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Majority of GPs to retain practice boundaries as GPC attacks Government 'fetish'

More than half of GPs are set to reject the chance do away with their practice boundaries from October, a policy described by one GPC negotiator as a Government ‘fetish’.

A Pulse survey of 459 GPs revealed that 52% would not take on additional out-of-area patients, while 73% said that they did not support the Government’s decision to allow practices in England to get rid of their boundaries in the autumn.

GP leaders said that the results proved that the initiative was a Government ‘fetish’ that should be abandoned.

The DH successfully pushed for a clause to be inserted into the GP contract for practices to be able to register patients from outside their traditional practice boundaries.

The BMA agreed to the clause on the proviso that GPs could opt out of the clause if they could successfully argue that their catchment area was already large enough.

The initiative has formed a key part of the Government’s drive to extend choice for patients, and has already been trialled in six areas.

The GPC has already warned that the pilot showed there was ‘little appetite’ for removing boundaries, and GPC negotiator Peter Holden told Pulse that the survey findings did not surprise him, adding it was a ‘fetish that the Government needed to stop’.

He said: ‘This is just pandering to the commuterati…part of the purpose of a GP primary care system is to have a person that is responsible and someone who has an overview, if you allow people to register near their work and allow dual registration, information will get lost.’

Dr Saj Azfar, a GP in Rochdale, said that his practice could not take on larger boundaries.

He said: ‘We do not have the capacity to take on patients outside our boundaries. We also believe this will give make it easier for patients to evade child protection surveillance and provide opportunities for abuse of the system by those with interests in doing so.’

Dr Nicholas Britton a GP in Dorset said that as most GPs were already working at close to 100% capacity they did not have room to cope with more patients.

He said: ‘Home visits take up a lot of  time, especially if further from the practice and other  care, particularly as district nurses are commissioned by the CCGs to cover areas which often do not extend beyond  existing boundaries.’

A spokeswoman for NHS England said that the ‘Choice of GP Practice Scheme’ was being extended across the whole of England on a voluntary basis for practices, from October 2014.

She said: ‘We are working with the GPC on the details of the implementation of the scheme and to help patients and practices take up this opportunity to improve access to GP services.’

‘Our approach will be a pragmatic one aimed at giving patients more flexibility and control about how they use GP services.’

Survey results in full

Do you support the Government’s decision to allow practices in England to get rid of their boundaries and take out-of-area patients from October?

Yes – 103 (22.49%)

No – 334 (72.93%)

Don’t know - 21 (4.59%)

Total - 458


Is your practice considering taking out-of-area patients after boundaries are scrapped in October?

Yes – 112 (24.4%)

No – 239 (52.07%)

Don’t know – 108 (23.53%)

Total - 459


About the survey: Pulse launched this survey of readers on 21 January 2013, collating responses using the SurveyMonkey tool. The 28 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. These questions were answered by 459 GPs.

Readers' comments (20)

  • If someone can explain how visits would be dealt with, we'd consider it.

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  • Vinci Ho

    This is Ministry of Truth and Plenty trying very hard to create an apotheosis of political jargon . This is to win votes for next year??

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  • The practice boundary can only be extended further if the requirement to visit patients beyond a certain reasonable distance is abolished.
    If home visits can be completely delegated away from the practice, then the whole of Europe can potentially be my practice area.

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  • As a rural gp my practice in Shropshire encompasses 100 square miles personally I think it is big enough although we used to have a patient who spent a lot of the year in Dar-es-salaam but he didn't ask for a visit

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  • Quite agree with home visit. I'd be happy to do away with it as unfortunately it is too often abused for convenience, rather then the true need.

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  • Maybe the solution is that practices should maintain a boundary for visits only then the patient could have a choice of whether or not to register inside of one practices boundary or outside of another practices boundary. Registration outside of a boundary would then come with the understanding that by doing so they are not eligible for visits. I sort of have this agreement with my own GP.

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  • On above idea - I can see family demanding visit when they are out side of visiting boundary on the basis they didn't realize the rule and it is too urgent to re-organize this on the 11th hour.

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  • So patient choice is dismissed by GPs as a "government fetish" because GPs don't believe in patient choice?

    What about allowing patients to choose whether they think it's a government fetish or not?

    How many patients in those pilot areas were even sent letters informing them that choice was allowed? Unadvertised pilots in a few areas doesn't count as "consulting" patients.

    Patient choice is the norm in many European countries and also in Asia and the Americas.

    Is there any evidence that child protection surveillance is worse in Europe than in the UK?

    Why does the UK always have to be so doctor-centred? Yet again we see services designed to meet doctors' needs - not patients' needs.

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  • The government has clearly stated that visits would be their responsibility for out of boundary patients, at. Of extra cost to gps.

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  • @ 1:17

    Patients in this country have a more paternalistic expectation from their GPs, which means GPs need to be aware of all the services in the patients area and how to access them.

    For example when a patient is struggling to get from the living room to the bathroom in the USA, the GP is not called for a home visit, the GP is not asked to organise emergency carers, the GP does not organise mobility aids etc. I struggle to know all the different services in my area let alone knowing the services in surrounding counties or other parts of the UK.

    There is also a problem with building size/ room numbers in GP surgeries in England. I recently joined a new surgery because of the increasing numbers of patients as a result of a new housing development. The numbers have grown at a steady and planned rate. We are surrounded by some terrible practices and if we had no boundaries are numbers would probably grow by another 4 thousand, which would make the workload way to excessive. We could not hire more doctors as our building is full to bursting - the only alternative would be to make more money (more patients) but provide a less good service - believe it or not, we do not actually want that.

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