ࡱ> U@ xbjbj 72]lt||||  0}0}0}8h}~D *T^"ԀԀԀ"ϙ ۙ$R  7v||ԀԀc&|Ԁ Ԁz[( l ԀH ^~0}ZS8D6nXp ||||& *Ѡ D[gDx( gDRAFT Brent  Teaching Primary Care Trust Working with our partners for a healthier Brent Patient Registration & Deregistration Policy (Incorporating Open / Closed Lists) Subject:Patient Registrations and Deregistration with General Practices and Application Process for Closed Lists Date of implementation:Date of review:Person responsible for Policy Implementation and review: Director of Primary Care Services  Introduction The NHS is responsible for those residents and nationals who meet the eligibility criteria for obtaining free NHS Primary Care (see Appendix 1). Since 1st April 2004 patients have been able to register with the Practice of their choice and can specify the individual General Practitioner they would prefer to be treated by. This could, for example, be a General Practitioner for the patients continuing care or for a particular condition. Patients may also choose another GP who specialises in a particular area. Also, under the new GMS contract, Practices are required to declare if their list is open or closed. This will help patients know which Practice they can register with and ensure transparency. Aim To ensure: Practices are aware of their rights and responsibilities to patients within Brent Teaching PCT regarding: Registration or refusal to register patients. Temporary assignment of patients for a minimum period of three months Deregistration of patients Practices are aware of the patients right to choose. Practices are aware of the circumstances within which they can operate an open, closed or short term closed list and how they should apply to the PCT for approval to operate such a list. Eligibility to register people eligible for NHS Primary Care Services. Eligibility to register asylum seekers and refugees. Objectives To put in place clear arrangements for patient registration. To put in place clear arrangements for patient deregistration. To put in place clear arrangements for the temporary assignment of patients. To put in place a clearly understood process to be followed by Practices when applying for Closed List status. Definitions Registration to a patient list Following Eligibility to receive NHS Primary Care Services Assignment to a Patient ListA process followed by Contractor Services to allocate a Patient to a GP for a 3 month period. The patient is put on the Patient List for that practice.  Temporary ResidentIndicates a temporary resident in the area who is not put on the patient list. Removal from a Patient ListA patient is removed from a patient list within a Practice.  SHORT TERM CLOSED LISTA Practice that has completed the application to operate a short term closed list [Appendix 2] and had the application approved by the PCT can be deemed to have a short term closed list for up to three months.  CLOSED LISTA Practice that has gone through the PCTs formal list closure procedure (Appendix 3) can be deemed to have a Closed List for three to twelve months.  PRACTICEPrinciple General Practitioner or Senior Partner with whom the PCT contracts. PCT Brent Teaching PCTContractor ServicesBrent and Harrow Contractor Services DESDirected Enhanced Services.  EEU NationalsEuropean Economic Union Nationals A patient who has provided evidence which confirms that they are settled in the United Kingdom (UK) and have no intention to return to their country for some considerable time. (see Appendix 1).  Asylum SeekersSomeone who has applied for asylum and is waiting for the Home Office to make a decision under the 1951 Refugee Convention. This includes people who are appealing an initial refusal for asylum. RefugeesThe Home office grants asylum under the 1951 UN Convention Relating to the Status of refugees because it believes that this person has a well-founded fear of persecution if sent back to his country or origin. Practice Responsibilities 5.1 Practices must only register those people eligible for NHS treatment (refer to Appendix 1). 5.2 Legislation states that Practices can have short term closed lists but decline to register new patients so long as they have good reason and are not discriminating and can demonstrate this. Practices should note that the key words here are short term, good reason and non discriminatory and can demonstrate this to the PCT. In this circumstance the Practice can apply to the PCT to operate a Short Term Closed List. 5.3 Practices need to let the PCT know if they wish to operate a Short Term Closed List. A formal application must be made using the Application for Operating a Closed List (Appendix 2). This will include list size and what size of list would trigger a re-opening. 5.4 In making their application, Practices must demonstrate that they have removed previous patients from their list in the previous six months. This will be audited and a reconciliation exercise undertaken with Contractor Services to confirm that these previous patients have been removed. Where this is found not to be the case, the Practice will be deemed as having committed fraud and appropriate measures will be taken by the PCT. Practices are obligated under the Statement of Financial Entitlements (SFE) to ensure that their lists of patients are accurate to the best of their knowledge. Practice must provide Contractor Services with timely notification of patient registrations and removals. The Practice must keep a written record of refusals of registration as made under paragraph 15 of the National Health Service (GMS Contracts) Regulations 2004 and the reasons for refusal shall be made available to the PCT on request. Where a Practice list is Closed, the PCT may still assign patients in accordance with National Guidance clause 257 of the GMS contract and clause 273 of the PMS contract and Delivering Investment in General Practice, Section 2.40 any completion of the Application for Operating a Closed List (Appendix 2). Where the PCT rejects the Application for a Closed List the Practice has the right of appeal to an Assessment Panel. For list closures of more than three calendar months the practice will not receive payment for Directed Enhanced Services for full month periods even if the list is closed for part of the month. 6.0 Patient Choice of Practice and General Practitioner 6.1 Since 1 April 2004, patients have registered with a Practice rather than an individual General Practitioner. However, patients can still ask to be seen or treated by a particular GP. This may be the same GP for continuing care, or for a particular condition, or another GP who specialises in that area. When patients register with the Practice, they should be asked if they want to name a preferred GP, for example, some women prefer to see a female GP. The general assumption is that the GP with whom patients are currently registered will be the preferred GP, but when patients attend they may wish to record an alternative preference, which should then be recorded in the patients medical record. 6.2 The choice of Practitioner cannot be absolute. It also depends on availability, appropriateness and reasonableness. Where a patient asks to see a particular Practitioner, the Practice must endeavour to meet these wishes and take into account the following: (i) The availability of the health professional. The patient may have to wait longer to see their preferred Practitioner. In which case the delay would not count against achievement of the access targets measured in the access DES or access bonus points in the quality and outcomes framework. (ii) Patients are under a general obligation not to unfairly discriminate, for example by refusing to see a doctor of a particular ethnicity or gender. (iii) The Practitioner is still allowed the right of reasonable refusal, such as in relation to violent patients (if the Practice does not have facilities to deal with such patients), actual or threatened physical violence, or verbal abuse to or fear for the personal safety of Practice staff or patients. (iv) The patient may be asked to accept an alternative if, for example, the service required was being delivered by another type of primary care professional. An example is if the Practices protocol specifies that a service or treatment is nurse-led or therapist-led rather than doctor-led. 7.0 Patient Registration 7.1 Patients who wish to access a Practice should contact Brent and Harrow Contractor Services. Contractor Services will provide the patient with a list of Practices in the patients area and to whom the patient may apply for registration. The Practice must note that there are five key determinants for whether a patient can register with a Practice: The patient provides documentary evidence to confirm they are lawfully in the UK and /or eligible for free NHS Primary Care (see Appendix 1). The Practices Practice area, in other words its catchment area must be specified in the contract. (This will be agreed with the PCT prior to signing the contract). The open/closed list status of the Practice. patients with a history of violence. patients who have previously been removed from the Practice list, for example because of an irreconcilable breakdown in the relationship. 7.4 A Practice with an open list may only refuse to accept an application if it has reasonable grounds for doing so and are not discriminating and can demonstrate this (see paragragh 5.1). Patients can still be assigned to these practices by Contractor Services as Assigned Patients. Assigned Patients are assigned for a minimum period of three months. 7.5 The refused patient must be given a letter of refusal by the Practice indicating the reason for refusal (Appendix 3). The Practice should provide this letter of refusal to the person at the time the person presents at the Practice. A copy of this letter must be sent to Contractor Services and copied to the Practice Development Manager at the PCT. If a patient is refused registration and is in possession of four letters of refusal, on contact with Contractor Services, Contractor Services will allocate the patient to a GP as an assigned patient using the process agreed with the PCT, as set out in Appendix 4 and 5. Patients may also be assigned to GP practices if the patient has vulnerable social or health circumstances. For these patients, if they have support from a health or social care professional the professional can request an Assignment Allocation Form (Appendix 5) and assist the patient to complete this. If the patient does not have this supportthen they can contact either Contractor Services or Brent tPCT PALS who can assist to complete this form. Contractor Services will endeavour to ensure that all appropriate requests for patient assignment are actioned within two days of the patient making an appropriate claim requiring assignment to a Patient List. Temporary patients will be assisted by Brent tPCT PALS Services (020 8795 6181/6140/6025) to find a suitable practice to be registered with. PALS will provide patients with information regarded Practices in their local area and about registration issues. If a Practice list is open, ie. the Practice has not entered into a formal agreement with the PCT regarding the closure of the list (Section 2.37 of Delivering Investment in General Practice), then the Practice must accept the patient. Practices with closed lists may still be assigned patients in accordance with 2.40 of Delivering Investment in General Practice De-registration of Patients from a Patient List 8.1 Patients can be de-registered from a patient list by a number of processes. Patients not eligible for free NHS Primary Care, i.e. those patients already on practice lists but found to be or have been out of the country for more than 3 months can rightfully be removed from a list as confirmed by the terms stated within the Medical Card; refugees and asylum seekers whos applications and appeals have been rejected by the Home Office; patients recognised as short term visitors to the UK; etc. Upon receipt of undelivered mail sent by Contractor Services via Royal Mail, a notification (FP69 card) will be sent to the practice. The Practice then has six months to inform Contractor Services of either the patients new address, no change in circumstances or whether or not they wish to keep the patient. This can be indicated by either the return of the FP 69 card or by the Practice making amendments via the Practice links. If no changes have been received by the end of the six month period the patient will be automatically removed from the patient list. If the Practice has written to the patient three times and received no reply then the Practice must instruct Contractor Services to remove the patient who is absent from their known home address with no forwarding address. The Practice notifying Contractor Services in writing of their wish to remove a patient if the Practitioner-Patient relationship has broken down and the patient has been given the patient warning within the last 12 months that he/she is at risk of being de-registered with a clear explanation of the reasons for this in accordance with the National Health Services (GMS Contracts) Regulations 2004. When the Practice notifies Contractor Services the Practice must also write* to the patient providing reasons for de-registration and 7 days notice to allow the patient to register at another practice. The patient will be removed from the patient list on the 8th day. During this 7 day period if the patient requires access to primary care consultation the Practice should liaise with the PCT to identify appropriate mechanisms by which to provide access to Primary Care. *Although the Practice has the option not to inform the patient of reason/s for de-registration it is good practice and in the patients interest to know why action to de-register has taken place, for example, to give the patient an opportunity to improve behaviour or relationships with medical professionals. The Practice is therefore encouraged to inform Contractor Services of reasons for deregistration so that Contractor Services or PALS can support the patient. Patient support Patients may require support when registering with a GP practice, during issues of conflict with the Practice and/or de-registration and the need to find another GP practice. In the first instance Patients should refer to the practice for confirmation or clarification about the actions they have taken. If the patient is not satisfied with the response they receive they should inform one of the following agencies: Brent Teaching PCT PALS department, Brent Teaching PCT Complaints department, Patient Registration and Assignments at Brent and Harrow Contractor Services Training and Information All Practices (both GMS and PMS) will receive a copy of this policy and the procedures that need to be followed. Additional help and guidance for all Practices will be available through the designated Practice Development Managers. Information regarding patient registration will be provided to patients at the reception sites within Practices, on contact with Contractor Services, on contact with PALS and the PCT. 11.0 Audit 11.1 The Performance and Development Manager within the PCT together with Contractor Services, will be responsible for producing quarterly monitoring information that will inform both the Primary Care Contracts Board and Professional Executive Committee members of the number of Practices that are or have been operating a Short Term Closed List or Closed List. 12.0 Financial Implications There are no financial implications. However, if there are a large number of Practices operating a Short Term Closed List or a Closed List, a review will be undertaken by an Assessment Panel to determine the need for additional resources and the identification of such costs. Membership of the Assessment Panel will be drawn from the Directorates of Primary Care and Governance. 13.0 References and Further Reading Department of Health (2003) - Delivering Investment in General Practice; Implementing the New GMS Contract Standard General Medical Services Contract (2004) Department of Health, London Model Personal Medical Services Contract (2004) Evidence for Eligibility for Free NHS Primary Care, August 2004, Navin Morjaria, Contractor Services Refugee Council, Information for Advisors, September 2004,  HYPERLINK "http://www.refugeecouncil.org.uk/publications/pub016.htm" www.refugeecouncil.org.uk/publications/pub016.htm LMC guidance -  HYPERLINK "http://www.lmc.org.uk/guidance/overseas_visitors.doc" http://www.lmc.org.uk/guidance/overseas_visitors.doc -  HYPERLINK "http://www.lmc.org.uk/guidance/eligibilitycriteriaFlowchart.ppt" http://www.lmc.org.uk/guidance/eligibilitycriteriaFlowchart.ppt Contact Details for Local Agencies Patient Advice and Liaison Service (PALS) Brent Teaching PCT Wembley Centre for Health and Care 116 Chaplin Road Wembley Middlesex HA0 4UZTelephone: 020 8795 6181 / 6025 Minicom: 020 8795 6140 Fax: 020 8795 6377 E-mail:  HYPERLINK "mailto:pals@brentpct.nhs.uk" pals@brentpct.nhs.ukComplaints Department Brent Teaching Primary Care Trust Wembley Centre for Health & Care 116 Chaplin Road Wembley Middlesex HA0 4UZ Tel: 020 8795 6771 Fax: 020 8795 6770Navin Morjaria Accredited Counter Fraud Services Brent and Harrow Contractor Services The Twenty-One Building 21 Pinner Road Harrow Middlesex HA1 4BB Tel: 0208 537 3162 Fax: 0208 861 3126 E-mail:  HYPERLINK "mailto:navin.morjaria@harrowpct.nhs.uk" navin.morjaria@harrowpct.nhs.uk Patient Registration and Assignments Patient Data Brent and Harrow Contractor Services The Twenty-One Building 21 Pinner Road Harrow Middlesex HA1 4BB Tel: Fax: E-Mail Evidence Required for Eligibility for Free NHS Primary Care Appendix 1 Those already within the NHS system the practice can request the patient complete a GMS1 and provide the following documentary evidence: A medical card or details of previous doctor Photographic Identity document e.g. passport, driving licence Proof of address e.g. Utility bill etc New arrival to the UK or Never registered with a GP including EEU nationals* The practice can request the patient provide the following: Passport or Home Office document or any other entry clearance document to confirm legal status within the UK Additionally to establish settlement documentary evidence such as: Work Permit and associated employment contract exceeding period of 6 months Tenancy agreement exceeding a period of 6 months Student visa and associated letter from college indicating attendance to a full-time course exceeding 6 months Pension details confirming pension is being received within the UK Utility Bill to confirm address *EEU Nationals, although allowed freedom of movement across EEU borders, are not automatically entitled to free NHS care. EEU nationals will need to provide evidence that confirms their intention to settle in the UK and not to return to their EU country for some considerable time. Registration should be declined in instances where documentary evidence confirms the new arrival to be a short term Visitor to the UK i.e. limited by the Home Office to a maximum stay of 6 months. An example is someone holding a Multiple Category C Visit Visa and limited to a maximum stay of 6 months on each visit. Refugees and Asylum Seekers - whilst their applications are being processed by the Home Office but not determined, are entitled to full NHS care together with their husbands, wives and children. . The practice can request the following: Photographic Home Office Document e.g. IND Application Registration Card Home Office Entry Clearance document with personal details and on occasions may include photographs Proof of address Local Housing letter, utility bill etc Their eligibility will come to an end should the Home Office reject all their appeals to stay in the UK Homeless People are only eligible to be registered if a suitable address is given i.e. hostel or voluntary organisation dealing with homelessness and collecting their mail or homeless people as their clients. Please Note: Eligibility to free NHS care is not related to nationality, payment of tax or National Insurance contributions. Brent  Teaching Primary Care Trust Working with our partners for a healthier Brent Appendix 2 LIST CLOSURE PROCEDURE In accordance with Paragraph 29, Schedule 6 of the National Health Service (General Medical Services Contracts) Regulations 2004, on behalf of the above named Practice I/we wish to make of formal application for our list to be closed to new patients and assignments, as follows: Please complete all sections and continue on separate sheet if necessary: WORKSHEET Name of Senior Partner or Principle General Practitioner Practice Address  Date notification received from Practice (attach notification):Proposed length of closure this may be for up to three months (Short Term Closed List) or 3-12 months. For periods greater than three months the Practice will not be allowed to provide Directed Enhanced Services and will not receive payments for this for the full month even if the list is closed for part of that month.  Short Term Closed List / Closed ListArrange meeting with practice normally within 7 days of receipt of notification (or as soon as practical) to discuss what can be done to keep the list open. Meeting Date:Outcome of discussions (should be completed within 28 days of the notification being received.)  Is the list going to remain open: Yes/No* Short Term Closed List / Closed List If* YES the PCT must confirm this in writing: Date letter sent:If *NO the Practice must complete a Formal Closure Notice Section for periods 4-12 months Date Notice Received:The Formal Closure Notice (FCN) must include the following:(i) The proposed closure period; (4-12 months): (ii) The number of registered patients at the time: (iii) The proposed percentage reduction in patients OR the absolute number of patients before the list closure will be suspended: (iv) The proposed percentage increase in patients OR the absolute number of patients before such a suspension is lifted:  FCN Section completed by: DATE: PCT DECISION (within 14 days of receipt of Closure Notification)Decision must be made by: Immediately confirm receipt in writing: Actioned by: PCT may initiate further discussions to resolve any differences of opinions or disputes about the contents of the Formal Closure Notice: Date of further discussions if initiated: Outcome of Discussions: Does the PCT approve the Closure Notification: (Decision must be made within 14 days of receipt of notice) Yes/No If the PCT approves the Closure Notification: The PCT must confirm its decision in writing: Set reminder in calendar/diary to notify the contractor that the list will reopen on a certain date: Time and duration of List Closure (full calendar months) From: To:If the PCT rejects the Closure Notification:Notify contractor of rejection: Date Notified:PCT must provide the Panel with all the relevant paperwork. Date Sent:Decision must take place within 28 days of the PCT Rejecting the closure notice Date written notification received:ASSESSMENT PANEL DETERMINATIONIf the Panel approves the closure notice: What start date has the Panel approved: What arrangements has the Panel stated for reopening the list: If the Panel rejects the closure notice the list will remain open:The PCT should discuss with the contractor whether any steps should be taken to enable it to continue to practice safely and effectively. FORMAL APPEALEither the PCT or the contractor can appeal to the SHA under the contract dispute resolution procedure, but only following prior consideration of the assessment panel. Throughout this process the list will remain open until otherwise determined. APPENDIX 3 Practice Name and Address Date Dear (Applicant/s), Letter Explaining Refusal to join the Practice Patient List Thank you for asking to join our practices list of patients. At present we are not accepting any applications except from immediate family members of existing patients. The reason/s is: [practice to indicate all relevant reasons] Your address is outside our practice area. Our list is currently recognised by the PCT as closed in the short term and we do not have resources currently to look after any more patients. One or more of our key practice team is away from work for the foreseeable future. Our Patient list is currently recognised by the PCT to be closed We are undergoing major building works. We have a strict Zero Tolerance policy in respect of violent or aggressive behaviour towards our staff and feel unable to accept you because: You have a history of violence or a relative who is known to be violent You pose a threat to the personal safety of Practice staff or other patients You were previously registered with this practice and removed because of irreconcilable breakdown in the relationship with an existing member of the Practice. Other reason Please ask the Brent Teaching Primary Care Trust to help with finding a practice able to accept you. Their PALS service can be contacted on (phone number). There are Walk-In Centres at Central Middlesex Hospital / Wembley Centre for Health Care / where you will be able to access primary care services until you have been registered. NHS Direct on 0845 4647 is available 24 hours a day to give advice on medical matters. Yours sincerely (The Practice) CC: Brent and Harrow Contractor Services, Practice Development Manager, Brent Teaching PCT Patient Registration and Deregistration Processes                   Appendix 5  ASSIGNMENT REQUEST FORM Our Ref: Date issued: 1 Last name 2 First names  3 Previous names 4 Title (Mr/Mrs/Miss)  5 Date of birth 6 Male / Female  7 Area, Town & Country of birth  8 NHS number 9Contact phone number  10 Present address 11 Last address  12 Postcode 13 Postcode 14 Date of arrival 15Intended length of stay 16 Expiry date of visa  17 Name of last Doctor 18 Address of last Doctor  19 Name and address of the four surgeries with whom you have already tried to register (if appropriate). A B date date  C D date date  Please read and sign the declaration below, which requests and authorises Brent and Harrow Contractor Services to assign you to the list of a local GP DECLARATION By completing this form, I am requesting and authorising Brent & Harrow Contractor Services to assign me to the list of a local GP. (Delete if not applicable)I have attempted to register myself with four other surgeries in the area, but am still without a GP. I have the following specific requirements (For example require wheelchair access, language)    Signature:  Date:  Please return completed form to: Patient Registration and Assignments Patient Data Brent and Harrow Contractor Services The Twenty-One Building 21 Pinner Road Harrow Middlesex HA1 4BB PAGE  PAGE 15 Brent Teaching PCT: patient registration policy draft 24.06.05 Sena Shah Brent Teaching PCT: patient registration policy draft 01.07.05 Sena Shah Appendix 4 Patient Able to Register Assigned Patient with a GP for minimum of three months Patient registers with Practice on patient list Patient Unable to Register or requiring assignment PALS / Contractor Services gives patient a list of GPs that have open lists for patient to approach for registration. 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