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CAMHS won't see you now

Number of out-of-area patients registered by GP practices quadruples

Exclusive Out-of-area patient registrations have almost quadrupled since May despite GPC concerns about patient safety, figures obtained by Pulse reveal.

In all, 37,032 patients have now chosen to register with GPs away from their home since the scheme went live in January – an increase of almost 300% on the 10,000 figure reported by Pulse seven months ago. 

Although falling far short of the 6% of all patients in England the Department of Health predicted would sign up to the scheme, the latest figure represents a significant increase.

The implementation of the voluntary scheme, launched on 5 January 2015 as part of the Government’s ‘patient choice’ agenda, was delayed by NHS England due to GPC concerns regarding patient safety.

The GPC attributed the rise in registrations to patients who have moved away from their practice, but do not want to change GPs.

GP have no ‘obligation to provide home visits or services out of hours’ to registered patients who live outside the practice area, with a DES intended to ensure patients can access another GP practice close to their home should they need to.

However, as previously reported, NHS England was forced to enlist out-of-hours GP providers to provide home visits for out of area patients because too few GP practices signed up to an enhanced service aimed at filling the function. Pulse also revealed that NHS 111 was advising patients using the scheme to go to A&E for urgent care, rather than to GP practices signed up for the enhanced service.

In May, GPs at the LMCs Conference in London voted to abolish the scheme and condemned NHS England for failure to provide home-visiting services for out-of-area patients. At the time, GPC deputy chair Dr Richard Vautrey warned that the 10,000 patients using the scheme at the time were ‘at risk’ because ’NHS England has not commissioned a full and comprehensive home-visiting service’.

Commenting on the rise in patients making use of the scheme, he noted that the number was ‘small but growing’ and said it was therefore essential that the sufficient cover was in place.

Dr Vautrey said: ‘Most areas now have commissioned visiting services for out-of-area patients but they are not well publicised and few patients who have this registration status fully understand how they would contact an emergency service if they needed one. It’s also not clear whether NHS 111 has the full information of what services are available in all areas and this new registration status is also not made clear on GP clinical systems. 

’As the numbers of out-of-area patients grows it becomes ever-more important for a comprehensive, consistent and reliable service to be easily available in all parts of England.’

NHS England told Pulse that 301 consultations and 24 home visits had been made between January and November 2015 for out-of-area patients, allowing these to access care in their home regions.

But, claiming that there have been ‘serious flaws’ in the implementation of the policy, Dr George Farrelly, a GP in east London, said: ‘From the beginning, the proponents of this policy have greatly exaggerated the benefits of the scheme and ignored entirely the problems inherent in the model. For someone working day-to-day at the frontline, the disconnect between the rhetoric and the reality was very disconcerting.’

Pulse has approached NHS England for a comment.

Readers' comments (9)

  • Lies ,dammed lies and statistics. If 4 people sign up a month compared to 1 person it is four times the amount. This reflects mostly people who have moved out of practice area.
    Also many Nursing/Residential homes are situated in outskirts where where is covered by one GP Practice and due to "functionalization" of Nursing?Residential homes in many CCG`s certain practices look after all residents in Nursing homes.
    This is because its easier to visit just a few homes rather than many geographically distributed homes, also due to lack of branch surgeries which are closing several patients moving into the area sign up with their old GP surgery again.
    So the numbers are misleading and also costing the NHS lots more money when money is at short supply.

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  • 'There are three kinds of lies: lies, damned lies, and statistics.'

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  • We have an added benefit/curse of having a Russian speaking partner in our surgery. Word-of-mouth being a powerful thing, there are 37 patients registered more than 25 miles away from the surgery. The number of eastern europeans registered with us, but living outside of catchment area is 12%.

    In addition to that, another 8 patients feel that our GP's have made a miraculous contibution to saving their lives and insist to stay registered with that Gp after moving out of the area (25+ miles).

    The way we are dealing with this is by reviewing the OOH registration list and making sure that the arrangement is "practical and clinically appropriate" as per guidance and turning away/cancelling registrations for at-risk groups that are likely to require visiting service.

    We have tested turning away registrations of OOA patients on those grounds under the watchful eye of NHSE and CQC and the experience has quite straightforward and reasonable from the practice's perspective, so no complaints from us there.

    Acute care is not a particular issue for this population group, - what is less straightforward is dealing with community teams from other localities and actually our own locality services are sometimes twitchy accepting outpatient referrals for patients living outside of the area.

    So from my own professional experience, - the disconnect is happening more on the local/CCG level, rather then NHSE, who are mostly on the ball.

    As long as the practices manages this process appropriately, - OOA registrations are working just fine.

    On a personal level, - I live close to the practice, and would prefer to be registered with a GP, whom I do not deal with as part of my employment, which rules out local surgeries. So I have identified a good practice on a juicy PMS contract 40 minutes drive away from home in a rather affluent area and would recommend anyone mobile enough to travel to do the same.

    P.S. I was toying with the idea of excersising my civil right to register with a certain practice in Birmingham just to book an appointment with Proffessor Field to present a complaint regarding stress and burnout due to work pressures, but decided this was a step a bit too far.

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  • I think it is a sensible idea as he is the one who is partly responsible for these problems in many gps. I think it is the least he could do.

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  • Does anyone know what happens if one of the patients in your practice boundary, who is registered with a faraway practice near their work, becomes ill at home and requests an appointment at the "home" practice as a temp resident? Who ends up getting the payment for looking after this person?

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  • |Anonymous | GP Partner|14 Dec 2015 3:55pm

    Technically, - both practices, one for a permanent patient, the second for the temporary registration.

    However, from what I understand, - in order for the payment to come through, the temporary patient should be registered on 16days-3months timeline. In order for "up to 16 days" payment to register they have to be on the border of your open exeter calculation.

    But also, a patient can turn up on your doorstep telling you they have run out of salbutamol inhalers and need to be seen and you cannot turn them away as this would come under immediate and necessary treatment for which you get no payment anyway.

    All of this is built into your contract with a view that this only gets used on a very rare occasion, but you might get unlucky and this will get abused.

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  • @Practice Manager I am an ex Practice Manager and yes I do the same my GP is 80 miles away. Someone I have known for years. Yes it works I agree and is utterly excellent. I would hate to registered with an Practices local to my home as they are massive Practices. You never see the same GP twice. My back up though is a private Practice I fall into their catchment area for home visits. Expensive but hassle free.

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  • NHSE target was 6% of the population.
    That is ~3 million.
    37000 have signed up.
    That is ~1% of the target.
    A resounding success!
    I wouldn't touch it with a barge pole.
    Too much hassle for too little income.

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  • From the Special people in the DOH who couldn't organise a p!ss up in a brewery - sums up this useless waste of NHS resources.

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