GP practices will be paid £60 per home visit to patients registered with an out-of-area practice under the new GP choice scheme being rolled out in January, service specifications released today have revealed.
The specifications for the new enhanced service also said that GPs will be paid £16 for conducting a appointments in practice with a patient registered elsewhere, which is more than had been previously expected, after Pulse revealed that one area team had arrangements in place to pay £40 for home visits and £11 for emergency appointments.
In separate guidance on the GP choice scheme unveiled by NHS England today it also revealed that in order to pay for the provision of local care to these patients it may have to reduce payments to the GP practices that are registering out of catchment area patients without the responsibility for home visits.
NHS England admitted that it only expected 0.4% of the population to use the new patient choice scheme, which allows them to register out of their area, including registering with practices closer to their work.
The details of this new enhanced service come after NHS England was forced to delay the scheme from 1 October this year to 5 January, following concerns raised by the GPC that practices had not been given enough time to prepare.
Under the terms of the enhanced services, practices who decide to provide home visits and emergency appointments to patients registered elsewhere should ‘provide urgent and local care’ for patients who fall ill in-hours, who are recovering at home after a period of hospitalisation and home visits.
It also says that there will be a review of any patients who need to be consulted locally at least four times, or have more than two home visits, in a 12-month period to see whether they should be registered closer to home.
NHS England said it is ‘considering whether there should be a small reduction’ in order to ‘off-set the additional costs in meeting their urgent care needs when at home’. It said it will review data from the first six months of implementation to establish the cost of this and then negotiate with the GPC.
It also intends for patients to be directed to the correct urgent care service via NHS 111, which would be informed by the area team which GP practices or walk-in centres are available.
The GPC has warned that area teams and GP practices will find it difficult to plan for the enhanced service because nobody knows exactly how many patients will register with a practice away from their home.
However, NHS England’s guidance said it was expecting that this could be around 200,000 patients in all of England, or 0.4% of the population, based on the uptake in the pilots. These ‘have been typically younger, in work and without complex health problems’, it added.
It said: ‘If this remains the case through national roll-out then the demand for clinically necessary home visits is likely to be low. However, this will need to be kept under review as a growing numbers of patients choose to register out of area without home visits.’
NHS England said ‘most’ pilot patients were also registering with a relatively local practice but lived outside its catchment area. The guidance said: ‘This group of patients should not, in general, need to access alternative arrangements for urgent in-hours primary medical care on the basis they will seek and be able to attend for routine appointments at their registered practice.’
Pulse revealed in September that service specifications for a new enhanced service were sent to GPs in a ‘pre-emptive’ letter from Hertfordshire and the South Midlands area team, before NHS England announced a delay to the policy.
The service specifications for the new enhanced service stated that practices would be offered £11.90 for every routine appointment or telephone consultation that they conduct for patients registered elsewhere.