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NHS England forced to rope in out-of-hours providers to provide home visits to out-of-area patients

Exclusive: NHS England is having to enlist out-of-hours GP providers to provide urgent home visits and appointments for patients who are registered out of area, Pulse has learnt.

It has made the move after just 64 of London’s 1442 GP surgeries signed for an enhanced service to provide home visits and in-hours appointments to patients registered out of area, leaving these patients at potential risk in case they needed urgent care.

The enhanced service was introduced due to safety fears after the Government had delayed the rollout of its scheme to allow patients to register in a practice outside of their area.

NHS England has claimed that the cost of bringing in out-of-hours providers would not exceed the £60 per home visit given to GP practices, but out-of-hours GP collectives said that the costs of providing any type of in-hours care were likely to be high.

Opening up practice boundaries was a pledge made in the 2010 Coalition Agreement that formed the alliance of the Conservative Party and the Liberal Democrats in government, but it has been besieged with problem, including a pilot that found low demand and fears over the provision of urgent care for these patients.

When it was finally introduced in the 2014/15 GMS contract, it was meant to go ahead in October, but NHS England called a delay to be ‘completely assured that robust arrangements are in place across the country’ to cover urgent care and home visits for patients registered outside their area.

As a result, the enhanced service was introduced in November, offering practices a fee of £60 per home visit they conducted, and £16 for conducting an urgent appointment in-practice.

Figures received by Pulse reveal that around 23% of practices have signed up to the scheme across the country.

The South had the highest overall uptake of the enhanced service, with an average of 34% of practices enlisted, compared with only 15% of practices in Surrey and Sussex. In Bath, Gloucestershire, Swindon and Wiltshire area team, 57% of practices signed up.

But in London, only 4% of practices signed up by the time the scheme went live on 5 January.

A spokesperson yesterday told Pulse that it was consulting out of hours providers to guarantee coverage for home visits and urgent in-hours appointments in future.

They said: ‘In London, 64 GP surgeries to date have signed up to the new enhanced service and we expect more to do so in the coming weeks. Our learnings from the 2012 pilot have shown that this level of sign up is sufficient to serve patients who are likely to need to access this alongside existing walk in centres. NHS England is liaising with CCGs to commission services with out of hours providers for this patient group.  We will continue to monitor the level of coverage across London.

‘We can confirm that the 111 directory of services has been updated to reflect this information to ensure patients receive appropriate urgent care when required.’

Londonwide LMCs medical secretary, Dr Tony Grewal told Pulse the scheme had been met with ‘massive indifference’ by London GPs.

He explained: ‘It’s partly a capacity thing; we’re having enough trouble providing services for our own patients without taking on more work. The other thing is that very few London practices see that there’s a real need for this, it’s going to benefit a few individuals, there wasn’t massive take up on the pilot.’

‘The problem will arise if somebody has a significant episode and is then discharged home from hospital, in terms of any follow up that’s there, that’s difficult.

‘And walk-in centres just don’t provide home visiting services, and the capacity of the out-of-hours service to provide in hours domiciliary visits is limited. So although it’s a small number of potential cases, it could be significant.’

GPC deputy chair, Dr Richard Vautrey told Pulse: ‘The home visiting element is a key part of the service provision, so if the area team has not put in place a service to visit patients at home – should that be required – then they are not providing a comprehensive service.

‘Before the New Year they did assure us that they believed the service was comprehensive, and the service they’d commissioned was safe to progress with. But clearly anecdotal stories starting to emerge are starting to question that.’

Pulse contacted a number of out-of-hours providers, who said they had not yet been contacted.

However, Dr Emma Rowley-Conwy, chair of the SELDOC out-of-hours provider in south-east London, said that costs were likely to be high if provided by a GP collective.

Dr Rowley-Conwy told Pulse: ‘In out of hours we estimate the cost of a home visit to be about £250. We’re actually charging £17.50 for GP advice over the phone, and we’re charging £60 for a base visit [GP appointment]. We’re being paid that at the minute.

‘For day time visiting, our price would be even higher; because you’ve got to have a GP sat there waiting, on the off chance that someone might call.

‘It’s a bit like doing half day cover, for educational events –which we do when all the practices might shut. We get a little bit of activity in that period, but we charge £2,000 for an afternoon.’

Pulse revealed before Christmas 20% of practices across eight area teams in the North and Midlands had signed up to the out of boundary patient enhanced service before Christmas.

Readers' comments (6)

  • Vinci Ho

    Typically , the whole thing was never thought through properly before pushing the enhanced service out . Safety is an issue as the visiting doctor will not have access to the full medical record and yes, these politicians really thought the cost of providing these 'extra' services were coming cheap and they could then satisfy their voters.

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  • A service a tiny minority want at what expense? Why not focus on the bigger picture?

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  • Own up, which of you London practices let the side down?

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  • Well done to 96% of London practices!

    The OOH services are realistic about the cost of this crazy policy.

    Why on earth should GPs visit people who have chosen not to register with them?

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  • £60 for a visit that might take over an hour in traffic. Is this good use of precious GP time, sitting in traffic?

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  • There are, broadly speaking, 2 sides to this brain-damaged policy. One is the task of providing care to those who are unwell and unable to consult with their registered GP practice because that is at a distance, and I believe this article is focusing exclusively on this.

    The other aspect is practices signing up to register patients who do not live in their practice areas. It is not clear how many London practices have expressed an interest or are registering out of area patients. If you are a commuter into London and want to register near your work, there is no list of practices offering this option. You have to ring practices one by one to find out. I know because I have asked NHS England.

    Getting the 'out of hours' service to cover 'in hours' times is clearly going to mean a significant additional cost because the service will have to run 24 hours a day, as opposed to just out of hours.

    The anomalies are numerous, and will become more evident as time passes.

    But the people who behind this policy do not, I believe, really care if it works or not, whether it gives people a useful choice or improved care. The covert, hidden driver behind this policy is to open general practice up to large for profit organisations which will offer a user-friendly centrally-located service to the mobile well. The system will cherry pick the patients for them, as the less well will opt for a local GP.

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