The Tredegar Practice
35 St Stephens Road
What we do not know is how many practices are participating. It is likely that many practices, especially popular ones, are already oversubscribed so are unable to take on additional, out of area patients.
At best, this policy will provide an improvement for a limited number of mobile, relatively healthy patients. And if they get ill at home, then they may be in trouble. In London there is no in hours cover for local residents not registered with a local practice.
It is really irresponsible of the Department of Health and NHS England to go ahead with the January launch without a robust and safe arrangement in place.
Well done, Dr Hughes.
We have been blighted by this flawed structure, for years. In 2009 we took a unilateral step & refused to register patients beyond a given number (3,520). We subsequently shrunk our practice area in an attempt to limit the patient population. We then opened the list again. Our list size is now 4,150 and growing...
See my blog, Mad Policy No. 2: http://onegpprotest.org/
It is vital that the GPC and the GP body be firm on this, no more prevaricating. There is such a thing as capacity, and if we go beyond capacity then the quality of the service suffers, it becomes unsafe, and morale plummets. This needs to be said, daily. It needs to be at the header of each project plan at the DoH and NHS England, and on the desk of each health minister and each member of the Health Select Committee.
Interestingly, no figures are given for London where there does not seem to be a reliable system for covering out of area patients when they cannot get to their registered GP. I know because I have rung three NHS 111 teams covering east, northeast, and central London. They were all unaware of the policy and did not have a list of local GPs signed up to the DES. So a patient living in, say, Notting Hill, but registered with a practice in Kentish Town, would have to go to a WIC or A+E if too ill to get to Kentish Town.
I predict that this scheme will in the end sign up few patients, and these will be relatively well, mobile, and childless. In Tower Hamlets 20% of the patients (the ones with complex needs) consume 80% of the resources: these patients will not be able to register with a practice outside their area because they need a local GP, and also because they will be deemed not 'clinically appropriate' if attempting to register with a practice at a distance from their home. In Tower Hamlets we have made a collective decision to continue to look after our local patients. See www.towerhamletsgp.org
I think Anonymous @9:51pm makes a valid point: many GPs will be selective and pragmatic as to how they buy into this. But I think we will find problems arise and the cracks will show.
Remember, in the end this policy is not actually aimed at giving patients an illusory choice, but to make it possible for for profit organisations like Virgin Care and Care UK to cream off the mobile well and not to have to worry about them if they are ill at home; they will not concern themselves with integrated, community-based, cradle to grave family medicine. There will, however, continue to be a demand for this.
Illegitimi non carborundum
I have now also rung NHS 111 for central London. The supervisor I spoke to unaware of the scheme and no system in place for unregistered patients to access primary care: go to urgent care centre or A+E.
I have made a video about this: http://bit.ly/1D1ktZh
There are, broadly speaking, 2 sides to this brain-damaged policy. One is the task of providing care to those who are unwell and unable to consult with their registered GP practice because that is at a distance, and I believe this article is focusing exclusively on this.
The other aspect is practices signing up to register patients who do not live in their practice areas. It is not clear how many London practices have expressed an interest or are registering out of area patients. If you are a commuter into London and want to register near your work, there is no list of practices offering this option. You have to ring practices one by one to find out. I know because I have asked NHS England.
Getting the 'out of hours' service to cover 'in hours' times is clearly going to mean a significant additional cost because the service will have to run 24 hours a day, as opposed to just out of hours.
The anomalies are numerous, and will become more evident as time passes.
But the people who behind this policy do not, I believe, really care if it works or not, whether it gives people a useful choice or improved care. The covert, hidden driver behind this policy is to open general practice up to large for profit organisations which will offer a user-friendly centrally-located service to the mobile well. The system will cherry pick the patients for them, as the less well will opt for a local GP.
For the Tower Hamlets response to this brain-damaged policy see http://bit.ly/Xzt7N4
Essentially this policy is brain-damaged. At best, the proponents of this policy are well-meaning but incompetent; but the likely explanation is that the real driver here is to change the model of general practice in England so that large for-profit organisations can run practices without the constraints of geography. They will be the winners. There will be mobile, articulate people who will benefit.
In Tower Hamlets we are sticking with geographically-based general practice. Here is what we are telling our patients: www.towerhamletsgp.org
I am a GP in Tower Hamlets and our practice has been burdened with this problem. There is an inherent flaw in the model of having to take on all patients in your practice area, a Kafkaesque & Herculean task scenario. The trouble is that Hercules was a superhero, and we are modest humans (hence the Kafkaesque nature of the problem).
Anything Andy Burnham proposes needs to be scrutinised thoroughly. It is unlikely to work. He is a fantasist, and not mindful of the practical world.
If general practice is hospital-led, then the game is up. Hospital staff (managers, doctors) mostly do not understand what happens in general practice and what we do. The idea that they would 'lead' us is frightening.
The likely result would be that they would asset strip the primary care resources to fund their debt.
Remember, Andy Burnham is the one who kick-started the drive to abolish GP practice boundaries in 2009 with a speech to the King's Fund. Amongst other things he said, "In this day and age, I can see no reason why patients should not be able to choose the GP practice they want. Many of us lead hectic lives and health services should be there to make things easier." No reason, not even one?
The real winners will be Virgin Care, Care UK, and others like them
An NHS England spodesman said:
'This has been an ambitious piece of work...', read 'This is a brain damaged policy and we are making it up as we go along, and I have a real headache....'
'...we have to be completely assured that robust arrangements are in place....' read, 'We have done our best to avoid considering the risks and flaws of this policy and hopefully nobody will notice.'
'This has been a big undertaking and we have taken the decision that more time is needed....', read 'This is more or less what we said in October 2010 and it seemed to work then so we're saying it again now.'
In Tower Hamlets we have a robust plan of our own:
This is a brain-damaged policy, emperor's new clothes, a house of cards. No amount of time will enable them to get around the non-negotiable issues of practice capacity and the fact that living at a distance from the practice leads to problems, in direct proportion to the severity of condition of the patient.
Do not delay the roll out. Roll it out, and watch it crash. Then the grotesque stupidity will be made manifest. It is a scam. The true aim of the policy is to make it possible for large for-profit firms to cream off mobile, relatively well patients.
@Sanjeev Juneja: "From October 2014, all GP practices will be able to register patients from outside their traditional practice boundary areas without any obligation to provide home visits for such patients. NHS England will be responsible for arranging in-hours urgent medical care when needed at or near home for patients who register with a practice away from home."
The actually details of the arrangements will in no way deal with the inherent flaws of this policy. For my submission to the Health Select Committee see http://bit.ly/HRL4iw
Is the Friends & Family Test a useful test? See Roy Lilley's piece http://bit.ly/1pcPVfl, which links to this article http://ind.pn/1nL1sV7
Of course it is not irrelevant that iWantGreatCare is a business. Alan Milburn was (still is?) at one point Chairman of the organisation http://www.iwgc.org/about/ but could not see current board members on iWantGreatCare.org . Does not feel transparent to me.
An important question for NHS England: how much is it going to cost to set up the 24/7 service that will be required in every part of England to look after people registered with a practice not near their home and who get ill and need a GP assessment? And where is this money going to come from? What services are going to be cut to fund this?
And also: what about continuity for these people? What if they need follow up? At the moment if someone is seen out of hours, their care is passed back to their registered GP; but in this boundary-free model there is no GP to pass the care back to.
It is important to be aware that this evaluation is not an evaluation of the policy but of the Pilot; they are not the same thing. The Pilot did not test the policy in any true sense; the proponents will maintain that the policy is independently evaluated. It is not.
For more information, see this link http://onegpprotest.org/?s=pilot
I am GP in Tower Hamlets and have taken a special interest in this brain-damaged policy for the past 4 years. Two of us have met with Professor Mays, lead author of the Pilot evaluation, and 2 of the other authors, in order to demonstrate to them the problems that a boundary-free model presents in terms of delivering good quality general practice services. They acknowledged that their evaluation did not in fact identify these problems. This was not their fault; it is inherent in the design of the pilot and the evaluation. The evaluation did not evaluate the policy, but the pilot. And the pilot in no way exposed the problems with the policy.
See this for more discussion: http://onegpprotest.org/?s=pilot
The boundary-free policy is a scam. I have been following this with some care for over 4 years. The only explanation that makes any sense is that all of this talk of patient choice is a pretext to abolish boundaries which will then allow Virgin Care et al to set up surgeries in choice urban spots and cream off relatively well mobile patients. If these patients are unwell and take to their beds, then NHS England area teams will have to find someone to see them.
I have been writing to people for 4 years to warn them of the problems, but they (understandably) do not want to hear about the unintended consequences.
For everything you want to know about this issue: http://bit.ly/1feh0dJ