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Boundaries to go next April

By Pat Anderson

Ministers plan to bring in changes to the practice boundary system to allow patients greater choice from next April, despite widespread opposition from GPs.

The Department of Health announced last week it was pushing ahead with the changes much sooner than expected, but remained tight-lipped on the form they would take and whether it might stop short of totally scrapping boundary restrictions.

The move comes as GPC chair Dr Laurence Buckman received overwhelming backing from GPs for his opposition to what he called a ‘barking idea', with delegates at the LMCs conference warning scrapping boundaries would damage continuity of care, threaten home visits and increase risks for children in need of protection.

A DH spokesperson said that the rules on practice boundaries would be relaxed from April 2012, and that officials were ‘working to address' GP concerns. But the DH left open the possibility that practices could still turn down patients' requests to register in some circumstances, amid concerns that scrapping boundaries could otherwise create ‘medication tourism'.

In November, the DH told Pulse practices would be unable to ‘refuse registration of a patient on the grounds of medical conditions suffered'. However, the DH this week refused to confirm that this was still the case.

Dr James Kingsland, the DH's special adviser on commissioning and a GP in the Wirral, said various problems with the proposals could be addressed – for example, to ensure commuters could receive urgent care near home if they registered with a practice near work.

‘There could be some arrangement between consortia, saying let's deliver out-of-hours services in Surrey for patients who have chosen to register in central London,' he said.

But the BMA, whose survey last week found that 84% of GPs were against the abolition of practice boundaries, said it remained staunchly opposed to the plans, with negotiators publicly identifying the issue at the LMCs conference as a ‘battleground in the coming year'.

GPC chair Dr Laurence Buckman said: ‘We and all other GPs out there know this is a barking idea. What happens to the vulnerable, the criminal, the housebound, and those who should not be allowed to change because their choices are motivated by risk taking, avoidance or surveillance?'

Dr Michelle Drage, chief executive of Londonwide LMCs, said abolishing practice boundaries had been considered by successive governments: ‘Usually ministers realise it's unaffordable. There are better ways of getting people what they need.'

Dr Michelle Drage Key questions on scrapping boundaries

• How will home visits and urgent/out-of-hours care be provided for patients registered near their place of work?
• Will practices in commuter-belt towns be destabilised by a sudden loss of patients?
• Could scrapping boundaries and GP consortia's new rationing role lead to ‘medication tourism'?

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