ICBs given powers to curb large-scale out-of-area GP patient registration

GP practices will have to seek commissioner approval before expanding out-of-area (OOA) registrations, under new guidance aimed at safeguarding patients and other providers.

From this month, ICBs are able to set thresholds requiring practices to pause new OOA registrations until they have demonstrated to commissioners that safety and quality measures are in place.

The move follows years of concern among GPs and LMCs that models such as GP at Hand destabilise neighbouring practices by attracting large numbers of their younger, healthier patients from outside their catchment area.

The guidance, published earlier this month, follows amendments to the GP contract regulations in July and makes clear that ICBs must consult LMCs when developing OOA policies. It warns that practices expanding rapidly through OOA registrations may present risks around clinical governance, safeguarding, workforce capacity, access to screening and vaccination programmes, and the wider impact on NHS services.

The guidance says ICBs should ‘prioritise assurance for any GP practices currently operating out of area registration at scale’.

‘For these practices, commissioners may wish to consider the position on whether they will exceptionally continue to allow new out-of-area registrations whilst this assurance is obtained, for example, because there are no clear patient safety or quality concerns or considerations.

‘Otherwise, the default will be from the point of communicating the local policy that approval is required, the practice’s patient list should be closed to new out-of-area patient registrations until assurance (approval) is gained.’

A BMA spokesperson told Pulse: ‘As this guidance notes, ICBs will need to engage with LMCs when developing an OOA registration policy applicable to practices, and notify all GP practices of it, to provide safeguards when GP practice patient lists are expanding rapidly with the registration of out-of-area patients.

‘As local representatives for practices, LMCs are vital in this process to ensure that any policies take into account the individual situations for practices and patients locally.’

Since 2015, the Patient Choice scheme has allowed GP practices to register new patients living outside the practice area. Practices have no obligation to provide these patients with home visits or out-of-hours (OOH) services when the patient cannot attend their registered practice. 

BMA guidance earlier this year highlighted risks that practices may be forced to make decisions that could discriminate based on medical condition, and that the scheme could be used to ‘cherry pick’ young, healthy patients, undermining the list-based system and destabilising other providers.

In recent years, Pulse has reported extensively on the rise of large-scale digital-first providers. GP at Hand, launched in 2017 by Babylon via a partnership with a Hammersmith practice, now has around 100,000 patients in London. Its Birmingham arm was closed after proving financially unsustainable.

Last year, Pulse revealed that GP at Hand planned to re-open registrations across London following its takeover by eMed, having previously closed its list. Pulse also uncovered that a north west London practice focused on remote consultation had erroneously re-registered more than 10,000 former patients.

Pulse has asked NHS England and eMed GP at Hand for comment.