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Gerada: Removal of practice boundaries will break link between GPs and their communities

Removing practice boundaries will break the link between GPs and their local population and undermine patient care, says former RCGP chair Professor Clare Gerada in a strongly worded attack on the Government’s plans to boost patient choice.break

In an exclusive interview with Pulse, Professor Gerada warned that the controversial initiative to allow patients to register with practices outside their locality would impair the ability of GPs and CCGs to plan care.

Professor Gerada also participated in a outspoken Q&A session with Pulse readers today and spoke to Pulse about her plans for primary care in London.

The former RCGP chair - who moved on from the college last month to become chair of NHS England’s Primary Care Clinical Board in London - expanded on the ideas raised in a ‘call to action’ consultation she helped to launch last week on primary care in the capital.

She suggested that the profession considered the possibility of co-locating primary care services in hospitals and giving patients a four-hour guarantee of an appointment, if resources were put in place.

In the interview, Professor Gerada also:

  • criticised the BMA and other medical leaders for failing to speak out against the Health and Social Care Act
  • said professional bodies – including the RCGP -  should take a uniform neutral stance on ethical issues such as assisted dying;
  • reaffirmed her belief that the independent contractor status of GPs should be reconsidered.

But she reserved her harshest words for the plans in the recently released GP contract deal for 2014/15 for the pilots of removing practice boundaries for out-of-area patients to be rolled out across England.

The controversial pilots 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 Gerada told Pulse: ‘Removing boundaries is wrong for a [number of reasons]. It removes the relationship between the patient and their local community, and the GP and their local community, which has been there for time immemorial. It makes planning difficult – how on earth will a GP know how many patients will be on their list in the next year, or the year after? And it is not good for patients.’

Patients will not be given more choice through this initiative, Dr Gerada warned. She said: ‘Patients seem to think they will be choosing their GP, but in fact it will be their GP choosing them. If you have a choice from 60 million people, why would you choose the very sick? The ones with mental illness, those that are homeless, those with complex comorbidities.’

‘I will attract [healthy patients] by offering free membership for a gym, or at the bottom of the swimming pool because they will be fit.’

Practices are already offering patients ‘solutions for their access’, she added.

‘For years, my furthest patient lived in Portsmouth, because they could not access the sort of care they needed. But that was a drug user who I needed to provide continuity for. I think federations are the answer – federations give choice that are beyond just that practice to a much wider geographical area.’

Dr Gerada said that NHS England’s call to action in London would allow the profession to consider a number of options for transforming primary care, including co-locating GPs to help them address the needs of hard-to-reach patients.

She said: ‘If we start designing services around the patient, we will stop getting in to this territorial argument and we will start to make things better… what I am against is the idea we should move GPs lock stock and barrel into hospitals for some pragmatic reason – eg, space.’

An ‘aspiration’ to see patients within four hours would be’ good news – good news for patients, good news for general practice’, but will only be done with more resources, she added.

She criticised other medical leaders for being ‘fearful’ over opposing the Health and Social Care Act: ‘I think the Act was quite an eye-opener about how those in leadership positions were fearful of being leaders and putting their views forward in case they said the wrong thing, or upset somebody.’

She added: ‘I think the BMA were slow. When they started to be lobbied and forced to act, they did well. But they were slow to act. They didn’t inform the public and the profession what lay behind the HSCA, which is now being played out as predicted as too much, too soon and the wrong changes.’

Dr Richard Vautrey, deputy chair of the GPC, said the GPC ‘shared her concerns’ about practice boundaries. He said: ‘We made our concerns very clear in the reponse to the consultation when the Government first announced the initiative.

‘If you look at the evaluation of the limited pilot that has taken place, many of the concerns are also expressed by the PCT managers. There are lots of potential consequences of what superficially might seem like an attractive scheme.’

In terms of the contract agreement, Dr Vautrey added: ‘The agreement was that we acknowledged the Government’s intention to roll out… there wasn’t negotiation about it, it was part of the Government’s intent. It was a recognition that this was going to happen.’

However, he said that Dr Gerada’s suggestion that the BMA was slow to oppose the Health and Social Care Act was ‘complete nonsense.’ He said: ‘If we look back in history, we will find that the BMA was the first organisation to come out against the bill, even before the RCGP.’