Should you close your practice list formally or informally?

This guidance is to help GPs decide whether they should formally apply to close their practice list, or if informal list measures would be better suited to their situation

Formal list closure

GMS (and PMS in England) practices can apply formally to close the practice list if their workload is impacting their ability to provide safe care for their registered patients, or to carry out their contractual obligations to meet their patients’ core clinical needs.

Practices that do not wish to have patients assigned to their list by their NHS board or area team must go through the list closure procedures set out in the regulations (paragraphs 26-28 of Part 2 of Schedule 6 in Scotland and paragraph 33 of Part 3 of Schedule 3 in England).

If the board or the assessment panel approves the closure notice:

• The practice’s list is officially closed to new patients.
• The closure period will be either for a maximum of 12 months or, if a range was specified in the closure notice, until an earlier point in time when the number of patients falls below the bottom figure of the range.
• The only patient registrations that practices may accept are those from immediate family members of existing patients.

This process requires the consent of the board. The BMA would, however, expect the board to take an understanding and supportive approach to practices, ensuring that all decisions are made with consideration to patients’ and practices’ best interests.

Steps to take when considering the possibility of list closure

Before applying for formal closure, the following should be taken into account.

1. Is there an opportunity to negotiate with the NHS board team or CCG for staffing support with other services?
2. There will be a responsibility on both the practice and the NHS board or CCG to ensure that all options other than closure have been considered.
3. Document what options you have considered in trying to address the problems and any outcomes, e.g. rejected or implemented, and why.
4. Discuss your individual practice problems at the earliest opportunity with your LMC which will provide you with support in line with the rules and regulations.
5. Consider possible impact on neighbouring practices and meet with them with LMC representation to discuss the problems that the practice is facing.
6. Could the neighbouring practices help in some way? Document the outcome of the discussions for future use.
7. Request a meeting with the CCG or NHS board and let them know you will be with an LMC representative.
8. Discuss with your patient participation group to explain how and why you have come to this decision and to listen to any suggestions they may have to ease the pressures.

Informal list measures

In addition to the formal list closure procedure, practices have the contractual right to decline to register any new patients without having to go through the formal processes and without needing to get permission from the board. However, the formal closure route makes it far more difficult for the NHS board to be able to add any new patients to your list.

Support from the board

Should a practice be unable to accept patients routinely, a discussion between the practice and the board (NHS board in Scotland) could take place. This could involve, for example, additional support being provided by the area team or board, or a formal closure of the list.

Declaring your intention

You (the contractor) do not need to make an official declaration; however, the regulations state you must provide patients with a written notice as in the regulations. 

Justifying your decision

The board may still assign patients to your list as it’s open to assignments within the regulations. They may ask you 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.

There are equivalent procedures in the regulations for the devolved nations.

Referring to your list as ‘closed’

In Scotland, practices should not refer to their list as ‘closed’ when it has not been formally closed and should only state that they cannot take on further patients at present.

Reduction of practice area

In England many practices have already asked their area team to consider reducing the size of the practice area in order to help bring practice list size and workload down to safely manageable levels.

This change would require a variation in contract and, therefore, the agreement of the board. The board will consider the needs of patients, the availability of alternative practices in the locality and the effect that a practice area reduction could have on their own workloads.

The board, therefore, may not agree, but this option would work for some practices provided patients can be accommodated elsewhere.