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New practice boundaries will be pointlessly complex

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I know it shouldn’t come as a massive shock. After all, there must come a time when the DoH runs out of fag packets to scribble policy details on the back of. But this one really takes the HobNob.

There are now less than three weeks before the Next Big Idea – the Government’s Practice Boundaries Initiative, enabling patients to register with a practice near work rather than where they live – is launched. Yet, despite this being a potentially massive shake-up of how general practice is organised, with all sorts of ramifications, the degree of detail we’ve received so far has exactly matched the average GP’s enthusiasm for the project.

What we have heard is that ‘NHS managers have begun setting up a National Enhanced Service’ and that ‘discussions are ongoing’. Brilliant. They’ve had six-months-plus to reach this point and will doubtless dump the details on us six minutes before they trumpet it across the media.

And even then I wouldn’t guarantee that those key questions will be resolved. And there are quite a few. Like who’s doing the visits, and for how much, when punters registered near work fall ill at home? And what will we be paid for registering an out of area patient? And where’s the funding coming from? And what about patients currently registered with us who are already out of area? And do we sign up en bloc or can we pick and choose patients? And which referral restrictions do we apply, home or away? Which CCG coughs up the dosh for hospital treatment? And so on and so forth.

The conclusion is absolutely obvious: the plan should be delayed. Or better still, quietly consigned to the same graveyard that contains the squarial, the Betamax video and the Sinclair C5.

Unless, that is, I’m missing something. Maybe the ‘delay’ is just obfuscation. Maybe the Government knows exactly what it’s doing and realises that unresolved issues will leave us GPs with patients in our area but registered elsewhere who, come 1 October, need our attention.

And it would only take a tweak of ‘Immediately Necessary’ here and ‘Temporary resident’ there to solve the visiting/urgent treatment problem – for free.

Clever bastards, these politicians, eh? Well, bastards, anyway.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield 

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Readers' comments (12)

  • I suppose if the compulsion was to 'make an assessment' of the temporary patient who is at home one might often conclude an ambulance was the best response to their symptoms. It would be awful if all GPs felt the same..

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  • Brilliant as always.
    Why wasn't Tony in the top 50 most influential G.P.s?!

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  • spot on !!

    tony copperfield for Top 50, maybe next year!

    - anonymous salaried!

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  • With all thats happening in Scotland, what is to happen to the patient who works on one side of the border, but lives on the other ??
    Mystery and mayhem afoot.........

    Fully agree with 11:53, a top 10 spot at the very least !

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  • What happens to patients who register where they work but want to see a GP when they are off sick? Do they turn up and expect to be seen at the GP practice where they live or go to A & E?

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  • I can't wait to be able to choose where I get my GP service from, and other people I know feel the same. If I was ill at home I would drive to see the GP and if I required emergency care I wouldn't be waiting for the practice to open as that is not emergency care. Most people I know are responsible and don't ask for home visits. My problem is I live in a small village where GP opening times do not match my health needs or working hours. What are my choices? Paying privately for my health care or finding an NHS GP out of area.

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  • No one thinks they will get old or housebound . When these young commuters no longer work, they will find the traditional GP surgery who took all comers, will be gone, because they could not function when they were only left with the elderly and those that needed a lot of care.

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  • Let us face it. Sadly, the average IQ of managers is a 100. They need really no qualifications to be one. Most of them have 2Bs and a C at A level. But they form the dumbest, most stupid policies ever. What else would you expect from such a lot ?They are not collectively Hawking. But, God forbid they run the NHS. And you can see it in LES,MES,QOF,CQC and on and on. Our Unions are weak and do not speak up when they hear utter rubbish from the mouths of - oh never mind.

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  • I was in the Top 50 last year, it was Pev's turn this time around ;-)

    TC

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  • 2 B's and a C was all you needed to do medicine a few years ago! (Back in myyyyy day all of 30 years ago).

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder