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Q&A: Setting an outer practice boundary

Nottinghamshire LMC chief executive Chris Locke offers a guide to the rules around setting outer boundaries

Q. What is the rationale behind the outer boundary concept?

Boundaries were designed to allow patients who move home a short distance outside your practice area to remain on your list and continue to receive the services you offer your patients.

Q. What advantage is there if any in having an outer boundary?

A. It could give you greater control over the size of your list. You could open your list to new patients in the outer boundary when you want to expand and not take any when you have too many, but to avoid complaints, you must treat applications to register consistently and fairly.

Q. Do we have to have an outer boundary?

A. No, but practices are expected to have them, agreed with their PCT, unless there’s a good reason why not. For example, if the practice area is already very extensive and geographically self-contained it would have a good case not to set boundaries.

Q. Do we have to provide a home visiting service (where required) to patients within our outer boundary?

A. Yes. They should be treated like any other registered patient.

Q. Do we have to keep patients who move from within our inner boundary to within our outer boundary on our list?

A. You are expected to, but may suggest they register with a practice nearer to where they live if it is in the patient’s interest or the interests of your other patients; e.g. where their condition merits frequent visits or they have moved into a care home predominantly catered for by another practice.

Q. Do we have to accept new patients onto our list from our outer boundary area?

A. No, you are free to decline but should be consistent. If you accept some but not others, you could be accused of discrimination.

Q. Can we keep patients who move to or live outside our outer boundary onto our list? Can we accept new patients from outside the outer boundary?

A. Yes, but this is not advisable. You are not obliged to provide a home visit so it is in the patient’s interests to register with a practice who can offer this service.

Q. Once boundaries are established, are we free to change them?

A. Only with the agreement of your PCT.

Chris Locke has been Chief Executive of Nottinghamshire LMC since 1996.

Readers' comments (1)

  • David Bush

    "Q. Can we keep patients who move to or live outside our outer boundary onto our list? Can we accept new patients from outside the outer boundary?

    A. Yes, but this is not advisable. You are not obliged to provide a home visit so it is in the patient’s interests to register with a practice who can offer this service."

    Is this advice correct? I was under the impression that I am contractually obliged to provide home visits to any patient on my list if their medical condition warrants it. If I am not, then who will visit the sick patient who is on my list but outside my boundary? I can't see the local GP being too keen to do the work whilst I receive the income.
    Imagine accepting 100 patients in a Care Home located several miles away across the city, then declining to visit them because it is too far to go. ........now there's an income generating idea.......

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