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Outer boundaries: ‘My practice shrunk its catchment area'

Dr George Farrelly, a GP in Bow in east London, on how his practice has responded to the Government’s GP choice drive

I had a call from a patient who had moved out of my practice area. He has moved to Commercial Road (about two miles from Bow) so he is not miles away, but really too far away for me to visit him. He had worsening asthma and ideally he should have come in to be seen and I would have given him some oil steroid tablets, he would have gone to the chemist, got them and started them.

He was not able to come to me, because he was some distance away, but had to travel up here to collect his prescription – without the physical prescription – at 10pm. I have told this man he has to register with another doctor and I am confident that once he has registered with a new doctor, he will settle down and not need me.

GPs deal with people who are sick. They need easy access to us, and we need easy access to them. It works both ways. If you live at a distance, that creates a barrier for them to come to us, which sometimes means we have to come to them. That is inefficient and a drain on practice resources.

You can’t treat people at a distance in general practice with quality. It creates all sorts of problems and at times it is dangerous. The problem is that politicians do not want to know that. My attitude towards the outer boundaries is that GPs have to set their outer boundary to the boundary where it is safe to look after patients. But it comes down to a geographical consideration.

In our practice, we have shrunk our practice area and the outer boundary is now what used to be our boundary. So we have an outer boundary which is in essence our previous boundary, and an inner boundary which is smaller than our previous boundary.

We have done that with the consideration: would it be safe for us to look after people outside this boundary? The answer is no. It will be difficult for them to get to us, and it is more difficult for us to get to them.

I think what you will find around the country is that GPs will decide which patients they are able to care for based on what is safe and efficient – and not based on some stupid idea from a politician.

Dr George Farrelly is a GP at the Tredegar Practice in Bow in East London

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Readers' comments (1)

  • This article was not written by me but based on a telephone conversation with a Pulse journalist. A clarification: it might sound as though we reduced our practice area because it was a way to create an outer boundary without actually increasing our practice area. No, we reduced the practice area because we could not register all the patients in the area who wanted to register with us. In May 2009 we took the decision (quite publicly) to stick to a limit to our list size (otherwise we would have imploded), but this meant we breached our contract which stipulated that we register all patients within our practice area. The only recourse has been to reduce the size of our area. If the demand still exceeds our capacity, we will have to shrink further. Incidentally, 2 other practices in our area have done precisely the same thing in the past 6 months, for much the same reason.

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