List Management: LMC In Touch Extract 2015

Many practices are struggling to cope with the escalating workload demands and are constrained by premises and or difficulty recruiting. One way of easing the workload is to manage the number of patients on the practice’s registered list using the regulations carefully.

Formal List Closure

Application to formally close the list involves an assessment process and results in closure for a period of time up to a maximum of 12 months. This requires the approval of NHS England which is not necessarily granted.

Informal List Closure

Many practices are now managing their lists by using paragraph 171 of the General Medical Services Contract which states ‘The Contractor MAY accept an application for inclusion in its list’. Note the word MAY not MUST!

The regulations continue to state an application to join the list ‘shall only be refused if the contractor has reasonable grounds that do not relate to race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.’ Within 14 days the practice must notify an applicant in writing of the refusal to accept an application to join the list and the reasons for this.

A lack of capacity is a ‘reasonable ground’ and a practice can produce a standard letter for reception staff to provide to applicants.

Practices must keep a written record of such refusals and be prepared to make it available to NHS England on request. A computer log or record book accessible to reception staff and updated as each applicant is declined should be maintained.

• Practical Considerations in operating an ‘informal list closure’
• Staff need to understand exactly what is required and not deviate from the rules. No exceptions.
• The simplest way to be non-discriminatory is to decline all applications to join the list.
• The only exceptions might be newborn babies or applicants who join an existing household eg returning students, new partners.
• The decision to operate an informal list closure should be recorded in the minutes of a practice meeting and reviewed on a regular basis possibly monthly.
• The letter to the patients should be honest and include statements to reflect that the decision remains under review and may be reversed if the situation changes. It must be reasonable, transparent and justifiable.
• Practices should have a written policy that all relevant staff have read and ideally signed.

Some practices maintain their lists at a level by taking on the same number of patients a month as left the list the previous month. This is within the regulations as outlined here.

In January 2015 the BMA published ‘Quality First: Managing workload to deliver safe patient care’. This is available on the BMA website and includes other advice such as reducing the size of a practice area.

The LMC can be contacted for advice or clarification.