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Independents' Day

Almost 40% of GP practices to accept out-of-area patients

Exclusive Almost 40% of GP practices are willing to dilute their practice boundaries and accept out-of-area patients under the Government’s flagship policy to allow patients to choose any GP, an NHS England survey has shown.

NHS England area teams in the north, Midlands and east of England surveyed GP practices in their area finding that the percentage of practices willing to take on out-of-area patients ranged from just one fifth (20%) in Merseyside to over half (51%) in Hertfordshire and the south Midlands.

Practices are able to take on patients out of their practice boundaries under a change in the GP contract last year.

Broken down by area, the survey found the practices willing to register out-of-area patients were as follows:

  • Hertfordshire and South Midlands: 71 out of 137 (52%) practices
  • Lancashire: 104 out of 230 (45%)
  • Durham, Darlington and Tees: 53 out of 169 (31%)
  • Cumbria, Northumberland, Tyne and Wear: 122 out of 301 (41%)
  • Merseyside: 63 out of 240 (26%)
  • Greater Manchester: 197 practices out of 495 (40%)

Home visits for patients registered out-of-area are meant to be covered by a new enhanced service that pays practices £60 for a home visit. But just 4% of London GP practices have signed up when the policy went live last month, and the GPC has warned this could affect patient safety.

GPC deputy chair Dr Richard Vautrey told Pulse: ‘Whilst some practices are prepared to accept patients from outside the area, it’s clear that many more remain concerned about the implications of doing so. However at the moment practices cannot be sure that a home visiting service is in place should their patient need one because area teams are failing to do what they should have already done.’

He added: ‘What area teams are finding is that it’s difficult to provide a comprehensive service across an area just relying on the enhanced service arrangements. So they do need to look at some broader measure to ensure they do have some comprehensive service, because at the moment it doesn’t appear to be a safe service, there’s very patchy service across the country.’

Readers' comments (16)

  • The greedy minority making the headlines (for a few pence, undervaluing themselves greatly) rather than the majority. Sad state of affairs. NHS england will call this a success, when it is a failure that 93% of patients are happy with opening hours or that 90% of patients would recommend their GP. Thanks guys, you've ensured this will soon be enforced through contract on the majority, rather than sticking together. As usual, divide the GP's by throwing peanuts, the monkeys will always jump for it.

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  • As the saying goes....
    How to you get 100 GP's to throw themselves under a bus??
    Answer.. Throw two pence under it.

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  • To those above - the response to this depends on how the question is phrased.

    It is worth remembering that you do not need to 'sign up' to the process of accepting out of area patients - just decide at the time. I would imagine plenty of surgeries have said yes, intending to sign up out of area patients on an exception basis.

    For example one of your seriously unwell patients moves just outside the practice boundary - would you be willing to keep them on your books? I would say yes.

    Rather than would you sign up most patients from out of area? I think most would say no.

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  • Anonymous @ 9.15. You have stated in a nutshell what is wrong with our profession stretching back to 1990.
    Divide and rule-the politicians win every time.

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  • Interestingly, no figures are given for London where there does not seem to be a reliable system for covering out of area patients when they cannot get to their registered GP. I know because I have rung three NHS 111 teams covering east, northeast, and central London. They were all unaware of the policy and did not have a list of local GPs signed up to the DES. So a patient living in, say, Notting Hill, but registered with a practice in Kentish Town, would have to go to a WIC or A+E if too ill to get to Kentish Town.

    I predict that this scheme will in the end sign up few patients, and these will be relatively well, mobile, and childless. In Tower Hamlets 20% of the patients (the ones with complex needs) consume 80% of the resources: these patients will not be able to register with a practice outside their area because they need a local GP, and also because they will be deemed not 'clinically appropriate' if attempting to register with a practice at a distance from their home. In Tower Hamlets we have made a collective decision to continue to look after our local patients. See

    I think Anonymous @9:51pm makes a valid point: many GPs will be selective and pragmatic as to how they buy into this. But I think we will find problems arise and the cracks will show.

    Remember, in the end this policy is not actually aimed at giving patients an illusory choice, but to make it possible for for profit organisations like Virgin Care and Care UK to cream off the mobile well and not to have to worry about them if they are ill at home; they will not concern themselves with integrated, community-based, cradle to grave family medicine. There will, however, continue to be a demand for this.

    Illegitimi non carborundum

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  • Get with the times. Many other countries allow patients to have a choice of doctor and don't consign patients to poor care due to a postcode lottery.

    Why not consider the situation from patients' point of view (a novel concept I'm sure) for once? If anything, it's sick patients with many diseases who need choice the most, not just the fit and mobile.

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  • I've had patients - mainly eastern European population from the whole of Medway and we started taking them on as they had language difficulties. However, we were neither paid nor sought payment for this for 3 years. It was a spur of the moment decision at a GP monthly where concern was expressed about the difficulty Practices were facing in organising interpreters for this group of polish and Russian speaking individuals.
    At present this population still constitutes about 30% of the present list of 4150. However, we had to stop due to inability to cope and lack of sufficient funding.
    To those who believe in the concept- Yes, it works provided you have sufficient funding going hand in hand. I'm in the Southeast but have had calls from Eastern European patients as far as Manchester or Birmingham wanting to join the Practice which I think is a joke. Some balance can be achieved and though the concept is good, there needs to be that elusive funding and manpower we are all looking for which is diminishing by the hour.

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  • I am personally against this (on principal of not diluting care for my existing patients) but...........

    Recently our local trust has unilaterally purchased beds in nursing home for "early discharge". We were getting called out as immediate and necessary TR review as the patient's registered practice does not cover these NH (requirement under GMS contract and we have no right to refuse "immediate and necessary" medical review). As a result, we were forced to dilute the service and I had to agree with my partners we are better off signing up and at least getting paid for providing the visits, which we are having to do anyway.

    So don't be too hasty in branding your colleagues "greedy".

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  • I have recently been to Australia and there is no such crap thing as practice boundaries.

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  • OHP@0.22
    I am not sure that you understand what is involved and all the implications. "Many other countries" don't have a home visit obligation. I really don't mind how far patients are willing to travel to see me but I am not able, in fairness to my other patients, to travel a significant distance to see them were they ill enough to require a home visit. This leaves patients at their time of most need with a random allocation of visiting doctor who is unlikely to be familiar with their history.
    In addition, GPs tend to gain local knowledge and know to whom patients should be referred locally; with the best will in the world, we could not acquire the same depth of knowledge over the whole country.

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