It seems that NHS England’s new idea for GPs is the old Aneurin Bevan tactic of ‘stuffing their mouths with gold’.
First there was the £55 payment for every additional dementia diagnosis, and yesterday Pulse revealed managers will pay £60 per home visit to practices for patients registered out of their area.
Although far from being ‘gold’ (particularly after tax and expenses) these payments are almost as much as GPs receive under global sum per patient for an entire year. Why the sudden urgency?
After an abortive launch in October, NHS England is desperate to make their policy of diluting GP practice boundaries work.
They have been plagued by the complexities of undermining one of the founding principles of the NHS – the locally based patient list – and rising opposition from the profession.
The fact that the policy was not exactly supported by data from the pilots run last year has not helped.
But giving patients a greater ‘choice’ (yes, there is that word again) of GP practice is a key part of the coalition’s plan for Government.
It seems that after they received their orders from ministers no-one at NHS England initially took much time to think through the complexities of diluting practice boundaries.
After many months, managers have managed to come up with what looks like an expensive fudge – offering a national enhanced service (NES) to practices to pay paid £16 for conducting a appointments in practice with patient registered elsewhere and £60 for a home visit.
Practices who register out-of-area patients under the scheme will – initially at least – get the full global sum payment for that patient despite not being responsible for home visits.
On the surface this looks like a financial boon for general practice, but there are some huge potential problems that will need to be overcome if this scheme is going to work:
1) NHS England says it expects only 0.4% of the population to register out-of-area, but in reality no-one knows how many will. In areas like London, it could cause massive problems if practices cannot plan how many patients they will register. Practices in suburbs will find their income increasingly unstable and dependent on a NES that only pays out when patients need a home visit. Is this any way to run a health service?
2) If a patient registered at a distant practice falls ill and requires a home visit, how will they know what local practice to call? Answer – via NHS 111. And we all know how functional that can be.
3) If a patient is at home and calls their registered practice (near work, say) for about advice for an acute illness. They are told they need to be seen. Who has to make this happen, the registered practice, or the local practice which is signed up to the home visit NES? Who is liable if it does not happen and they go on to develop something more serious?
4) It is far from clear how out-of-area patients will be signposted to community services. NHS England says the registered GP practice should consult those listed on NHS 111 and NHS Choices and if this does not work, the relevant CCG. Community teams should provide one point of contact. This sounds like a chaotic merry-go-around.
5) It seems that current out-of-area patients registered with GPs will have to unregister and re-register in order to be eligible for home visits under the NES. Is this really necessary? How on earth can practices explain that to patients?
So many unanswered questions and just weeks before the scheme goes live.
Nigel Praities is editor of Pulse
