Snags over patients registering near work
Government plans to allow patients to register near their work are on the verge of being shelved because of problems working out how to pay GPs and PCTs.
A Department of Health source told Pulse working out how money would follow the patient was proving hard to reconcile.
The source said the scheme risked destabilising PCT finances and could create a mountain of red tape for a policy that would benefit relatively few patients.
'The idea of being able to register near work is certainly on the books,' the source said. 'The problem is when you start doing the sums.'
Dr David Colin-Thome, primary care tsar, has already admitted that rules surrounding home visits are a major obstacle to registration near work.
Patients ill at home would have to rely on the generosity of a local practice if they wanted a visit.
Critics of the policy also warn that allowing registration near work would upset the 'family dynamics' of practice.
Dr Mike Dixon, NHS Alliance chair, said the Government would have to come up with a formula which would not destabilise 'home' PCTs.
If patients were allowed to register near their work, Dr Dixon said, a suburban or rural PCT could be saddled with a disproportionately high number of patients with chronic diseases and a budget that did not reflect the higher workload.
He said: 'Patients able to access care from work are less likely to have chronic diseases or require home visits.'
Officials are understood to be considering whether temporary residents rules can be adapted or whether 'work' PCTs could commission out-of-hours care from patients' home PCTs.
Dr Hamish Meldrum, GPC chair, said there were 'a whole lot of problems' to overcome. 'There will be certain duplications of finances, It's not just a question of unbundling there will be some double payments and that might be a problem.'
Dr Meldrum added that ad hoc arrangements on home visits would not work. He said: 'You can't have that if someone lives a long way away.'
Dr Rob Hughes, a GP in south London and chair of the London GP Forum, said offering holistic care would be more difficult if families were split across many practices.