Practices who wish to formally close their list must go through the list closure procedures set out in the GMS regulations (paragraphs 29-31 of Part 2 of Schedule 6). This includes applying to the commissioner (NHS England area team or CCG). If the commissioner approves the closure notice, the contractor’s list is officially closed to assignments. The closure period will be for a minimum of 3 months and maximum of 12 months. Permission is required from the commissioner to re-open the list earlier than the agreed date.

Formally closing your practice list requires the commissioner’s approval. On application, a practice will need to demonstrate ‘the options which the contractor has considered, rejected or implemented in an attempt to alleviate the difficulties which the contractor has encountered in respect of its open list’. The commissioner has 21 days to consider the application and may request further information from the practice or consult persons affected by the proposed list closure.

During the process, the commissioner must enter into discussions with the practice as to what support it can offer to them. There is nothing stipulating the format of those discussions, and the practice may be required to provide further information and explanation during this part of the process. The commissioner may consult persons affected by the proposed list closure – this could include letters to the practice’s patients, letters to neighbouring practices, and also potentially to the practice’s creditors, landlord (if applicable) and their insurers.

Legislation relevant to practice list closures can be accessed here.

A rejected application can be appealed to the NHS Dispute resolutions procedure