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Tories pledge to tear up GP contract

By Lilian Anekwe

Exclusive: The Conservative Party will tear up the GP contract if it comes to power and implement radical plans that would allow patients to register with any practice.

Opposition leaders are pledging to allow complete choice of practice so commuters can register near their place of work rather than their home.

The Tories would overhaul the funding formula to compensate practices in commuter belts who could face a mass exodus of working-age patients.

GPs would have responsibility for commissioning home visits and out-of-hours care for their registered patients – even those who lived miles away.

Details of the plans emerged this week after being hinted at by shadow health secretary Andrew Lansley in his party conference speech.

A party spokesperson told Pulse: ‘We want to allow patients to choose to register with a GP of their choice.

‘The money would follow the patient – but to avoid disadvantaging practices in rural areas, we would adjust the funding formula to take into account local demographics, so the amount paid per patient will vary across the country.

‘GPs would also be responsible for commissioning contracts to cover home visits and out-of-hours care.'

Under Labour, the Department of Health has ruled out commuter registration – which was mooted by the NHS Confederation last November.

The confederation has since backed away from the idea and this week responded coolly to the Tory proposals.

David Stout, director of its PCT Network, told Pulse: ‘There are some problems such as how home visiting might be covered.

‘Also, as the number of practices offering extended opening hours continues to rise – now up to 44% – interest in registering with a practice close to work may be limited.'

GPC negotiator Dr Peter Holden, a GP in Matlock, Derbyshire, said the funding plans could create a two-tier system.

‘What they are proposing is to differentially fund practices in commuter – and largely Tory – areas. Unless the Conservatives discuss their plans with people who know about GP finances they could destroy general practice. They have a way to go to win me over – and I'm a card-carrying Tory.'

Dr John Rawlinson, a GP in Ascot, Berkshire, said: ‘I can see the logic but there are significant pitfalls – not least the danger that practices in commuter belts like mine are going to be destabilised.'

Dr Rob Sadler, chair of Kent LMC, said commissioning home visits miles from where patients were registered would be ‘completely impractical'.

‘They are living in cloud cuckoo land – and pandering to one section of the population but not offering anything to the patients who need it most.'

Andrew Lansley wants to give patients free choice of where they register Andrew Lansley wants to give patients free choice of where they register What the Tory plans might mean

Allowing everyone to register with the GP practice they want


Pros
• Offers patients choice and flexibility
• Market forces could help drive up standards
Cons
• Risks destabilising practices in commuter belts
• May overwhelm practices in large towns and cities

Shake up funding formula to reflect practice demographics


Pros
• May offer a solution for practices under threat of destabilisation
Cons
• Would require complicated, drawn-out negotiations – and would have winners and losers

Give GPs responsibility for commissioning home visits


Pros
• Would give GPs closer control of out of hours
Cons
• Would be difficult to maintain continuity of care

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