In 2009 Andy Burnham, the then Secretary of State for Health in the Labour government, delivered a speech at the King’s Fund. He promised to abolish GP practice boundaries within a year; he wanted to give people ‘real choice’, unfettered by artificial constraints.
Now, little over five years later, his policy has officially come into effect.
Or sort of.
Because if Andy Burnham had his way, patients throughout England would now be able to walk into any GP practice in England, get themselves registered and, presumably, seen by a GP within 48 hours (sounds like a good idea, but would actually lead to gridlock and meltdown).
What is actually on offer to patients is this: they may register at a practice of their choice provided that the practice is voluntarily participating in this scheme, that the practice has capacity, and that the practice deems the patient ‘clinically appropriate’ to be registered at a distance from their home. Should they need urgent care when they are not near the practice, the practice cannot care for them. Instead, NHS England area teams have the responsibility to arrange for them to be seen locally by a GP.
So if you are, say, a commuter into London, there is no directory for you to consult in order to find a participating practice: you have to contact them one by one.
Even more worryingly (as the fact that NHS England has had to ask out-of-hours GPs to provide home visits for out-of-area patients shows), there is no credible cover for London residents under this scheme yet (despite NHS England having had five years to sort out the details).
‘Never heard of it’
This became clear after I rang NHS 111 in late January to check on the arrangements for Tower Hamlets residents. The nurse advisor I spoke to was not aware of the new policy. She said that Tower Hamlets residents not registered with a local GP and needing assessment would be directed to a walk-in centre or to accident and emergency. She checked with her supervisor who was also unaware of the new policy. They suggested I ring the health Ombudsman, which I did. The Ombudsman staff member advised me to contact NHS England London. I await their reply.
Two days later I rang NHS 111 again, and this time spoke to the team covering Islington, where I live. The person that I spoke to again had not heard of the policy. They did not have any lists of participating GPs, so if a resident of Islington or Camden needed a medical assessment in hours, they would have to go to a walk in centre or A&E.
This is a major problem, and it is shameful that the scheme has been introduced before cover for these residents has been sorted out.
I sympathise with the NHS England staff who are having to try to implement it but the scheme is a mess. It has in-built flaws which cannot be ‘worked out’. It is a textbook case of how not to plan healthcare – a house of cards, a case of ‘emperor’s new clothes’, a confidence trick.
I have been working in Tower Hamlets as a GP for almost 23 years and much of what I do is possible only because the individuals and families I see are local to my practice. When people move away but stay registered, distance is a very real barrier to access and care, which can be unsafe. A scheme like this might, in theory, work for people who are well, mobile, and well-organised, but in my experience the moment serious illness strikes, everything usually falls apart.
The other major issue is capacity. We are presently looking after too many patients and despite shrinking our practice area, we continue to grow. As a result our access and quality of service declines. This is another reason we cannot keep patients on who move away or register out of area patients.
Most, if not all, of practices in Tower Hamlets are in a similar position to my practice. So we have reached a collective stance and, in the interests of providing a good quality, sustainable, accessible service to our local residents, we are not signing up to this scheme.
Dr George Farrelly is a GP in East London
References
1 See the NHS Choices guidelines.
2 A case in point is the alleged benefit of registering with a GP near your child’s school. Watch my video on the issue.
3 See our poster here.
