Exclusive GPs will be offered £40 for every home visit they undertake for patients registered away from home, under proposals for the Government’s policy to remove practice boundaries, Pulse has learnt.
Service specifications for a new DES were sent to GPs in a ‘pre-emptive’ letter from Hertfordshire and the South Midlands area team, before NHS England announced a delay to the policy.
The service specifications for the new enhanced service also state that practices will be offered £11.90 for every routine appointment or telephone consultation that they conduct for patients registered elsewhere.
The specifications were developed by NHS England, and the Hertfordshire and the South Midlands local area team was the first to inform their GPs about the details. It is unclear if this proposal will be implemented when the policy is fully rolled out in January, but local leaders are meeting with the area team today to discuss the policy.
Pulse reported earlier this month that an enhanced service had been proposed to tackle the problems thrown up by the practice boundaries policy, which allows practices to register patients from outside their traditional boundaries, but this is the first plan to give any details about how much practices could make from providing cover for the additional patients.
The letter from NHS Hertfordshire and South Midlands area team, dated 15 September, asked GPs to notify the area team whether they will be opening their practice boundaries or signing up to the new DES by 23 September – one week before the policy was due to be implemented.
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But, at the eleventh hour, NHS England announced the scheme would be delayed until January 2015 to be ‘completely assured that robust arrangements are in place across the country’.
An appendix to the area team’s letter gave details of the ‘New Directed Enhanced Service (DES) to ensure in-hours urgent primary medical care (including home visits) for patients registered out of area.’
It stated: ‘Payment under the DES for each consultation at the practice (excluding home visits but may include telephone consultation etc.) will be a fixed price per consultation (the price is yet to be finalised but current thinking is that this will be around £11.90).
‘Home visits fee… will be paid to a maximum of two times per annum for any individual patient before triggering a review of whether it is more clinically appropriate for that patient to register with a practice closer to home (the price is yet to be finalised but current thinking is that this will be around £40).’
The consultation fee will be paid a maximum of three times before triggering a review of whether the patient should register near their home, while the home visit fee will be paid twice before a review, it added.
Dissolving practice boundaries was part of the Coalition’s election manifesto, and the GPC have accused the Government of pushing the scheme through, despite pilots showing ‘demand was not high’ among patients.
The pilot found that one third of practices involved failing to register any additional patients and that a minority of inner-city practices signed up large numbers of patients, while a Pulse survey found that the majority of GPs would not be opening their boundaries.
Hertfordshire and Bedfordshire LMCs chair Dr Peter Graves told Pulse it was vital patients understood how a change of GP would affect their care.
He said: ‘A letter went out from the area team last week in preparation for implementation on 1 October, which has now been stalled at the request of the BMA’s GPC until January 2015. So the area team were rather pre-emptive.
‘We have heard that there wasn’t a massive rush for this service from the pilot practices and as the details are very unclear we don’t predict a massive rush now.
‘Further, we will expect practices and the area team to make it clear to patients with long-term conditions that this could seriously interfere with continuity of care and create some interesting difficulties accessing repeat medications if you are living a long way from your registered doctor.’
