Refusing a patient registration request

GP PRACTICES will accept most patients who wish to register with them, provided they live (or work if the practice is part of the “choice of practice” scheme) within their agreed catchment area.

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 a practice list is closed, they are 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.

The most common reasons practices contact MDDUS for advice on this 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.

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.

So going back to the list above – 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.

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 (PCO) 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.

ACTION: Avoid a knee-jerk reaction in refusing any patient applying to join the practice list as this could result in a complaint to the ombudsman or a legal challenge. Consider requests to join the practice list consistently and only refuse where you feel you can provide reasonable grounds in writing. Contact an MDDUS adviser to discuss options.