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Scrapping boundaries could stymie commissioning reforms, says NHS Confederation

By Gareth Iacobucci

Exclusive: The Government risks undermining its own flagship commissioning reforms by pursuing plans to abolish GP practice boundaries, NHS managers have warned.

In its response to the Government's consultation on the proposals, the NHS Confederation said there was a ‘tension' between expanding patient choice and giving GPs greater freedom to design services that must be resolved before the plans can be progressed.

The Confederation said GPs could lose the ability to co-ordinate and provide ‘high quality services' if they are not allowed to retain some control over which patients register with them.

It advised that the Government should consider any changes to the GP registration system in the context of GPs' new commissioning responsibilities, after the White Paper has been published.

David Stout, the NHS Confederation's PCT Network director and author of the response, said: ‘There exists a tension between offering unrestricted patient choice and providing GPs with the freedom to design their services as they choose.'

‘When GP consortia become responsible for commissioning care for the patients on their practices' lists, the question of whether or not it is mandatory for GPs to accept distant patients onto their lists will become crucial.'

‘If GPs are not permitted to refuse to allow distant patients onto their lists… in effect, their ability to judge for themselves whether they are able to co-ordinate and provide sufficiently high-quality services for a distant patient will be removed.'

He added: ‘The PCT Network considers it essential to establish at an early stage whether accepting a distant patient onto a practice list would be mandatory or at the practice's discretion.'

Meanwhile, the BMA's response to the consultation has rejected all four of the options put forward, and instead urged the Government to consider a fifth proposal, that would allow boundaries to be widened, particularly in densely populated urban areas, to give patients greater choice of where to register.

Their proposal also suggests modifying the ‘temporary resident' arrangements to allow unregistered patients to be treated by a distant practice on an ‘ad hoc' basis, simplifying the system of opening and closing practice lists, and increasing the use of remote consultations to allow patients who are away from home to have a consultation provided by their existing practice.

GPC chair Dr Laurence Buckman said: ‘GPs are extremely worried about the proposals to reform practice boundaries being put forward in the Government's consultation, because they will damage patient care.'

‘We do, however, want to address the needs of the one in ten patients who aren't currently satisfied with the care they receive, and that's why we've put forward a fifth proposal for the Government to consider.'

The RCGP's response to the consultation also criticised the plans, claiming they would fragment care, and instead suggested that extended patient choice be acheived through the current system of ‘limited walk-in services' and extended hours.

Allowing patients to register at any practice could cause problems for the Government's commissioning reforms, the NHS Confederation has warned Allowing patients to register at any practice could cause problems for the Government's commissioning reforms, the NHS Confederation has warned

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