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LMCs stage boycott of practice boundary pilots

Exclusive: GPs in one of the most deprived areas in the UK are to boycott the Government's controversial practice boundary pilots, amid fears an influx of commuter patients will ‘inevitably' result in cuts to services for existing patients. 

The chairs of four LMCs in east London have urged their constituent practices not to take part in the trial of relaxed boundaries, unless the DH agrees to fund all secondary care, community care and prescribing costs arising as a direct result of the pilot out of the sums available for the pilot. 

The pilots, which will allow commuters to use an alternative practice near where they work, either as a non-registered or registered out-of-area patient at any volunteer practice within the pilot areas, are due to begin on 30 April, with GPs in six PCTs across London, Manchester and Nottingham to be paid £13 per ‘day' patient visit.

But in a letter to GPs, the LMC chairs said they had ‘grave concerns' over DH guidance which states there will ‘not be any adjustments to unified allocations to reflect the secondary care costs arising' during the pilot year 2012/13. 

Read the full letter here.

The LMCs are also concerned that PCTs in the pilot areas will be responsible for prescribing and treatment costs incurred by commuters attending as day cases, but will not receive any additional funding for this. 

The letter - signed by Dr Deborah Colvin, chair of City and Hackney LMC, Dr Kambiz Boomla, chair of City and East London LMC, Dr Prakash Chandra, chair of Newham LMC and Dr Sella Shanmugadasan, chair of Tower Hamlets LMC - told GPs: ‘In the current financial climate, making Tower Hamlets PCT and City and Hackney PCT absorb all costs relating to commuters registering with practices under the scheme can only have the effect of reducing the amount of funding available to your existing patients. This will inevitably result in cuts to services to existing patients, as PCTs have a legal duty to balance their budgets.'

‘We believe it is unacceptable for patients in two of the most deprived PCTs in the country to have funding for their services cut in order to fund this pilot. We believe that protecting our services to our existing patients must be our greatest priority.'

It added: ‘We urge you, therefore, to hold off agreeing to take part in the pilot unless and until the Government agrees to fully fund all secondary care, community care and prescribing costs arising as a direct result of the pilot out of the sums available for the pilot.'

A Department of Health spokeswoman said: 'The guidance issued to GP practices in the pilot area by the Department reflects the discussions and views of the GPC who agreed that the pilots should operate in order to test potential new arrangements. Analysis suggests that those people most likely to register as ‘out-of-area' patients will be relatively young and in work (aged 18-35 without long term conditions). The average cost of hospital or other care for these patients is relatively low and therefore are not expected to be significant new costs during the pilot period.

'Nevertheless, we have asked PCTs (and emerging CCGs) to monitor the secondary care costs associated with out-of-area registrations and this will allow the NHS, through PCTs, to manage any cost impact through their planning and financial management arrangements.

'We expect the pilots to begin from 30th April 2013'

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