The GP choice pilot has been extended for six months. Here in City and Hackney we have boycotted the study and we will continue to do so.
The concept benefits those in least need of healthcare, namely the fit and mobile. This is not to say that the fit and mobile do not have equal rights to healthcare, or that we don't understand the needs of working people coping with chronic disease – the NHS is there for everyone. But in a time of decreasing resources, we have to think how best to use these resources.
Expanding the pilot would increase the administrative costs in primary care, with money moving from healthcare to administration in order to improve access for the fittest.
The patient choice pilot pays scant respect to the importance of continuity of care at a time when this is increasingly being shown to be a key factor in improving healthcare and containing costs. Patients who register fully with a practice far from their home will need to see local GPs on a temporary basis, and patients who regularly use GPs near their place of work on a temporary basis will similarly have potentially several different practices involved in their care without these practices having the ability at present to exchange information.
The concept is also unsafe, in that the IT support is not of sufficient sophistication to ensure transfer of records between different areas of the country. For example if a patient is taken seriously ill at night in their home but is registered at their place of work forty miles away, their records will not be accessible to any GP who becomes involved in their care locally. In particular, we have concerns about safeguarding children whose parents might decide to register with a GP away from home, making it harder for health and social services to identify at-risk children.
GPs with patients registered at their place of work may well have to organise referrals to secondary care for that patient without any knowledge of local services. This will take more time to organise and will remove time available for locally registered patients.
In Hackney we already have a lack of primary care capacity for our local population. The needs of mobile working people who live elsewhere should not take precedence over those of people who are unwell and cannot travel far.
There has been no commitment to looking at the funding of secondary care needs for patients registered away from where they live. So in an area like Hackney with high levels of need, our commissioning budget could be partly used by people commuting in to London from a more well off area of the country whose commissioning budget would then be saved. To have not addressed this before the start of the project shows an extraordinary lack of understanding of the movement of money within the NHS – or a blatant lack of regard for the needs of the less well off.
Finally, although this scheme is called the ‘patient choice' pilot, it will disenfranchise those unable to exercise ‘choice' through illness and immobility.
Dr Deborah Colvin is a GP in Hackney and chair of City and East London LMC
