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Independents' Day

GPC demands delay in practice boundary changes three weeks before rollout

Exclusive GP leaders are to urge NHS England to delay its flagship policy to give patients a greater choice of practice because of concerns that GPs and local area teams still do not know how the scheme will work in practice.

The GPC told Pulse that it plans to write to NHS England to call for the October implementation date to be pushed back because no national guidance has yet been issued for the scheme, which will allow GPs to take on patients from outside their boundaries without having to provide home visits.

This is despite NHS England saying in June that it was ‘urgently’ working on finalising the the details of the plans.

GPC deputy chair Dr Richard Vautrey said there is ‘a whole host of unanswered questions’ surrounding the policy, which could pose a risk to patients and therefore it would be ‘wise’ of NHS England to delay the rollout.

He said: ‘[October] is still the timeline but we have real concerns about that. We have had concerns about the removal of practice boundaries ever since it was suggested. This is an initiative that has been in gestation for a number of years now, and even with that long timeline we are now looking at three weeks before implementation and the health service is not ready for it.’

‘It shouldn’t be implemented if there is a risk that patients might register in one part of the country and not have available services should they become ill when they are at home because those services are not in place. And at the moment there is no sign of that because area teams have not yet been told, and have not yet been given the full details about what they should do.’

‘So I think it would be wise for NHS England to delay this until the guidance has been developed and area teams have commissioned home visiting or in-hours consultation services.’

Other outstanding unknowns include how much GPs will be paid for their out-of-area patients, given that they will not have to provide home visits, he said.

‘Patients on 1 October could walk into a practice and ask to be registered as an out-of-area patient and yet practices haven’t got any information at all about what it means and what the implications are. In many ways it is a bit like the NHS 111 implementation, we called repeatedly for it to be delayed, eventually it was and I think we were proved right.’

‘There is no urgency to do this and there is a risk that if they were to go ahead before everything was in place, and before the necessary services have been appropriately commissioned then there could be a risk to patients.’

The scheme has previously been criticised for being rolled out despite being insufficiently piloted, as the official pilot was dogged with delays and the final evaluation revealing that a third of surgeries failed to register a single out-of-area patient.

Pulse revealed last year that the pilot was struggling to get off the ground, with practices at two of the selected PCTs boycotting the project altogether and only 12 patients registering out of their area by June 2012, a number that was still only at 514 by the following January.

NHS England did not respond to Pulse’s request for comment.

Readers' comments (21)

  • We're going to use a really small map and redraw our boundary to be just around the practice building itself. If we submit it on paper NHS-England will be too busy playing with their £1.2million ipads and iphones to notice and then we'll only have to visit patients who live at the surgery. Muhahahaaha

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  • One can register all patients outside local CCG area with promise of free Cialis and play havoc with local CCG budget!
    What happens when someone living in York is registered in London where he works and has a admission in London- who will the NHS Trust charge- the local CCG or the original CCG or NHSE.

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  • When your neighbouring prctice closes or closes its list NHS England will be able to register those patients with you, even if they are outside your boundaries!
    I wouldn't touch this with a barge pole, it's their get out of jail card. They then only have to provide a visiting service for the rest.

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  • This is a brain-damaged policy, emperor's new clothes, a house of cards. No amount of time will enable them to get around the non-negotiable issues of practice capacity and the fact that living at a distance from the practice leads to problems, in direct proportion to the severity of condition of the patient.

    Do not delay the roll out. Roll it out, and watch it crash. Then the grotesque stupidity will be made manifest. It is a scam. The true aim of the policy is to make it possible for large for-profit firms to cream off mobile, relatively well patients.

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  • No, it is mother policy designed to allow organisations like care Uk to have a central hub with shared records so that patients can be seen anywhere. This is like a David Lloyd member being able to visit any David Lloyd gym. Traditional general practice is not meant to cope with it.

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  • It'll wither on the vine if we all say no. But that won't happen as other GPs will embrace as a way of topping up before jumpinng ship. Being a commuter belt practice could be very dodgy soon especially as when sick those healthy voters[-opps patients] won't want to see their near work GP

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  • Like most practices, we have a small number of patients who, over the course of time, have moved just outside our practice boundary. Most have been patients for years. Normally, in the interests of patient continuity, we have accommodated this and visited when necessary. But if NHS England insist on bringing in this half-baked, ill thought-out and ridiculous scheme in 3 weeks time, we would be very tempted to write to these patients apologetically and inform them, that because of new government legislation, we will no longer feel able to provide a home visiting service. Multiply our small number of patients by the number of practices in the country and you have a very significant of patients. I don't think it will take a very long time for the scheme to be shown for the nonsense it really is.

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  • To understand this policy you must appreciate it has no relevance to current model of GP delivered primary care. Fast forwards a few years into the down sized, large primary care centres left behind after many surgeries have been shut down by the financial destabilisation (MPIG and seniority defunding) and Prof Field's CQC practice closure program. Primary care contracted ready for corporate takeover. The HMO Kaiser model does not want profit extraction to be limited by practice boundaries. Their million plus patient lists will not be entitled to visits. Only those with transport and medical insurance will be welcome. The rest? Who cares. They are unprofitable and must either find the means to access care if there is a still a hospital close by that has not be closed and land sold off to property developers. Welcome to the brave new world to which the GPC still remains blind or atleast pretend to be.

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  • You don't have to do home visits at all if the patient lives outside of " boundary" .. That's the point of this scheme. I am in complete favour of this. Gpc is wrong on this.

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  • No, but the patient becomes the responsibility of some otter GP, who at this point in time has no guarantee of any money if he has to visit.

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