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GPs may win on Saturdays plan

Ministers want patients to be able to register at two practices ­ Ian Cameron looks at the issue it will raise

The idea of allowing patients to register with more than one GP has been kicking around the corridors of Whitehall and the BMA ever since the foundations for the new GMS contract were being laid.

First the GPC put it forward at the start of the contract negotiations. But the NHS Confederation dismissed it, arguing the technology was not available to make it work.

In the interim, Department of Health officials have at various times been either very keen on the idea or lukewarm.

Now it finally looks like it is going to happen. A health White Paper in the autumn will include proposals for dual registration, ostensibly to enable commuters to see a GP close to their workplace as well as their home.

These plans are set to split GP opinion down the middle.

Many GPs on message with the Government's patient choice agenda say enabling people to visit a GP at a place most convenient for them is essential to bring about a consumer-led NHS.

Yet there are at least as many other GPs who believe dual registration threatens the fabric of general practice and will undermine continuity of care.

Dr Claire Gerada, chair of the RCGP's ethics committee, is one of the latter. She says bringing in dual registration is a 'retrograde step' and panders to a minority of patients who would be best served by attending a walk-in centre.

Dr Gerada, a GP in south London, adds that the move will mean patients are no longer protected from inappropriate care and will lead to 'doctor shopping'. She says: 'One of the strengths of British general practice is single registration with one practice.'

Proponents of dual registration say advances in NHS IT, notably the ability to transfer patient records electronically between practices, will ensure continuity of care is protected.

Dr John Williams, a GP in Guildford who is in charge of overseeing the development of GP-to-GP records transfer for NHS Connecting for Health, says the technology will support dual registration. 'The technology could certainly move a record from practice A to practice B very quickly ­ perhaps within half an hour or an hour,' he says.

For it to work smoothly, he adds, the patient's 'second practice' would first have to have notice the patient was due to attend so it could request the record from the 'home' practice. The home practice then needs a protocol to prioritise that patient over other routine requests for records for patients moving practice. When the consultation is completed, the record is filled in and may be sent back electronically.

For Dr Gerada, this is no reassurance. It is difficult enough to keep track of changes to records made by different members of staff in the same practice, she says, never mind people from different practices.

She adds: 'Expand that to a patient who lives in Norwich but works in Newcastle and I don't see how it would work.'

Dr Williams says GPs may have to 'run with it' and learn from the experience. 'We have to look carefully at how we keep records so people in the next practice understand them.'

As well as the technical questions, there are many other issues that need to be worked out. On whose list will the patient reside? Who will earn the quality points for the patient? Can they register with more than two practices?

Dr Laurence Buckman, GPC deputy chair ­ who says he 'doesn't have a problem' with dual registration ­ believ-es these can all be thrashed out around the negotiating table. 'It's all incredibly complicated but that doesn't mean these issues can't be overcome.'

Nigel Edwards, policy director at the NHS Confederation, is more sceptical but recognises the Government is determined to make it happen.

He is concerned continuity of care is being 'undervalued' by ministers who are fixated with extending choice: 'We probably have to pursue this but there are some very big technical and design challenges.'

Roy Lilley, an independent health economist, believes any opposition among GPs to the concept of dual registration will prove academic.

Continuity of care, he says, is a relic and GPs consigned it to history when they voted for a practice-based contract.

'GPs need to wake up and smell the disinfectant,' he says. 'The whole game is changing and the NHS is becoming a Martini health service ­ any time, any place, anywhere.'

Some of the major

questions on dual


·Who has clinical and legal responsibility for a patient registered at two practices?

·How do you fund practices involved?

·Would dual registration be an enhanced service or would global sum per patient funding be shared?

·Who would get the quality points?

·How would practices fit in the extra patients?

·How do you stop patients gaming the system by seeking second opinions or attempting to get two prescriptions?

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