This is a very thoughtful paper, and I am sure we would all agree with the main thrust of your argument. You might want to send it to [the PCT]… also.
Negotiations are always a compromise, and what we had to be aware of when we had to negotiate at LMC level to produce this document was a recognition that the old “open but really closed” option was unsustainable. The second thing we had to recognise that the contract specifies we cannot discriminate against patients so if a list is open we have to register everyone, including those from neighbouring practices. Now it is true the government, who believe in choice and competition, would like a 30% churn of patients every year between practices. But patients don’t want this, so I don’t believe that there will be massive flows from one practice to another. If there are, then this might raise clinical governance issues about the practice the patients are all leaving, that the PCT or the LMC may have a duty to intervene in.
Far more of a threat to us all, but perhaps especially to your practice is the rising Tower Hamlets population. Here there is a dilemma. Either the existing practices soak all that up and expand capacity, or we ask the PCT to procure more practices and they will only be allowed to do this by an APMS procurement route that opens the door to more privatisation. Each practice has to make its mind up about this. You could close your list, or attempt to reduce your practice area. If you closed your list, the PCT would feel they could refuse to give you enhanced services. If you wanted to shrink down your practice area, then you would undoubtedly get LMC support I think, if the PCT refused this.