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The waiting game

LMC leaders declare war over practice boundaries

By Gareth Iacobucci

GPs have overwhelmingly rejected the Government's plans to abolish practice boundaries, with representatives at today's LMCs conference urging the GPC to 'staunchly resist' the controversial proposals.



The Government this week hinted that it hopes to bring in the policy by next year as part of its patient choice drive, despite GP leaders' repeated warnings over the many pitfalls and complications associated with the relaxation of traditional geographical boundaries.

GPs left health secretary Andrew Lansley in no doubt as to their fierce opposition to the plans, voting for a motion that denounced the policy as 'a threat to locality based, personalised, holistic general practice', and one which will have 'serious consequences for the organisation, provision and funding of NHS services'.

The motion also warned the policy would 'damage continuity of care, threaten home visits, education of doctors in training and potentially increase risks for children in need of protection'.

The motion was supported so strongly that no opposing speakers could be found, a rare occurence in LMC conference debates. It was backed overwhelmingly after GPC deputy chair Dr Richard Vautrey identified practice boundaries as 'a battleground in the coming year'.

'We [GPC negotiators] need all the help we can get,' he said.

Dr Julian Bradley, a member of Buckinghamshire LMC, a first time speaker who proposed the motion, received a round of applause as he pointed out that the policy ran contrary to prime minister David Cameron's pledge to promote integration of care.

He said: 'Does this policy meet the prime minister's promise of integrated care?'

He added: ‘Can you call in a policeman from another force if you don't like your Bobby? Can you call in another dustman if you don't like the colour of their jacket? It just looks incompetent.'

Dr William Hollington, a member of Bedfordshire LMC, supporting the motion, said the plans were 'damaging and unworkable'.

He said: 'Palliative care relies on continuity of care…and co-ordinated local healthcare. These would be complicated by removing boundaries. Children will be more at risk of abuse as fragmentation would make patterned recognition more difficult.'

The vote came after GPC chair Dr Laurence Buckman had earlier announced the GPC's intention to stand firm against the policy.

He said: 'I can see on the face of it why patients might find it appealing, but I would remind those who are enthusiastic for unfettered choice that their freedom to choose restricts those who cannot exercise choice so easily.'

'Unlike politicians, we and all other GPs out there know that this is a barking idea. How does continuity work if the patient can have a GP who, due to distance, cannot visit and who does not know the environment in which they live? What happens to the vulnerable, the criminal, the housebound, and those who should not be allowed to change because their choices are motivated by risk-taking or avoidance or surveillance?'

'It's a proposal which would increase bureaucracy and costs for the NHS at a time when it can least afford it. We will continue to push the GPC alternative way forward, which is cheaper, simpler and will improve access and choice of practice for patients, including those who want to be seen away from home.'

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