GPs want to be able to close their lists to patients who are looking to switch practices without having changed their address.
Delegates at the England LMCs Conference voted in favour of a motion which said the BMA’s GP Committee should negotiate with NHS England the new option for temporary closing lists.
GPs who are struggling with workload are currently able to temporarily close their lists to all new patients, if they gain permission from NHS England. However, there is no mechanism for only barring patients who are simply looking to switch GPs without having moved to a different area.
The motion called for the development of ‘a new category of list closure that would allow a practice to close its list in agreement with the commissioners, and in the interest of patient safety, so that it can, for a period, decline to accept new registrations from patients who have not changed address’.
Proposing the motion, Dr Julie-Anne Birch from Cleveland LMC suggested it was aimed at protecting practices in difficulty from losing patients, and related income, plunging them deeper into trouble.
She told delegates: ‘We have found that often when a practice is in difficulty, it can cause patients to start moving to nearby practices pre-emptively even when their practice stays open.
‘We would like to see a form of temporary list closure in areas of practice instability that allows for the registration of new patients to the area who have no access to a GP [but] the refusal of patients who already have a GP locally.’
She added that this would ‘not be a long-term solution as it goes against patient choice’ but she said it would be a short-term solution ‘in the interests of patient safety and to allow the stabilisation of practices in that area’.
The motion comes after the BMA wrote to health secretary Jeremy Hunt warning that GPs would be willing to close their lists en masse unless the Government tackles the ’urgent challenges which have led us to this position’.
The motion in full
AGENDA COMMITTEE TO BE PROPOSED BY CLEVELAND: That conference asks GPC England to enter into discussions with NHS England:
(i) to develop a new category of list closure that would allow a practice to close its list in agreement with the commissioners, and in the interest of patient safety, so that it can, for a period, decline to accept new registrations from patients who have not changed address
(ii) to improve financial support to practices taking on patients following a list dispersal with the creation of a centrally negotiated payment per patient
(iii) to work towards funding to practices taking on patients after a list dispersal flowing in ‘real time’ and not in arrears at quarter-end,
(iv) so that commissioners must agree the terms of any list dispersal with the LMC(s) involved to ensure neighbouring practices taking on extra workload are supported appropriately and not destabilised.
But, speaking against the motion, Dr Brian Fraser from Sefton LMC said it was ‘fundamentally flawed’ and would ‘niot actually do anything to prevent the forced allocations that take place in the event of practice closures’.
Dr Fraser added: ‘We therefore run the risk that we waste time and effort in negotiating a contractual change that would end up being of little practical use.
‘In addition we could also be open to accusations that we’re singling out patients who’ve not changed address but may have had a problem at a previous practice.’
Dr Robert Morley, GPC contracts and regulations lead, said helping practices to manage their workload through list management is an ‘absolute imperative and priority’.
But he said the new type of list closure would require a change to current regulations and might cause ‘unintended consequences and might actually not be a huge solution to the problem’.
The other parts of the motion, which were also passed in full, will see the GPC arguing for extra financial support for practices taking on patients following closures and list dispersal becoming subject to LMC negotiation.
List closures
Some practices are already starting to close their lists, with all seven practices in Folkestone applying to close their lists saying they are ‘unable to take on more patients safely’.
The BMA balloted at the UK-wide LMCs conference in May on whether to close their lists to new NHS patients en masse, with the motion passing narrowly.
A poll of 1,870 GPs in September then found that 54% of practices would consider temporarily suspending registration of new patients due to workload pressures.
Pulse reported in September that the GPC is to decide this month on its next steps towards industrial action, with GPC chair Dr Richard Vautrey saying that ‘all options are on the table’.
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