December 2004 (but not yet overturned so far as we know)

Gloucestershire Primary Care Trusts

Patient Assignments Policy

1.0INTRODUCTION

1.1The PCT will always try to assign patients to practices with open lists. However, this may not always be possible. As the PCT is under a duty to ensure the provision of sufficient primary medical services to meet the reasonable needs of our population, it may be necessary to assign patients to contractors with closed lists.

1.2In assigning patients to a practice the PCT will take the following into consideration:

i)the patient’s wishes and circumstances including the distance between home and the GP practice

ii)the contractors list status

iii)the patient’s registration history

1.3The PCT will never assign a patient to a contractor with a closed list without following the procedure set out in Section 3.

1.4This policy applies to both GMS and PMS practices.

2.0ASSIGNMENT PROCEDURE IN RELATION TO CONTRACTORS WITH OPEN LISTS

2.1The PCT will via Gloucestershire FHS Shared Services, assign a patient to a contractor, whose practice area covers their address and whose list is open, within 48 hours of receiving a signed form. If the practice covering the patient’s address has a closed list then the procedure outlined in Section 3 will be followed.

2.2Assignments will be done on a rota basis of contractors who cover the area in which the patient lives who have open lists or who are approved to accept assignments if their list is closed (following the procedures set out on Section3). The rota will take account of the number of WTE GPs the contractor has including salaried

2.3 Where the patient is living at an address not covered by a practice area then FHS Shared Services will assign patients to nearby practices on a rotation basis still subject to clauses 2.1 and 2.2.

2.4Both the patient and the contractor will be informed in writing of the assignment.

2.5The contractor will have access to the dispute resolution procedure in cases where the PCT and the contractor cannot agree to a patient assignment. The PCT would however wish to try and sort out any such disputes locally without recourse to the formal dispute resolution procedure. The local process could involve:

a)Discussion between the contractor and the relevant local manager, which should take place within 2 working days. If this is not resolved, then

b)Discussion with the contractor, relevant local director and possibly the LMC representative within 7 working days. If this is not resolved, then

c)Local conciliation meeting involving Board members within 14 working days

d)Referral to the Assessment Panel

If the matter still cannot be resolved then the formal dispute resolution procedure may be invoked.

2.6Whilst the dispute is being resolved the patient will remain on the contractors list.

2.7An assignment will be for a minimum period of 3 months or until a more acceptable alternative can be found.

3.0ASSIGNMENT PROCEDURE IN RELATION TO CONTRACTORS WITH CLOSED LISTS

Stage 1 – Informal Discussion

1. The PCT will carry out discussions with the contractor to try and achieve informal resolution.

Stage 2 – Assessment Panel Determination

1. The PCT will prepare a proposal for consideration by the Assessment Panel which will include details of the contractor to whom we would wish to assign patients.

2. The PCT will notify all the contractors in the area with closed lists, those contractors who may be affected by the Assessment Panel’s determination, the SHA and the LMC.

3. In making its determination, the Assessment Panel will take into account whether the PCT has sought other ways of providing essential service for new patients other than assignment to closed lists, and the workload of those contractors with closed lists which may be subject to having patients assigned.

4. The Assessment Panel’s determination will be made within 28 days of receiving the PCT proposal. The Assessment Panel will notify the SHA and contractors with closed lists.

5. The Panel may set out the GMS contractors to which the PCT may assign patients.

6. Once the new arrangements are in force the PCT will have discussions with the contractor before the first assignment to the contractor occurs. Thereafter they will happen as appropriate given the frequency and volume of assignments.

Stage 3 - Fast Track Appeal to SHA

1. The PCT or the contractor can appeal to the SHA, who is the formal arbiter, under a fast track process.

2. Appeals must be initiated within 7 days of the determination.

3. More than one contractor may appeal jointly to the SHA. In this case the SHA will consider the appeal in respect of all the contractors as a whole.

4. The SHA will write to all parties to the dispute within 7 days to

  • notify of its appointment
  • give the parties the opportunity to provide written representations within a period of up to 2 weeks
  1. The SHA will provide copies of any written representations to the other parties and invite them to respond in writing within 2 weeks.
  1. In considering the appeal the SHA may give the opportunity for oral representations to be made on behalf of the parties. It may also consult with experts (subject to any conflict of interests) who may be able to help.
  1. The SHA will make a determination within 21 days and send copies to the parties. This date may be extended by mutual agreement of the parties and the SHA.

4.0THE ASSESSMENT PANEL

4.1The Assessment Panel will comprise of the following members, all who come from another PCT:

  • A PCT Chief Executive
  • A patient representative
  • An LMC representative

5.0REMOVAL OF PATIENTS FROM CONTRACTORS LISTS

5.1Removals from the list at the request of the patient

5.1.1The contractor or patient will advise FHS Shared Services in writing of any request for removal from its list of patients received from a registered patient. Any request received from a patient whether via the contractor or direct from the patient will result in the patient being removed from the contractors list.

5.1.2The removal will take place either on the date on which the PCT receives notification of the registration of the person with another provider of essential services or 14 days after the date on which the notification or request was received by FHS Shared Services, whichever is the sooner.

5.1.3As soon as is reasonably practicable FHS Shared Services will notify both the patient and the contractor in writing that the patient has been removed from the contractor’s list and the date this took effect.

5.1.4The PCT reserves the right to reassign a patient to the same contractor.

5.2Removals from the list of patients who are violent

5.2.1 If the removal is in respect of a violent (See Note 1) patient, then this will take place with immediate effect and the appropriate arrangements put in place. In such a case the contractor should fax FHS Shared Services immediately with the signed removal request and the completed incident form and then follow this up in writing within 7 days. FHS will confirm the removal with the practice, which will take place with immediate effect. FHS Shared Services will give written notice to the patient of their removal together with details of alternative GP arrangements.

5.2.2The contractor should also inform the patient concerned, unless it is not practicable to do so or there are reasonable grounds that to do so would be detrimental to the health of the patient or would risk the safety of others. The contractor should also confirm in the patient’s medical records that they have been removed and the reasons for this.

5.2.3Once a patient has been removed because of violent behaviour they will be subject to the terms of the Violent Patient Programme

5.2.4Other removals from the list at the request of the contractor

5.3.1Where the contractor has reasonable grounds for wishing a patient to be removed from its list of patients, the contractor must notify the FHS Shared Services in writing that it wishes to have the patient removed. The contractor must also notify the patient in writing of the specific reasons for such a request. Except for the following reasons the contractor may only request a removal if within the 12 months prior to the date of its request it has warned the patient that they are at risk of removal and explained the reasons why. It is hoped that a discussion would take place between the contractor and the PCT, via FHS Shared Services, before a contractor removes a patient from their list. This is especially so where no contractor covers the area in which the patient resides.

5.3.2Reasonable grounds for removal include:

  • Patient’s change of address
  • The contractor has reasonable grounds for believing that the issue of a warning would be detrimental to the health of a patient or would risk the safety of others.
  • In the opinion of the contractor it is not reasonable or practical for a warning to be given
  • The contractor must record in writing the date of any warning of removal and the reasons for the warning as given to the patient. If no warning was given a note should be kept of the reason why.
  • The contractor must keep a written record of all removals and the specific reason for the removal. This record will be made available to the PCT on request.
  • A removal requested by the contractor will take effect from the date on which the patient is registered with another provider of essential services or the eighth day after FHS receive the notice, whichever is the sooner. If the patient is receiving treatment from their existing contractor, the contractor should inform the FHS of this fact and the removal will then take place on the eighth day after FHS receives notification from the contractor that the patient no longer needs such treatment or on the date the patient is registered with another provider of essential services, whichever is sooner.
  • It is hoped that in most circumstances, except violent patients and a patient’s change of address, that discussion will take place between the PCT and the contractor before a contractor removes a patient from their list. This is especially so where no other contractor covers the area in which the patient resides. The PCT reserves the right to reassign a patient to the same contractor.
  • FHS will confirm in writing to both the contractor and the patient that the patient’s name has been removed from the contractor’s list and the date this is effective from.
  • The PCT reserves the right to reassign a patient to the same contractor.

Note 1:A violent patient refers to a patient who has committed an act of violence against any of the following people or behaved in such a way that any such person has feared for his/her safety and where the act has been reported to the police. People referred to include:

  • Individual medical practitioner
  • Partner in the partnership
  • A member of the contractor’s staff
  • A person employed or engaged by the contractor to perform or assist in the performance of services under the contract
  • Any other person present on the practice premises or in the place where services were provided to the patient under the contract

C:\WINDOWS\Temporary Internet Files\Content.IE5\KRDBIM3L\Patient Assignments Allocations amended version created 11Nov 04 with proposed changes Dec 04.doc Amended version created 02/11/04

Change history

Change reflecting 3 months for the length of patient allocations from 12 as agreed with the LMC October 2004