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Reaction: Andy Burnham's speech

Key figures have given their reaction to health secretary Andy Burnham's keynote speech today, in which he revealed plans to scrap GP practice boundaries within the next twelve months.

Dr Hamish Meldrum, Chairman of Council at the BMA

'Doctors are always happy to discuss ways of improving quality and choice for patients.'

'However, some of the aspirations announced today require much more thinking through. Abolishing practice boundaries would mean a major change in the way GPs and other healthcare staff provide their services. Ending the current system, where everyone's family doctor is close to where they live, would make home visits more difficult and costly for the NHS to fund. The loss of large numbers of young, healthy patients could affect the funding of many practices in rural and suburban areas, threatening their future existence.'

Dr Laurence Buckman, GPC chair

'We are open to discussing ways of improving choice for patients, and most GPs would be comfortable with flexible boundaries. The idea of getting rid of practice boundaries altogether has been discussed many times in the past, and we are happy to discuss it again.

However, major logistical barriers would need to be overcome for patients to be able to register with practices a long distance from home.

Home visits with a GP a long way away would become difficult, and costly for the NHS to fund. Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability. Meanwhile, city centre practices would be inundated with requests for appointments at lunchtime and evenings, which would effectively limit patient choice.

All district nurses, hospital services, and social services operate within defined boundaries, and these too would have to change if patients were to be able to access them. These problems are not insurmountable but will need a lot of careful thinking if they are to be solved.'

Professor Steve Field, RCGP chair

'I support the move on practice boundaries. It's entirely logical - as long as protect those who need home visits.'

Dr Mark Hunt, managing director of Care UK, the largest independent provider of healthcare in the NHS

'The ending of catchment areas is great news for patients and the NHS. Allowing patients to choose their GP combined with the publication of GP performance data will mean patients can make a more informed choice on quality and not just have to go to the nearest GP.

Being able to register with a GP near work will dramatically improve convenience as patients don't have to take half a day off work just to attend their GP. It will also provide a mechanism for good practices to grow and expand services to a greater number of patients.

Most importantly because patients will now have real choice, GPs will have to be responsive to their needs. Patients will benefit from longer opening hours, more personalised care and improved performance across the board. It is this kind of choice and competition that needs to be extended across as many areas of the health service as possible.'

Steve Barnett, chief executive of the NHS Confederation

'It is welcome to see that the political debate is now starting to move towards an agenda which is likely to reinvigorate and enthuse front line NHS workers although this will be done against the background of a very challenging financial environment. Today signals a move towards quality of experience and care and this is a priority which the NHS is already working very hard on.

The suggestion that payments to providers of healthcare should better reflect patient experience and staff satisfaction is something to be welcomed. However, it should be remembered that payment structures are only one way of encouraging these behaviours and not the whole solution. Managers, doctors and nurses at a local level need the freedom and flexibility to deliver the best possible patient care.

We have concern if the suggestion is that commissioners of services would be limited in their ability to move services swiftly to alternative providers where there is clear benefit to patient care and value for money for taxpayers.

At a time of great financial pressure on all public services it is even more important for the people who commission services to be able to choose the most appropriate provider - we will want to see much greater clarity about what this means in practice.'

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