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Independents' Day

Decision on extending practice boundary pilots to be made without 'robust' economic data

Exclusive Negotiators will base their decision on whether to extend pilots allowing out-of-area patients to register with GP practices without ‘robust’ information on the likely costs or benefits, Pulse has learnt.

The lead researcher tasked with evaluating the scheme on behalf of the Government says the pilots have not been going long enough to evaluate the economics of the scheme, or estimate which patients might use it.

Professor Nicholas Mays, professor of health policy at the London School of Hygiene and Tropical Medicine, says he was asked to supply an interim report by NHS England to use in contract negotiations with the GPC that contained a range of options of continuing with the scheme.

But he says he was unable to make any recommendation of whether the scheme was a ‘viable option’ to take forward, and that he will not be able to supply the final report until November - when contract negotiations are likely to conclude.

NHS England promised in its business plan published in May that it would evaluate the results of the so-called GP choice pilots and ‘consider how we can apply successes more widely’.

The pilots, begun in April 2012, have suffered from delays and a lack of patients and practices signing up. All GP practices in two out of six PCT areas chosen for the study refused to participate and earlier this year, a Pulse investigation revealed that just 514 patients had registered with an out-of-area practice and 129 people had made use of being treated as a ‘day patient’.

Professor Mays said that he suspected the pilots would be taken forward in some way, and his report presented NHS England with a number of options to do this.

He said: ‘We produced an interim report for NHS England at the end of July, which was somewhat incomplete in that we need to analyse the rest of our data. But we wanted them to have something that they could take into their discussions concerning the GP contract for next year.’

He added: ‘The way we presented our findings were to, within reason, discuss what were the main issues with the pilot and the two offers of choice that were in the pilot. Then we also identified issues that, if the Government intended to continue with this, should taken into account.’

‘We didn’t think it was appropriate for us to make a recommendation on whether they should continue the pilot or whether they should extend it. We will be presenting our view on whether we think that it is a viable policy [in the final report].’

The team hopes to be able to share the final report with NHS England in November, with new data that it collected at the end of the summer and could not include in the interim version.

Professor Mays said: ‘When we can publish will depend on whether this forms part of the contract for the next year, when that resolves. I think their objective is to have tidied it all up by the end of November.

‘While piloting is a good idea there are a number of aspects [we could not conclude]. For example we couldn’t estimate who is going to take it up. We tried as best we could, and we will have some data in our final report, from samples of the public about what would motivate them to make an out-of-area registration for example, but that is more hypothetical.’

‘We have not been able to make a full economic evaluation, 12 months doesn’t allow enough patients to go through the system to do that, so we’ve made some general observations on costs and likely benefits but you need a bigger, longer pilot to collect robust information.’

The coalition Government has already hailed the scheme as a success in its mid-term report on its progress so far, but both the BMA and the RCGP have warned that any extension of the pilot will destabilise practices.

Dr Chaand Nagpaul, GPC chair, said he could not comment on contract negotiations while they are ongoing, but added: ‘Our position on the pilots was always that it needs to be evaluated and when the evaluation was concluded that we would then look at the results. That is the purpose of having a pilot.’

An NHS England spokesperson said: ‘The report on the GP Choice pilot schemes by the London School of Hygiene and Tropical Medicine is not yet complete and is currently only a draft. It will be published when it has been finalised and peer-reviewed. We do not have a publication date confirmed at this stage. Contract negotiations are underway and remain confidential until an outcome is reached.’

Dr George Farrelly, a GP in Bow in east London and a long-tie campaigner against the pilots, said that he feared the evaluation will be just a ‘cosmetic exercise’.

He said: ‘How is it that the evaluation has been completed before the end of the pilot, when this was to be extended to September 2013?’

He added: ‘What I feel is essential is a proper review of this policy, a proper risk assessment which truly looks at all the issues, all the systemic aspects of the policy.’

‘If the [patient] numbers are small then the problems will not become apparent. The problems will become apparent if the scheme goes national. Then patients will find that most practices will not be able to register them due to capacity issues, and the real problems of being registered with a practice at a distance from home will crop up.’

Readers' comments (15)

  • When did the Govt ever need robust data for making widespread changes to the medical arena.

    Health and Social Care Act / CCGs?
    QOF (I'm looking at you, GPPAQ and PHQ9)?
    Dementia Screening?
    Adult Health Checks?


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  • It's almost as if the government relies on ideology-based commissioning rather than evidence-based (or even common sense!).

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  • What is the biggest issue in primary care at the moment?
    I would say it was the crisis in GP numbers.
    How come then it appears everything possible is being done to exacerbate this - driving foreign doctors away; pushing experienced GPs into early retirement; making things so tough that those in mid career are reducing their hours; giving increasing opportunities to the business minded amongst us to reduce clinical hours as they embrace the reforms by becoming managers. .
    Who is going to provide primary care in the future?
    Just what is the agenda?
    With the ridiculous idea of extended practice boundaries being yet another of the hundreds of things being forced upon us are we going to continue our supine pacifism, grow some professional balls,or, as I suspect, individually find our own ways of quietly surrendering?

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  • It will be the last option, definitely.

    Unfortunately it will happen so slowly the the public won't know how and what happened. Everyone will have their own views, but I suspect many will eventually look back on this era as the one where an awful lot was delivered for very little outlay. I doubt the corporate providers will be comparable.

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  • Other countries' medical systems work perfectly well with open boundaries and provide maximum choice and patient-centred care for patients.

    Why does the NHS have to be so doctor-centred?

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  • Anonymous @11.53 - it's actually patient-centred. GPs in this country have to agree to do home visits to registered patients when clinically necessary. Out-of-area patients either cannot receive this service (so no GP cover when really ill) or would do so at the expense of taking the doctor out of area and away from other patients. Moreover, GPs naturally know their own local hospital and consultants best and so able to offer specific recommendations for secondary care.

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  • Why does the NHS have to be so doctor-centered?

    Because there aren't very many of them!

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  • >Other countries' medical systems work perfectly well with open boundaries and provide maximum choice and patient-centred care for patients.

    Perhaps you could enlighten us and give us a few examples of other countries which offer potentially unlimited home visits based on clinical need with no upfront payment or co-payment and based on a single capitation fee.

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  • The problem, 11:53, or may I call you nearly 12:00? is that the model of primary care delivery in this country is dependant on locality, especially when it comes to extended primary care teams. For example, it would be impossible to deliver adequate care to our dying palliative care patients out of area. I cannot for the life of me understand that this is not obvious to anyone who cares to look at how such teams operate or are we to be relieved of responsibility for any care outside our surgeries?
    I suggest you engage your brain before you type. .

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  • You could have seen a lot of patients whilst driving around or stuck in a traffic jam. This is why people struggle to get appointments!

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