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GPs 'to be offered £40' for home visits for patients registered out of area

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.

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.’

Readers' comments (41)

  • 20 quid after tax
    woopy doo
    get lost

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  • Not enough,?how much would a plumber get, or a skilled manual worker.As the dragons would say I'm out.

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  • £11.90?! I cant even get my hair cut for 11.90 and my hair only takes 10minutes!!
    A clear resounding NO, should be the only response to this nonsense.
    Bear in mind, these patients will register elswhere and take their 'subsidy' with them. This will leave us to see 'unsubsidised' patients who sometimes need seeing weekly or even daily! This will be the downfall of general practice leaving surgeries with only vulnerable comorbid patients.

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  • A private family physician i know in the US charges $200 for house calls.Kinda puts it in perspective doesn't it?

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  • Dissociated with reality.
    It gets worse by the day.
    These manouveres are designed to get rid of Partners and get Private companies running practices.
    The only consequence possible is a repeat of the out of hours crisis.

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  • Here we go again, patient power. Pilots show there is little demand so they continue to endorse something that shows limited patient interest. They then intend to insult GPs with a remuneration that does not even cover their basic costs and lets not forget the transactional costs to reimburse and the added task of advising the registered practice of the consultation.
    As a patient I'm all for choice but we have to be practical, we have limited spending power so must spend wisely and dissuade this demand and supply cycle we seem to be in.

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  • As long as the scheme is voluntary I don't see a problem for GPs in this proposal.
    It will be a huge problem for NHS England as the chances of finding a practice willing to do it reliably with full 5 day cover for this fee must be fairly remote

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  • £71.40 per hour, to see doctor, is a deliberate insult by the NHS. No doubt the NHS paid their lawyer or accountant £250 per hour to price this insult.

    Where oh where is the useless cowering craven GPC?

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  • The local OOH charges £175 for a private home visit!.
    As the Americans call it Diddlt Squat. Consider the cost of medicolegal claims which are higher for OOH callouts - I wouldnt touch it with a bargepole.
    Lets calculate same. Average time to travel for a home visit - 15-45 min (depends on area), average tiem spent with patient 10-30 min (sometimes much longer e.g palliative care), typing up notes another 10 min.
    So the pay per hour is £40 before tax. The MDU fee for OOH GP is £14,000 /year for 10 sessions. No OOH service would accept that (given the cost for car, driver etc) offer unless they use Nurse Practitioners to do home visits.

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  • Good for VIRGIN led practices, lot of slaves working for them and this is aimed to those slaves who work for these private companies

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