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Managers delay publication of practice boundaries pilot evaluation once again

The publication of an independent evaluation of pilots that removed practice boundaries in certain cities has been delayed once again by NHS England, despite the policy being rolled out nationwide later this year.

The report by researchers at the London School of Hygiene and Tropical Medicine was due to be published last year, but NHS England told Pulse it will now be released ‘before the end of March’.

The evaluation looked at the GP Choice Pilot, which allowed commuter patients to register out of area in four areas of England.

The GPC said that they had yet to see the final findings from the pilots and that they had requested NHS England publishes the report.

In December, NHS England said the report would be published ‘before the end of the year’ and later on in the month ‘late January’.

A request for a copy of the report under the Freedom of Information Act submitted by Pulse in January was also refused.

As part of the 2014/15 GP contract, practices will be allowed to take on patients from outside their boundary zone from October, but the scheme will be voluntary.

Pulse recently reported that the majority of GPs intended to keep their practice boundaries intact despite the new policy.

The pilots, which begun in April 2012, suffered from delays and a lack of patients and practices signing up. All GP practices in two out of six PCT areas chosen for the study refused to participate and a Pulse investigation revealed that just 514 patients had registered with an out-of-area practice and 129 people had made use of being treated as a ‘day patient’ by early 2013.

An NHS England spokesperson said: ‘NHS England is working with the Policy Innovation Research Unit to make final preparations on the report before publication.  We are expecting that publication of this report by the London School of Hygiene and Tropical Medicine will be before the end of March.’

Dr Chaand Nagpaul, chair of the GPC, said it was important to ‘share the lessons of the report’.

He said: ‘I have no idea why they are holding it, you would have to ask those that are delaying its publication. But I think even without the evaluation we know that the uptake was extremely small in these pilots. We know that there is really not a major need for this change amongst the population. That is what I can say without seeing the report itself.’

‘We have been involved in regular meetings with the evaluation team, but the final version I have not seen.’

GPC negotiator Dr Beth McCarron-Nash said: ‘We have requested that they publish the report on the pilot.

‘Obviously best practice is to pilot something, see if it works and then make changes according to the result, but they are actually going ahead with this without any evidence that it is actually even necessary.’

In September, lead researcher Professor Nicholas Mays, professor of health policy at the LSHTM, admitted that his team had been unable to do a robust evaluation, including of the economics, because of the lack of people coming through the scheme within the short timeframe they had to work with.

Where is the practice boundary pilot report?

April 2012: One-year pilot, dubbed the GP Choice Pilot, begins, but GPs in two out of six areas decide to boycott the trial.

September 2012: First delay hits the project as the DH is forced to extend the pilot by six months, until September 2013, because of the ill-fated slow start to the project that saw just 12 patients signed up to the pilot by June.

January 2013: Pulse investigation shows just 500 patients register with out-of-area practices as most GPs shun boundary pilots.

July 2013: LSHTM gives an interim report to the Government, which is not published.

November 2013: Draft final report is submitted to the DH and NHS England, but is not shared publicly.

5 December: NHS England says the report will be available on the LSHTM website ‘before the end of the year’.

20 December: Without giving a reason, NHS England says it is now ‘expecting the report to be published late January’. 

6 January: A Pulse request to see the draft of the final report, plus accompanying correspondence on the GP Choice Pilot, under the Freedom of Infomation Act from NHS England is refused.

7 March: An NHS England spokesperson says the report is now expected by the end of March.

Readers' comments (10)

  • It must be taking a lot of time to..ahem..make sure all of the figures are consistent and correct.

    I would be useful to see how those 12 patients got on.

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  • Just think how much time money and effort is been spent on this, with no real benefit to patients and only serves to undermine general practice.

    I think the LMC and BMA need to come up with a response to patients who have dual registration - to ensure they realize it undermines care for everyone else

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  • They're waiting to bury it in bad news such as the findings of the DDRB .

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  • An NHS England spokesperson said: ‘NHS England is working with the Policy Innovation Research Unit to make final preparations on the report before publication.' How independent is an 'evaluation' when NHS England has a hand in making 'final preparation' on the report.

    For my blog posting on the 'evaluation', see

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  • Vinci Ho

    This government has a habit of forcing people to believe in nonsense . Unfortunately( to the government ) ,even their own study(s) did not support what they claimed. Remember last week the Tories were withdrawing the study report of the less than estimated influence of immigration on unemployment ?
    No matter what , there are serious issues of trust on this government .......

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  • HMO and NHS England want large companies to take over NHS General Practice. Once they have a patient registered it becomes easier to keep them even if they move. Welcome to branded NHS General Practice.

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  • "It's conclusions are open to other interpretations and it leaves many important questions unanswered ", - Sir Humphrey Appleby

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  • Open the gates of Hell even a crack, and all manner of Ghosts and ghouls will escape.

    This is as mentioned above is the next step to open up the NHS to private providers, as you can't justify the spending of millions to allow 514 patients to register out of area!

    The real end goal is to fragment GP practices to allow a large US style provider to take on a small practice on an APMS contract then expand to take on City workers and register them from all over the Capital so commuters don't have to register locally.

    Win/win for big business, as they have a potential huge base of potential punters to sign up, and no responsibility to provide care when they are at home, for about 50% of the day, and all holiday and weekends.

    Also companies in London then don't have to give employees the time off for an appointment ass their GP will be based in either the City or Docklands - making more profit for them as less time away from the office.

    This has Never been about the patient. We just need to give them time to 'FIX' the report to make it look like the pilots were not a complete disaster, as they are already planning to push through the changes regardless.

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  • How were these pilots advertised? If patients are unaware that they can register elsewhere - how can these pilots be considered accurate?

    Perform a massive postal campaign informing the population of their right to register at a practice of their choice and then run the pilot and record the data.

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  • This is such an excellent idea. Let's see:

    Patient works in London, lives in Hertfordshire (commutes)
    Patient is registered with a practice near work
    Patient has minor health issues (trivial stuff), see Dr near work, is happy. OK so far.

    Patient then becomes genuinely unwell - can't go to work.
    Stays at home due to being unwell
    Wants to see local doctor - who correctly refuses
    Patient has to go to work anyway to see own doctor.
    Everyone realises how stupid the system is


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