GP practices have the contractual right to refuse to register new patients under specific circumstances without the need for formal processes or approval from commissioners. This is often referred to as an “informal list closure.”
A practice can decline to register new patients if it has reasonable and non-discriminatory grounds for doing so. Commonly, this is done to ensure the quality of patient care and manage demand effectively. Such refusals are governed by the regulations outlined in Schedule 6, Part 2, paragraph 17 of the GMS regulations.
Reasonable Grounds for Refusal: Practices can refuse to register patients if there are legitimate reasons, such as overcrowded patient lists, lack of resources, or the practice being unable to provide high-quality care. Importantly, refusals must not be based on discriminatory factors, such as race, gender, age, disability, or medical conditions.
Written Notice: Practices are required to provide applicants with written notice within 14 days if they refuse to register them. This notice must clearly state the reason for refusal, and in the case of a child or someone who lacks capacity, the notice should be provided to the person making the application on their behalf.
Record-Keeping: Practices must maintain a written record of all refusals, including the reasons behind them. This record must be available for review by NHS England upon request.
Engagement with the Area Team: If a practice is unable to accept new patients, it can engage in discussions with the area team to explore potential solutions. This may include additional support or even a formal closure of the list.
Justification for Refusal: Practices must be prepared to justify their decision not to register a patient if requested by the area team. Practices should ensure their refusal decisions are non-discriminatory, and having a clear, written acceptance policy can help demonstrate fairness in decision-making.
In contrast to an informal list closure, practices that wish to formally close their patient list must follow the prescribed procedures set out in paragraphs 29-31 of Part 2 of Schedule 6 of the GMS regulations. This process requires approval from the commissioner (NHS England or the relevant CCG) and includes the following steps:
Application to the Commissioner: Practices must submit a formal application to the commissioner, providing evidence of the difficulties they are facing with their current patient list. The practice must demonstrate any efforts made to alleviate these challenges, such as staffing changes or adjustments to working hours.
Commissioner Review: The commissioner has 21 days to consider the application. They may request further information or consult with relevant stakeholders, including patients, neighbouring practices, and other impacted parties. The commissioner will assess the situation and may offer support or recommend alternative solutions.
Closure Period: If the commissioner approves the closure, the practice’s list will be officially closed to new registrations for a minimum of three months and a maximum of 12 months. If the practice wants to reopen its list earlier than the agreed closure period, it must seek approval from the commissioner.
Support and Consultation: During the process, the commissioner will engage in discussions with the practice to explore potential support options. These discussions could include providing additional resources or assistance to help manage the patient list and alleviate the issues leading to the list closure.
While practices have the right to informally close their list, they must follow the regulations to ensure their decisions are fair, transparent, and non-discriminatory. In cases of formal list closure, practices must seek approval from the commissioner, who will evaluate the practice’s situation and may offer assistance. It is essential that practices keep accurate records and provide clear communication to patients about the reasons for refusal.
Legislation relevant to practice list closures can be accessed here.