GP practices will accept most patients who wish to register with them, provided they live within their agreed catchment area, or the practice has decided to allow out-of-area registration.
The most common exception to this is when a practice list is closed. This is usually because the practice has reached capacity and it can only happen with the agreement of the contracting NHS body. Even when the list is closed, a practice is likely to continue to accept registrations from immediate family members of patients who are already registered.
But what happens when a practice receives a registration request that they would prefer to decline? This can be a risky area.
Rules on registration requests
The rules on patient registration requests are clear. Patients have the right to choose their GP practice and to be accepted by that practice unless there are reasonable grounds to refuse. The GMS contract states that these grounds must not relate to race, gender, social class, age, religion, sexual orientation, appearance, disability or a medical condition.
The practice is required to provide the patient with the reason(s) for their decision to refuse in writing. In order to ensure the risk of a complaint is minimised in this area, practices should consider having clear criteria for assessing registrations to ensure consistency is applied at all times.
Why practices may want to refuse registrations
The most common reasons practices contact MDDUS for advice on refusing a registration include:
- The applicant is a close relative of a current patient with whom the practice has a difficult relationship.
- The applicant has previously raised a third-party complaint about a GP in the practice or a service the practice has provided to a friend or family member.
- The applicant has previously been a patient of the practice and left some time ago after becoming dissatisfied with how the practice dealt with a complaint – and now wishes to re-join as they are even less satisfied with the alternative.
- The applicant has a locally known history of violence.
- The applicant has previously been removed from the practice list.
Are any of these reasonable grounds for refusal? The answer is: ‘it depends’.
For example, even where a patient has previously been removed from a list, the practice team may have changed so that a previously relevant reason supporting a ‘breakdown in doctor-patient relationship’ may no longer apply and a blanket policy of refusal may be challenged.
Minimising the risk
To minimise risk, practices would be prudent to accept patient registration requests and then, if there are any subsequent difficulties, the correct process should be followed. This would include issuing a written warning to the patient and, if necessary, implementing a ‘removal with reasons’.
If a patient is unhappy with the practice’s reason for refusal they may decide to take their complaint to the ombudsman who can investigate allegations of poor service or failure to provide service within the NHS.
A patient could also make a complaint about the practice to the local primary care organisation or their MP. Depending on the reasons given for refusal, they may also have grounds to take legal action in relation to any perceived discrimination.
Violent patients
Under the GP contract for 2018/19, practices in England were given clearer powers to refuse to register violent patients. The contract clarifies that practices can refuse to register people with a 'violent patient' flag on their medical record under the existing rules that allow them to turn patients away when there are 'reasonable grounds for doing so'.
NHS England and the GPC have agreed that where patients are flagged as violent, this constitutes reasonable grounds for a practice to turn them away. There is more detail on this here.
Key points to consider
- Avoid a knee-jerk reaction in refusing a patient applying to join the practice.
- Refusing patient could result in complaint to the ombudsman or a legal challenge.
- Consider requests to join the practice consistently.
- Only refuse requests where you feel you can provide reasonable grounds in writing.
Liz Price is senior risk adviser at the MDDUS. www.mddus.com
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