How to informally close your practice list
The LMC has recently received questions from practices about how to informally close their practice list. We have prepared these FAQs to assist practices.
Which practices can informally close their list of registered patients?
All practices have a contractual right to decline to register any new patients without having to go through any formal processes and without needing to obtain commissioner permission. This is often referred to as an informal list closure.
Which patients can a practice refuse to register?
Practices can decide to refuse to register all patients. Practices can also devise a policy to only register particular patients, for example:
- Children born to registered patients, and/or
- First degree relatives/partners of registered patients and/or
- New residents in a care or nursing home that the practice already has registered patients and/or
- Other people living in the same residence as already registered patient(s) etc
Practices must ensure that whatever policy they adopt is non-discriminatory as per the regulations.
Please note that the practice would have to accept any patients assigned to the practice by the ICB.
Which regulations allow a practice to implement informal list closure?
Section 18(1) of Schedule 3 of the National Health Service (General Medical Services) Regulations 2015 as amended states “The contractor MAY [our emphasis], if the contractor’s list of patients is open, accept an application for inclusion in that list made by or on behalf of any person whether or not that person is resident in the contractor’s practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.”
Section 21 (1) states “The contractor may only refuse an application made under paragraph 18 or 20 if the contractor has reasonable grounds for doing so which do not relate to the applicant's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.”
What does a practice need to do to implement informal list closure?
When declining an application to register the practice must give notice in writing with the grounds for the refusal (Section 21 (3)) within 14 days of the decision, and must keep a written record of the refusals and the grounds, and make these available to the ICB if requested (Section 21(4)).
What are the reasonable grounds to decline registration?
The regulations cite the specific examples of a patient not living in the practice area or living in the outer boundary.
Other reasonable grounds could include a practice that is unable to provide a safe service due to a GP leaving or on longterm leave and unable to recruit a replacement, part of the practice premises being temporarily unusable, due to a sudden influx of patients due to a new development or a neighbouring practice closing etc. These are only examples and is not an exhaustive list. The most important consideration is to ensure that the grounds are not discriminatory.
How long can the informal closure be for?
As this is an informal process using a practice’s contractual rights there is no minimum or maximum time.
Should a practice inform the ICB when considering an informal list closure?
There is no contractual requirement for a practice to inform the ICB. However, the LMC would encourage practices to consider an OPEL report if due to a problem with capacity, or if the arrangement is likely to be ongoing (in particular to consider formal list closure – see Sections 33 to 37).
What checklist should a practice use when considering an informal list closure?
- Decide the non-discriminatory grounds for the informal closure.
- Decide the dates between which you will informally close your list.
- Decide whether the practice will continue to register any specific group(s) of patients.
- Ensure that a list is maintained of all declined applications.
- Write a standard letter to applicants to advise that they have been declined and the grounds.
- Consider discussing your plan with the ICB
- Consider whether application for formal list closure would be more appropriate.