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A faulty production line

Little patient demand for abolishing practice boundaries, claims GPC

The Government is pressing ahead with the abolition of practice boundaries, despite the official evaluation of the pilots showing patients do not want to register remotely, claims the GPC.

Members of the negotiating team told Pulse that uptake of pilot schemes was so low that it ‘demonstrated there was no need to remove practice boundaries’.

Pulse previously reported that the lead researcher tasked with evaluating the scheme on behalf of the Government says the pilots have not been going long enough to evaluate the economics of the scheme, or estimate which patients might use it.

But the GPC says that the evidence they have seen does not indicate a great call for a choice of practice and that it would have been better to go with their proposal of ‘fuzzy’ practice boundaries.

Under the new contract deal for 2014/15, all GP practices will be able to register patients from outside their traditional practice boundary areas from October 2014 without any obligation to provide home visits for such patients. NHS England will be responsible for arranging in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

GPC negotiator Dr Beth McCarron-Nash, told Pulse that the move was a major part of the Government’s ‘agenda’, but that it was trying to fix a problem that doesn’t exist.

She said: ‘We have always been very clear that the removal of practice boundaries is not necessary, there has been a pilot but the number of patients who enrolled in that pilot is so small that, in our view it demonstrated there was no need to remove practice boundaries.

‘This is the Governments agenda, they feel it will improve choice but the evidence from the pilots shows, that actually patients did not choose to move, on the whole. The main reason patients in the pilot decided to register remotely, was in line with our policy which is fuzzy boundaries – patients who moved a street or two away from where they were currently registered.

‘So the number of patients registering remotely was very small, so that’s why I say this is the Governments agenda for a problem that doesn’t exist.’

Under the new contract, the Local Area Team will be responsible for arranging in-hours urgent medical care when needed at, or near home, for patients who register with a practice away from home.

The Department of Health told Pulse: ‘We believe that choice can be an important lever for raising standards. Not everyone may want to take advantage of the scheme but  it is important to offer people more say and flexibility of their care – for example there are people who move home a few miles and wish to stay with their GP, or those people who commute to work and so cannot access their local surgery during the times it is open.’

Dr Mike Ingram GPC member and a GP in Radlett, Hertfordshire, told Pulse that the pilots had been an ‘expensive failure.

He said: ‘It’s interesting that Jeremy Hunt’s continuity of care, old-fashioned doctors, your own GP – and in our practice it happens, we do run personalised lists. Then you’re going to have another GP who doesn’t know you, somewhere else, offering you other care.

‘It doesn’t sound very “coordinated”, “integrated”, “continuative care”, “your own GP”, Jeremey Hunt buzzword-type stuff does it? It sounds divides, and inefficient.

‘Now that we know that of the pilots, the uptake has been as close to zero as you can get. The take-up has been very poor so far.’

He continued: ‘It just really hasn’t taken off so far, the idea’s been there, and it’s proved an expensive failure. A lot of money’s been invested in it and not much take-up’

Readers' comments (19)

  • A solution looking for a problem

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  • How well publicised were the pilots? Did any patients even know they were "allowed" to register elsewhere?

    I welcome this change. The restrictions on choice of healthcare provider in this country are appalling.

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  • Good idea.

    Somehow I will try to get the 2% of high need patients who I will be responsible for 24/7 out of area and then every time I am contacted I will authorise a GP visit. Oooh goody - that won't be me.

    Like I said - good idea???

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  • 'The restrictions on choice of healthcare provider in this country are appalling.'

    Sounds like you want to pay market rate and choose then.
    Choice is an illusion for most except for those with hods of cash

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  • To anyone who understands the ecology of good quality UK general practice, this policy of pretending that geography does not matter will appear as brain-damaged. It simply will not work at many, oh so many, levels; this will become evident once it is implemented.

    It is actually a hoax. They really do not care about choice: this is about the de-regulation of general practice. This will benefit Virgin Care, Serco, Atos, and other large for profit 'healthcare' companies.

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  • The real reason for this 'solution looking for a problem' is to prepare the ground for HMO's to take over with as few a rules and regulations to get in the way of 'mass produced healthcare'. This is just one of them.

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  • @5:29

    Strangely enough, patients in various European can choose their own doctors and the cost is managed through the insurance system with plenty of social provision for the most vulnerable people.

    The UK (no choice, monopoly provider paid regardless of service quality) and US (choices only for the rich) systems aren't the only available options for healthcare systems.

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  • @7:05
    Good luck in Europe or the rest of the world getting a GP who looks after you for as many visits you require for circa £100/year.
    When the structure we have maintained by being independent and cheap has gone, people will stop pining for Dr Findlay and will miss the Daily Wail's overpaid over golfed greedy GPs.

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  • I appreciate people think they want more choice, but our over stretched surgery in a too small for us already building would not be able to cope with an influx of new patients from outside the boundary. The only way we cope at present is by keeping to the boundary.

    Also of another note all the patients that are unhappy with another practice and move to us are usually nightmare patients.... Innapropriate requests and over demanding. I wonder how many times you could move surgerys perhaps someone in Devon may end up on Birmingham having worked their way up the country or the other way round. Good use of tax payers money!

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  • Firstly, there should be good surgeries wherever you go so there shouldn't be a need to find a better surgery in another area.
    Secondly, it is a huge headache referring to other hospitals not in area with no link to results, investigations, no knowledge of the specialists etc plus the ccg doesn't allow it anyway.
    It doesnt encourage localism which is wrong on many levels in my opinion, but mostly its just inpractical.

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