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LMCs across England scramble to negotiate practice boundary LESs

Exclusive: LMCs across the country are scrambling to negotiate dozens of LES agreements to ensure patients can receive care at home even if they register with a practice close to work, before the practice boundary pilots begin later this month.

The GPC has warned every practice in England to be prepared within the next two weeks for one of their patients registering in a pilot area – even though relaxed boundaries will only be trialled in three cities.

And negotiators also raised fears over the additional costs of the pilots, with no new central funding and PCTs forced to raid existing budgets to pay for the LESs.

The Department of Health announced last week that the boundary pilots will begin on 30 April, with GPs in six PCTs in London, Manchester and Nottingham paid £13 per ‘day' patient visit.

The DH instructed all PCTs in England to put arrangements in place for home visits for patients who register elsewhere, through either a LES or extending out-of-hours provision. The DH included an example LES specification in its guidance, but said it was up to PCTs to make local arrangements.

Commuter-belt LMCs have begun drafting agreements, but said they were concerned about the scarce amount of time available.

Dr Paul Roblin, secretary of Berkshire, Buckinghamshire and Oxon LMC, said the £12.93 fee for day patients in pilot areas had been taken as ‘the starting point' for negotiating locally: ‘The sticking point would be what multiple of the basic fee a home visit will attract. We'll be trying to negotiate around the £60-£70 mark per visit, because a home visit can take an hour.'

‘The timescale we have in which to negotiate a LES is about two weeks. We've asked why it wasn't negotiated centrally rather than every area having to go and negotiate separately.'

Dr Chaand Nagpaul, GPC negotiator, said: ‘There are a large number of PCTs that haven't yet put in place a mechanism. My biggest concern is the pilots proceeding without this being in place. No PCT should consider itself immune - even it's just one patient registering elsewhere, they need to make arrangements.'

Dr Nagpaul also raised concerns over how the LESs would be paid for, with no new central funding and practices in pilot areas who register patients receiving the full per patient fee.

‘The PCTs will have to find the money,' he said.

But a DH spokesperson said the pilots would test if overall savings could be made: ‘There is compelling evidence that getting quick, convenient access to general practice ensures people get advice, diagnosis and treatment faster, preventing more lengthy and costly treatment later in hospital.'

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