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Independents' Day

LMC leads boycott of practice boundaries scheme

Exclusive GPs all across a London borough are planning a boycott of the flagship Government policy to remove practice boundaries over fears it will disadvantage the most vulnerable patients.

Tower Hamlets LMC, which has been centrally promoting the boycott to practices, warned that the new rules allowing GPs to accept out-of-area patients from October would divert funding to the ‘articulate worried well’ at the expense of elderly and mentally ill patients.

From September, Tower Hamlets practices will be supplied with posters to place in their waiting rooms explaining to patients why they will boycott the scheme, a flagship Government policy aimed at improving access to ‘working people’.

It follows a Pulse survey earlier this year that found that less than a quarter of GPs were considering taking up the scheme.

The boycott is the latest indication about the popularity of the scheme, and Tower Hamlets leaders say that there is concern among GPs about how it will affect vulnerable patients.

LMC vice chair Dr Jackie Applebee said: ‘In Tower Hamlets the widely held belief amongst GPs is that opening practice boundaries will divert care from those who really need it to the more articulate worried well, as people exercise their right to register with a GP of their choice, those more vulnerable patients living nearby, such as the elderly, mentally ill and those who have complex multi-morbidity will be squeezed out.’

She added: ‘The buzzword of the day is “integrated care”. This means locally based, multi-disciplinary team working. We cannot deliver this if we are to care for patients who live miles away from our surgeries. With all of this in mind Tower Hamlets GPs have developed a letter for patients and a poster to put up in surgeries, explaining why we will not be abolishing our boundaries.’

Dr George Farrelly, a GP in Bow, who is organising the boycott, said: ‘Two months ago I warned my colleagues about this policy and most were aghast at this and thought this would not be right for Tower Hamlets. Coming September we are going to put up posters in our waiting rooms to say we are not doing this and why we are not doing it.’ 

‘There may be one or two practices that will not do it but the vast majority of us will openly refuse to do it, and we’ll explain to our patients why.’

Dr Naomi Beer, a partner at the Jubilee Street Practice in Stepney and leader of the ‘Save Our Surgeries’ campaign, said removing boundaries would be ‘irresponsible’.

She said: ‘Local practices wouldn’t have the capacity to take any more patients on. We are all full to bursting. In Tower Hamlets we have made it very clear that we feel it would be irresponsible to have open boundaries. I think there are other ways to address the issues that the Government has raised and I don’t think this is the right way.’

No other LMC leaders have as yet reported any joint approach to the opening of boundaries, although a Pulse survey of GPs conducted in March showed that 52% were not even considering the move, while 24% were considering it and a further 24% did not know. A further 73% of GPs said they did not agree with the policy, which was negotiated as part of the 2014/15 GP contract to come into effect from October.

It comes after the LMCs of Tower Hamlets, City and East London, Hackney and Newham staged a joint boycott of the Government’s pilot for removing practice boundaries last year, after east London was chosen represent one of four major inner-city trial areas across England.

Meanwhile, only 500 patients registered at an out-of-area practices in the regions where trials did go ahead.

In June, Pulse reported that NHS England still has not finalised the details for plans to allow GPs to take on patients from outside their boundaries without having to provide home visits, despite the scheme beginning in October.

Related images

  • Patient registering registration boundaries practice  PPL

Readers' comments (9)

  • I am not morally against the idea of cancelling practice boundaries but:
    1 - I have no idea what NHSE/ CCGs plan to do about visiting out of area patients - and have no confidence that they will provide an appropriate service.
    2 - We are so busy that the idea of taking on more patients is ridiculous. Finding more GPs would be impossible and even if we could there is not enough room to cope.
    3 - We are of the opinion that the patients most likely to move around to find the "best practice" are going to be those who create the most work - without it providing a rewarding experience to the doctors. I really do not mind putting in a lot of effort for someone who has a major illness, palliative situation or family crisis; but they are likely to stay with a local GP. The mobile patients will be those who complain the most, argue the most and are have the most consumerist attitude.

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  • NIce to see GPs actually standing up to government impositions for a change. Good on them! We need more of this kind of thing as opposed to bending over and taking it as usual

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  • I would also like to thank these East London GPs for essentially fighting on all our behalfs as well as for their patients.

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  • How do your boycott something if there are no details yet released as to home visit cover, pricing or OOH cover for these patients. I would rather wait till the cat is out of the bag though from past experience with NHSE brainwaves, when that finally happens - we might as well be devoured before we get to understand the true mechanism of scheme function. Do the LMCs know more than us mortal GPs?

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  • @Sanjeev Juneja: "From October 2014, all GP practices will be able to register patients from outside their traditional practice boundary areas without any obligation to provide home visits for such patients. NHS England will be responsible for arranging in-hours urgent medical care when needed at or near home for patients who register with a practice away from home."
    The actually details of the arrangements will in no way deal with the inherent flaws of this policy. For my submission to the Health Select Committee see

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  • @George Garrelly: sincere thanks though I still would like to know the financial side of this as recpetion and execution of this scheme may depend on the carrot that goes with it.

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  • In an under-resourced service, where it is already stretching us to the limit to register even the patients we do, how is it responsible for us to take on more patients from outside our area when those patients already have GPs local to their homes? We should be pushing for proper resources for general medical services so that local GPs can give responsive local services. A solution does need to be found for working patients but it is NOT the highest priority in cash strapped Primary Care. There are far greater priorities that need to be dealt with first such as ensuring there are good integrated local services that can meet the needs of the chronically sick!!
    ...and by the way- thank you to the GP above who acknowledged the campaigning of East End GPs. It is within the power of all of us to stand up together. GPs everywhere are and can be extraordinary...

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  • Leafy commuter areas are likely to suffer as well as their worried well register near work and then need to seen when worried unwell nearer home! So we'll ber seeing them anyway without the funding as they become T/Rs when not fit for work (perhaps we can visit them all if that attracts a bigger fee!) This leaves us with less investment to look after the kids and elderly.

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  • Is there any minimum and maximum list size for- a GP. I understand is- less than 1,500. per GP.Who is responsible for over loading the practice.?

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