By Gareth Iacobucci
GP practices which register high numbers of patients when practice boundaries are abolished could be offered extra funds to expand their services if they reach maximum capacity, the Government has revealed.
The proposal for PCTs to offer ‘an expanding practice allowance' for popular practices is contained in the Department of Health's consultation on abolishing practice boundaries, launched today.
The Department of Health also revealed that patients wishing to register at distant GP practices may have to agree to a ‘trade-off' on their entitlement to receive home visits from their GP.
In an exclusive interview with Pulse on the eve of the launch, health secretary Andy Burnham said the Government had an ‘open mind' on how to take forward the policy, due to come into effect by October. He urged GPs to engage with the consultation to help forge workable plans.
The Government's preferred option is for practices to retain responsibility for home visiting for local patients; but for PCTs to take on responsibility for home visits for patients who register further away from home.
However, it admits that this option might place additional demand on A&E departments and ambulance services if patients do not use or understand the arrangements put in place by PCTs.
Other options on the table include maintaining the requirement for GP practices to provide or arrange home visits for all patients on their list, regardless of where they live, dual registration, or handing all responsibility for home visits to PCTs.
The consultation suggests that guidelines could be developed to define the area beyond which a practice can cease to be responsible for home visiting, based on how long it takes to travel between the practice and the home.
It says the cost of home visits for patients registered further away would have to be calculated as part of GP contract negotiations, with practices either having an amount top-sliced from their annual capitation payments for having patients on their list, or having the cost of individual visits charged back to the practice.
Mr Burnham said: ‘If someone chooses to go to a PCT out of area, they may have to accept they can't get the same level of home visits [from their GP]. This is the trade off that we will want to explore in the consultation.'
‘It could be that a person chooses a practice many miles away, and that the PCT might then have a residual responsibility with regard to home visits. We'd have to have a payment mechanism that reflected that.'
Alternatively, he said practices could provide home visits to registered patients who live outside their traditional boundary areas to remain competitive with their peers.
The consultation also reveals that popular practices reaching maximum capacity could be given extra funds to help them 'take on more patients who can benefit from the responsive services on offer.'
'PCTs can, for instance, offer an 'expanding practice allowance', ie a one-off grant to help a practice invest in increased infrastructure - staff and/or premises - in anticipation of a larger patient lists.'
'PCTs have in the past been reluctant to offer additional funding for practice expansion, partly because they have been concerned it could undermine choice and competition principles. However, additional support of this type is permitted under the National Health Service Act 2006.'
The DH insisted that scrapping practice boundaries 'should not have an adverse impact' on commuter-belt practices who could stand to lose patients as a result of the change.
'GP funding system means that the funding associated with patients leaving the practice would follow them to their new practice,' it said.
Mr Burnham added: ‘I think this should be a positive debate about solutions rather than people throwing up all kinds of problems.'
Health secretary Andy Burnham Health secretary Andy Burnham
