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Independents' Day

GPs offered enhanced service to provide home visits for patients registered out of area

Exclusive NHS managers have begun setting up a national enhanced service for practices to take on home visits and urgent in-hours care for patients who have registered outside of the area, in the first indication about the details of the Government’s practice boundaries initiative.

The enhanced service, revealed in a letter from an NHS England local area team, will see GPs sign up to providing home visits, urgent treatment in-hours and post-hospital discharge follow-up care to patients making use of the Government’s flagship practice boundary removal policy set to launch 1 October.

However, there is still no detail about how much practices will be paid for taking on the enhanced service, or for registering patients from out of their area as part of the practice boundary scheme.

GP leaders said discussions on the enhanced service were ongoing, but have warned that the scheme should be postponed because of the lack of detail around the practicalities of the initiative.

Under the practice boundaries policy, GPs can register patients who live outside their catchment area but do not have to provide home visits, although the Government has not said how much funding GPs will receive per such patient.

Now the Darlington primary care commissioning team for NHS England has written to local practices informing them that there is ‘a national enhanced service specification in development for the delivery of urgent in-hours consultations and home visiting’, but did not include any information on how much money GPs would get for providing the service.

It added that it was ‘awaiting a national letter to launch the initiative’ for practice boundary removal, which it understood to be ‘imminent’.

The local area team also said it was ‘awaiting the publication of a national framework and guidance to support services for out-of-area registered patients when at home’ but that it understood this ‘has been delayed’ and is now expected around 14 September.

The letter said: ‘In light of the timescales in commissioning services for this cohort of patients we felt it prudent to highlight the contractual changes to practices and to request information as to whether practices would like to express an interest in: registering patients who reside outside of their practice boundary post 1 October 2014 [or]; delivering services under a national enhanced service for urgent in-hours consultations and home visiting to out-of-area patients who live in their area.’

The news comes as GP leaders have urged NHS England to delay the removal of practice boundaries because of concerns that GPs and local area teams still do not know how the scheme will work in practice.

GPC deputy chair Dr Richard Vautrey said: ‘NHS England are talking to us about the arrangements relating to the choice of practice scheme, including details about what will happen when patients registered as an out of area patient are unable to travel to their new practice. Discussions have not yet concluded.’

It comes as one London LMC is leading a boycott of the policy, which they said would disadvantage the most vulnerable patients and divert funding to the ‘articulate worried well’.

Readers' comments (31)

  • A bit late to start thinking about the problem now. I think they are going to find the problems are numeous and very expensive. Will the home visit fee and the fee to the in hours GP add up to a lot more than they were paying to the origonal GP ? Can we afford this luxury in these straightened times ?

    Theproblems may not be solvable.

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  • Sounds about right - announce the scheme with a big fanfare - ignore it - then announce a DES 22 days before the scheme starts and not give any further info until even closer to the launch date.

    Absolutely crazy.

    The only good this will do is provide a structure to how much practices should be paid per appointment/ visit. The uptake will reflect how good (unlikely) or bad that value is and then we will eventually get to a more unrealistic figure.

    What happens if nobody from an area signs up to the DES, will patients who live in that area be banned from signing up to practices further away?

    Which CCG pays the costs of the patient? Which CCG's referral criteria are used? Can patients change practice if their local CCG does not fund the particular treatment they want?

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  • It would take a large number of zeros on that DES to make me visit someone on the other side of the city.

    We do have other things to do during the day, you know.

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  • When NHSE come up with their predictably derisory payment for visiting (£20 is my guess) we should remember how much a plumber would charge for an emergency visit and cut our cloth accordingly.

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  • Hussain Gandhi

    So NHS England announce a half-baked plan of a national specification (what is that?) to finance GPs managing patients outside of their practice boundary.

    No plans about the finance are given (surprise surprise) despite being only 3 weeks till the start.

    This at a time when practices are struggling to manage their current workload let alone take on more. Simply put unless the payment is significantly more (at least double) than the current amount per patient, it does not make financial sense and more importantly clinical sense to manage a patient outside your practice area.

    Most boundaries are set to manage the workload and allow effective offerings of visits. Having to see a patient 2 miles outside of a practice boundary could either: increase admissions, offer subpar care to the patient or mean cancelling/delaying patients booked at surgery.

    Personally will not recommend engaging with idea.
    Practices that do will show that they either have spare capacity, or value potential income over effective patient care.

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  • whats a hourly rate for a GP?
    close visits minimum time taken 20mins but often longer.So visits out of area likley to much longer.I would suggest
    it would need to be 3/4 hours charge to make it viable.
    This allows reasonable travel time and time with the patient. Any patients further than 15minutes away should be chrged at higher rate.

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  • my question is will we get the same payment for visiting or seeing TR's? or will that line now be removed from the contract. As far as I am concerned this is not to be touched with a bargepole!

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  • Hold on a minute, surely we are talking about those patients who live WITHIN your practice area who have chosen to register outside ( eg near work) and who become unwell and require a home visit.
    Personally, I would have very little desire to drop those patients who choose to register with me for those who do not, so a very easy decision.
    No thanks!

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  • I think this is talking about payment for doing the visits on patients that are not registered with you but requires a visit due to bring out of area.

    I have 3 main concerns.
    1. Will the payment reflect true cost? A visit will take 30-50 min in my area, founding on traffic. It well have to be £45-90 to make it worth the while. Otherwise I'd be better off not taking extra work and ensure I don't have to employ locums.
    2. Will the registering practice be paid less for out of area patients due to visiting duty being taken away? The article seems to suggest this is being considered. It will massively destabilize commuter area practice.
    3. How will patient record be managed in a timely manner? And if the patient is over 75, will the registering practice's named GP be accountable for the patient despite not stung the patient at all?

    The scheme has all the hall marks of political sound bites with no thoughts to practicality or patient safety. If GPC had ant balls, they would be advising practices to boycott this dangerous scheme.

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  • No chance.
    Visits in my opinion are the most time consuming and intrusive (and unenjoyable) part of my day.
    There's a pile of steaming sh1t waiting for me at the surgery to complete when I return.
    And I am hungry and need to eat my lunch, just like any normal person.
    A few extra quid for driving around in bad traffic for someone outside the area?
    This DES can be rammed right back up where the sun don't shine.

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