Practice threatened with breach notice after closing list to protect patient safety

A Midlands practice has been told it is in breach of contract after it followed BMA guidance and informally closed its list to protect patient safety.

Dr Hadrian Moss: threatened with contract breach (Photo: Philip Reeson)
Dr Hadrian Moss: threatened with contract breach (Photo: Philip Reeson)

Partners at Dryland Surgery in Kettering, Northamptonshire, took the decision to stop registering new patients because they feared patient safety was at risk.

The practice lost a GP to retirement at the beginning of the year but had been unable to recruit a replacement. It has not had a single application since advertising the vacancy in July 2014.

Dr Hadrian Moss said the remaining partners had seen the number of patients they look after jump from 2,000 to 2,500.

Patient safety risk

‘We feel we have reached a critical point where, there is no way we are unsafe at the moment, but if we were to continue to have an increase in list size then patient safety could not be guaranteed,' he said.

GPC workload guidance issued in January told practices they are allowed within the terms of their contract to take ‘informal list measures’ to decline to register new patients.

The guidance said: ‘A practice can decide not to register new patients, provided it has "reasonable and non-discriminatory grounds for doing so", (such as protecting the quality of patient services). In such cases, the regulations allow practices to refuse to register new patients.’

Dr Moss said NHS England found out about the practice’s decision through the local media. ‘We had one email from NHS England asking us to confirm if we had closed our list and informing us we are in breach of our contract if we had closed it. We replied saying we had informally closed it, and quoted the BMA evidence.’

BMA advice

GPC deputy chairman Dr Richard Vautrey said the BMA stands by its advice, which it has taken extensive legal views on, and called on NHS England to work with practices rather than ‘bully or threaten’ them.

Dr Moss said he had received ‘nothing but positive’ responses. ‘All very, very positive from our patients, expressing gratitude that we are looking after their best interests.’

The practice had had ‘unanimous support’ from other GPs, he added, with the profession ‘saying we are 100% behind you, and we might follow you’.

The practice is now likely to make an application to NHS England for a formal list closure, but will continue to refuse new patients while NHS England deliberates.

NHS officials

A spokeswoman for NHS England Central Midlands said: ‘NHS England commissions primary care medical services; the terms of those contracts include the processes which must be followed in the event that a practice believes they need to close their register. NHS England (Central Midlands) and the CCG are planning to meet with the practice to discuss their current position.

‘To date, NHS England (Central Midlands) have not received a written application from Drylands GP Practice [sic] to close their patient list.’

Dr Vautrey said: ‘Our guidance is clear about how a practice may informally manage their list. As with the whole guidance document we took extensive legal advice on this matter before issuing it. 

‘This is not only an issue for England, but practices around the UK are facing unprecedented workload pressures which can often be suddenly compounded by being unable to replace GPs who have left the practice.  Practices taking this action are likely to be in extreme situations and have an overriding responsibility to deliver safe care to their patients. It is in all parties' interest not to bully or threaten practices in these difficult situations, but to understand the issues, work with them and offer support to help resolve the problem.’

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