Avon Primary Care Support Agency

Procedures for dealing with Registration and Assignment of Patients and Closed Lists

Avon Primary Care Support Agency
Document status: Final
Version / Date / Comments
1.0 / 01.04.04 / PCT approval. Procedures became effective 01.04.04
1.1 / 01.05.04 / To reflect application to PMS practices also
1.2 / 20.04.05 / Review by APCSA Board. Amended to recommend minimum closure period is not less than three months
1.3 / 10.08.05 / Amended following variations recognised in GMS/PMS regulations. APCSA Board Approval
1.4 / 02.05.06 / Minor grammatical amendments by APCSA
1.5 / 24.05.06 / Review and approval by APCSA Board
1.6 / 01.05.07 / Minor amendments by APCSA
1.7 / 30.05.07 / Review and approval by APCSA Board

Julie Cooper General Manager

If you need this document in a different format please telephone Helen Bond on 0117 9002559

1 Background………………..…………………………………………………………………... / 1
2 Patient Registration…………………………………………………………… ………….… / 1
2.1 Acceptance/Refusal to Accept a patient…………………………………………….. / 1
2.2 Open but full lists………………………………………………………………………… / 1
2.3 Patient Assignments…………………………………………………………………….. / 2
2.3.1 Patient Assignments to an open list…………………………………………… / 2
2.3.2 Patient Assignments to a closed list…………………………………………... / 2
3 Practice Boundaries……………………………………………..…………………………… / 3
4 List Closure………………………………..…………………………………………….…..… / 3
5 Assesment Panel……………………………………………………………………………... / 4
6 Public Involvement – how this will affect patients…………………………………….. / 4
7 Review of policy………………………………………………………………………………. / 4
Annex 1 – Illustration of assignments to closed Lists Process
Annex 2 – Illustration of List Closure Process

Contents

1 Background

The National Health Service (General Medical Services Contracts) Regulations 2004 and Personal Medical Services Regulations (Statutory Instrument No. 627) introduce new rules regarding patient lists. The PCTs covering the former county of Avon, in conjunction with Avon Local Medical Committee have developed a single procedure document to cover these requirements. An initial working party consisted of PCT Representatives, Avon Primary Care Support Agency (APCSA) and Practice Managers.

2Patient Registration

There are now new procedures for practices to follow when a patient approaches them for registration. The course of action depends on whether the practice has an open or closed list.

2.1 Acceptance/Refusal to Accept a Patient

If a list is open, a practice cannot refuse to accept a patient except:

-if the patient lives outside the practice area

-if there is just cause, eg. a history of violence

-if the patient has been removed previously from the list, eg. irreconcilable breakdown in the relationship

The practice also needs to provide the patient with the reason for refusal in writing, within 14 days of its decision (this could be a standard letter if the patient lives outside the practice area).

Patients who have been refused acceptance may contact the APCSA for assignment. The APCSA will ensure the patient has not been refused acceptance by a Practice with an open list without reason. The APCSA will notify the relevant PCT if regulations are not being adhered to.

If the practice list is closed, practices cannot accept a patient onto the list unless the person is an ‘immediate’ family member of a registered patient (definition in Interpretation of Regulations).

2.2 Open but full lists

The new GMS and PMS do not provide for maximum patient list sizes for practices which means an end to the concept of lists being "full". Instead, a practice list is either open or closed and there are new procedures for practices who wish to close their lists. These are set out in the new GMS contract agreement and regulations.

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Key features are:

there is now no such thing as a "full" list
a practice with an open list can decide to refuse an application from an individual and should consider each application on its merits (please see Acceptance/Refusal to Accept a patient above)
if a practice wants to refuse all new patients - such as where it considers it cannot provide services to more patients, it should begin discussions with the PCT under the list closure procedure.

2.3 Patient Assignments

The APCSA, when making an assignment shall have regard to:

the wishes and circumstances of the patient to be assigned
the distance between the patients residence and the practice premises
whether the patient has been removed from the contractor’s list previously

2.3.1 Patient Assignments to an Open List

Agreement was given for the APCSA to change the method by which it assigns patients to GPs with effect from 1 April 2004. Historically, patients were assigned to practices on the basis of the number of GPs in the practice, but this was longer the fairest method (due to the new skill mix flexibilities of Personal Medical Service (PMS) and new General Medical Service (GMS) Contracts). From 1 April 2004 (a pilot of six months ensured the process was equitable) the APCSA assigns patients on the basis of the list size of the practice as at the first day of each registration quarter (e.g. A practice with a list size of 10K patients will receive twice as many assignments as a practice with a list size of 5K patients). Practice income is now based on this, either via Global Sum for GMS practices or PMS baseline funding for PMS practices.

2.3.2 Patient Assignments to a Closed List

Patients cannot be assigned to a closed list unless:

(i)most or all of the practices in the area have closed lists;

(ii)there has been a determination by an assessment panel (made up in the same way as for making a determination for list closure notices, but convened to consider how assignments to closed lists should be handled); and

(iii)discussions have taken place between the PCT and the practice.

Assignments will only be made to practices with closed lists when all practices in the patient’s area are closed and an Assessment Panel has granted permission to do this. The APCSA will follow the attached flowchart to do this. (Annex 1).

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The APCSA may be unable to assign to an ‘open list ‘ if for example the patient has previously been removed from the practice whose list is open. APCSA will talk to closed practices first to see if they will accept the patient voluntarily. If not, the matter will be referred to the PCT to discuss. Where there is no resolution the APCSA will convene an Assessment Panel.

Practices who are adversely affected by a determination of an assessment panel in respect of assignments to closed lists have a right of appeal to the Secretary of State (the local Strategic Health Authority will in this instance act as the Secretary of State).

3Practice Boundaries

Practices may refuse to accept any patient outside their agreed boundary. The process for changing a practice boundary remains unchanged for all practices whether contracted for GMS or PMS. Practices will apply to the PCT via the APCSA (an application form to do this can be obtained from the Contracts Team, APCSA). APCSA will consider the application and make a recommendation to the PCT.

PCTs need to be aware of any areas within its boundary where there is limited coverage and therefore restricted patient choice. It should be noted however that if a patient requests assignment, although the distance between the patient’s address and practice address does need to be considered it does not prevent a PCT from assigning a patient to a practice even when they live outside the practice boundary.

4 List Closure

Practices who wish to close their list should apply directly to their PCT who will administer the process. Practices can no longer close their list informally.

PCTs will follow the attached flowchart for this process (Annex 2)

When reaching a decision the PCT shall consider the size of the practice list in relation to the average list size, assess the impact on other practices, assess the impact on the population of the area and current service profile with the practice.

The regulations do not give a minimum closure period, but it cannot be longer than twelve months. Closure for less than three months is not considered manageable.

Temporary opening of the list should not be granted, except in exceptional circumstances i.e. influx of students at certain times of the year. It would be impractical to ‘police’ temporary opening.

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PCTs can refuse to give practices with closed lists the opportunity to offer Additional or Enhanced Services. It is not possible to adopt a ‘blanket’ approach to this. One of the purposes of the new contract was to reward GPs for areas of work that were previously unpaid. In many cases there would be valid reasons for closing a list, perhaps if the surgery was relocating, and to withdraw enhanced services would be unreasonable. It was agreed however, that practices with closed lists should not be allowed to provide those new services where they do not have preferred provider status.

5Assessment Panel

The APCSA will facilitate the Assessment Panel process for Assignment to Closed List.

PCTs will facilitate the Assessment Panel process for List Closures.

The APCSA will provide comments/information relevant to the request for closure, e.g. of assignments in that area, practice coverage, patient turnover, closed lists in neighbouring PCTs. As part of this process, the APCSA will decide if an Assessment Panel needs to be convened for Assignment to Closed Lists.

Assessment Panels consist of aPCT Chief Executive from another PCT and a patient representative from another PCT area. The third member of the panel differs GMS and PMS. As GMS practices are, by statute, represented by Local Medical Committee’s (LMC’s) the assessment panel must include ‘a person representative of a LMC which does not represent practitioners in the area of the PCT which is a party to the contract’. This means that we may need to contact a neighbouring LMC. For PMS practices the requirement is ‘a general medical practitioner or other person, who in the opinion of the PCT leading the assessment panel is representative of the contractors interests and does not work in the same PCT area as that contractor’.

6 Public Involvement – how will this affect patients?

PCSA will work with Patient Advice and Liaison Service Managers to provide information to patients about what to do if they can’t register.

7Review of this document

This document will be reviewed annually. This will be a responsibility of the Avon APCSA Management Board.

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