Scrapping practice boundaries could lead to 'demise of the family doctor', MP warns

21 Dec 09

Speaking during a Westminster debate on the proposals, David Taylor, Labour MP for North West Leicestershire, accused the Government of pandering to ‘a minority who can shout loud enough’, and said the plan could exacerbate health inequalities and destroy the patient-doctor relationship.

But health minister Mike O’Brien said the move – which the Government plans to have in place within nine months - was necessary in order to offer more choice and drive up standards in underperforming practices.

Mr Taylor, who tabled the debate to express his opposition to the move, warned that the proposal was focused too much on creating competition between providers, rather than tackling health inequalities.

He said: ‘The abolition of practice boundaries will undoubtedly increase competition within the NHS. That will be especially so in urban areas, as GP practices have to compete for patients with walk-in centres and one-stop primary care centres.'

‘That will merely distract the NHS from tackling health inequalities, as consistent and lengthy patient records will become more difficult to compile.’

He said the plan risked ignoring the needs of the ‘most vulnerable’, including psychiatric patients, who rely on social services being geographically tied to the local authority.

‘The consequences may include an increase in the administrative complexity and cost of providing appropriate care packages for all who need them. Dementia patients living at home will be particularly vulnerable to instability and uncertainty,’ he warned.

He also echoed GP leaders’ concerns about how home visits would be carried out, and said the plan appeared to have been tabled to appease affluent and middle class patients, rather than the most vulnerable.

He said: ‘We must not shape our primary care system around the needs of the middle-class, peripatetic, urban elite who go to their local paper and MP every time they cannot get an appointment to treat their squash injury.

‘This proposal is designed to satisfy the few, not the many. To abolish practice boundaries is to hasten the demise of the family doctor.’

But the health minister said the current system of general practice could not be relied on to address poor provision in deprived areas, and said the move would act as an incentive to encourage poor performing practices to improve.

Mr O’Brien said: ‘We cannot simply rely on current general practice to address such problems. That approach has been tried for 60 years and it just has not worked. In some places, patients may be restricted to a single practice. They may wish to move, but find it difficult to do so. That is all very well if their practice is good, but what if it is not?'

‘Limited choice reduces competition between practices to attract patients and weakens the incentive for some GP practices to improve quality.’