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Government plans 24-hour urgent care service to support abolition of practice boundaries

By Gareth Iacobucci

Patients who choose not to register with a GP close to their home will receive home visits and out-of-hours care from the same provider under radical plans to create a new 24-hour urgent care service.

Ministers pledged to press ahead with the controversial abolition of practice boundaries and establish a new service to provide both GP out-of-hours and in-hours urgent care for those who decide not to register with a local GP.

The radical plan for a ‘daytime out-of-hours service', first proposed to widespread ridicule by then Labour health minister Mike O'Brien, is outlined at the launch of a new Government consultation on its GP choice agenda, which ends in January.

The consultation document also details plans to write choice into the GP contract, revamp Choose and Book and increase use of GP-rating websites.

The Government said it was clear plans to scrap GP boundaries were backed by ‘an ‘overwhelming' majority of patients, and dismissed calls from the BMA and RCGP for alternative plans that would preserve boundaries in some form.

But GP leaders warned the plans risked a potentially dangerous fragmentation of care, and could prove unaffordable at a time of biting cuts.

The BMA had suggested widening practice boundaries in urban areas, creating flexible boundaries and using remote consultations, while the RCGP suggested expanding walk-in facilities and promoting longer opening hours.

The Government stated: ‘These proposals may offer people an alternative of where and when they receive care, but fall short of offering real choice. It is clear the overwhelming number of patients responding support proposals to give people the choice to register with any GP practice with an open list.

‘If you choose a GP practice further from where you live, it is important you also have access to urgent medical care near home. We propose to develop a 24/7 urgent care service in every area of England, incorporating GP out-of-hours and in-hours urgent care where necessary for people who aren't registered with a local GP.'

Dr Chaand Nagpaul, GPC negotiator with responsibility for out-of-hours, said the plans risked fragmenting care and might not be affordable: ‘Giving patients choice to register away from home might sound attractive, but there are logistical problems and risks. There could be fragmentation and there are concerns over clinical care.'

He added: ‘There is a price to be had with choice. There is a concern we can't afford a system of being able to register away from home and get home visits by another provider.'

The consultation pledged to negotiate with the GPC over plans to introduce choice into the GP contract, and make it a contractual responsibility to accept patients regardless of where they live.

It vowed to ensure GPs were given the right refer to specific consultant-led teams when on Choose and Book to drive its use, and to extend opportunities for patients to rate their GP online via sites such as NHS Choice and Iwantgreatcare.

Government to launch 24-hour urgent care service to support abolition of practice boundaries

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