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GPs to be paid less for new 'commuter patients'

By Steve Nowottny

Exclusive: GPs could soon have to register a new category of ‘working hours only' patients, who would attract a lower global sum payment, under controversial proposals from NHS managers.

The NHS Confederation wants to reshape the rules for registration, with commuters allowed to register near their work rather than their home.

GPs would receive reduced global sum payments for registered commuters, with the savings used to commission alternative providers for home visits. The plan is one of a series of radical ideas to boost GP access set out in a briefing to MPs obtained exclusively by Pulse.

The proposals were submitted as the Department of Health told Pulse it had effectively ruled out formal dual registration on the grounds of cost and continuity of care. It is instead looking at ‘new models to enable patients to switch GPs more easily and register with GPs outside where they live'.

The NHS Confederation billed the plan as a ‘potential solution' to the problems associated with dual registration, with inner-city GPs no longer responsible for commuters' home visits.

But academics and GPs have attacked the plans, warning they would hit practices in commuter belts hard and jeopardise patient safety.

Dr John Rawlinson, chair of Berkshire LMC and a GP in Ascot, fears the plans would be a ‘double whammy' for commuter-belt practices.

‘You'd lose your global sum payments as well as those patients who need the least attention,' he said. ‘It would destabilise the whole primary care set-up in the commuter belts.'

Dr Rob Sadler, chair of Kent LMC, where many practices have high numbers of commuters, said communication between the practice near the patient's work and its home visit provider was a major problem – and would remain so until confidentiality and consent concerns over shared electronic records had been resolved.

‘It comes back to patient safety,' he said. ‘Until Connecting for Health is working properly, you're never going to have communication that is safe enough, patient-wise.'

In its own submission to the MPs' inquiry into GP access, the National Primary Care Research and Development Centre warned: ‘Registering at a GP near work would be fine for people who don't get ill. People often need to see a GP near their home if they are off work because of illness. Under those circumstances a GP at work would be highly inconvenient.'

Dr Chaand Nagpaul, GPC negotiator, said the GPC would be willing to look at the idea, but said it was ‘hard to make it a cost-neutral proposal', and warned lack of continuity could result in ‘suboptimal care.'

‘The devil will be in the detail, as well as the funding,' he said. ‘There will still be occasions where a patient is ill at home, and will need to make use of local GP services.'

Other proposals outlined in the NHS Confederation's briefing include extending the GMS contract to include A&E and walk-in centres.

A new class of patient?

• Working patients to register close to work rather than home
• Inner-city GPs with commuter patients will not be responsible for visiting them at home
• Funding for commuter patients to be diverted to pay for home visits by alternative providers NHS Confederation evidence to access inquiry

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