A GP practice recently hit the headlines when it refused to register a new patient. While the practice argued it was because the patient was a member of a family that had a history of being ‘difficult’, the media latched on to the story because the wannabe patient was an EU migrant. Given this story – plus the fact we’re sometimes asked what the rules are regarding refusing patient registrations, what are the regulations surrounding the issue?

Legislation

According to NHS England, practices can refuse to register patients, but only in certain circumstances.

Under the terms of the primary medical services contract, GP practices cannot refuse an application to join its list of NHS patients on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Other than that, they can only turn down an application if:

• The commissioner has agreed that they can close their list to new patients
• The patient lives outside the practice boundary
• If they have other reasonable grounds

The final point is a little bit woolly but reasons practices have used to refuse patients 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

Even when the above criteria do apply, it can still be tricky for practices to refuse registration.

One practice manger told us: “We had a patient a couple of years ago who really didn’t like one of our GPs and started to become abusive. As a result we removed them from the list.

“A while later that GP left our practice and, out of the blue, the abusive patient turned up one day asking if they could re-register as their health had deteriorated and they wanted to return to their local practice. Against our better will, and on the advice of our CCG, we agreed and registered that patient again. Twelve months on we’ve had no problem at all, which shows how careful a practice has to be when refusing patients.

“My advice, following our experience and discussions with our CCG, is to accept patient registration requests and then react if any problems do arise. I think it’s easier for practices to follow correct procedures this way round.”

Refusing registration

Finally, it’s worth noting the rules that have to be adhered to when refusing a patient.

If a practice refuses any patient registration then they must record the name, date and reason for the refusal and write to the patient explaining why they have been refused, within a period of 14 days of the refusal. This information should be made available to commissioners on request. Commissioners may ask practices to submit the numbers of registration refusals, along with age, ethnicity and reasons, as part of their quality assurance process. 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.

Refusing patient registrations is a grey area for practices and one that needs handling carefully. Further guidance on the topic can be found on the BMA website by clicking here.

Have you ever refused to register a patient? On what grounds? We would love to hear from you, either by commenting below or in the forum here.

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