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GPC calls for further delay to practice boundaries scheme over fears for patient safety

Exclusive The GPC has called for the Government’s flagship practice boundaries scheme to be halted again over fears for patient safety, as figures obtained by Pulse reveal that only one in five practices has signed up to provide urgent cover for patients registered out of area.

Initial figures covering eight NHS England area teams in the north of England showed that only around 20% of GP practices signed up to do the new enhanced service designed to ensure patients can be seen near their home when they are too ill to travel to their registered practice.

The figures, obtained by Pulse almost two weeks after the 5 December deadline for signing up, come as NHS England said a majority of area teams had decided to extend the deadline or accept rolling entry to do the enhanced service.

It has indicated it will allow practices to register patients from outside their area from 5 January as planned.

However, the GPC has said that there is a ‘risk to patient safety’ if the Government ploughs ahead with its plans, as there will not be sufficient cover to provide home visits or urgent care sessions.

NHS England has already delayed the scheme from its original starting date of October this year, to be ‘completely assured that robust arrangements are in place across the country’, following GPC concerns.

Allowing patients to register outside their area was a pledge made in the 2010 Coalition Agreement that formed the alliance of the Conservative Party and the Liberal Democrats in government, but it has been besieged with problems.

One of the major concerns was the lack of urgent cover for patients who are registered outside their area, so NHS England unveiled a new enhanced service in November that will see GPs paid £60 per home visit to patients registered out of area and £16 for conducting an appointment in practice.

Pulse understands that NHS England is on schedule to roll out the scheme from 5 January, but despite this, most area teams could not describe the urgent care services they will be commissioning locally.

In the south of England, all practices ‘have different deadlines’ for signing up to the enhanced services to provide home visits, a spokesperson said, including Surrey and Sussex local area team allowing practices to sign up until 5 January, when the initiative goes live.

In the north, sign-up to the enhanced service was lowest in South Yorkshire and Bassetlaw, where just 29 out of 216 practices (13%) are on board to date. This was closely followed by North Yorkshire and the Humber, and Arden and Worcestershire, both at 15%.

The highest sign-up was seen in Cumbria, Northumberland and Tyne and Wear, where 110 out of 301 practices will do the enhanced service, driving up the average across eight area teams to a 22% take-up.

According to NHS England, the area teams in question ‘will accept ongoing applications’, and asked whether the area teams thought the sign-up rate was sufficient to ensure the safety of patients choosing to register out of area, a spokesperson for NHS England in the north, Midlands and east said: ‘I don’t have any indication from them on that but it’s important to remember that the sign-up process is still ongoing effectively.’

But GPC deputy chair Dr Richard Vautrey said there were still major concerns about patient safety.

He said: ‘This is not a surprise as it demonstrates that practices share the concerns GPC has been expressing for the last few years about this policy and are yet to be convinced that this will work in practice. It also reflects the huge workload practices are already trying to cope with, leaving them with little capacity to do additional and unpredictable home visiting. It means that area teams will need to find other mechanisms to provide a comprehensive service.

‘The scheme must not go ahead until NHS England can guarantee that a comprehensive service in place. If there isn’t a comprehensive service in place in every part of England there is a risk to patient safety and the scheme should not be rolled out. This is what we said in October and is why there was a delay, and the same should happen in January if any area teams have not then commissioned a service.’

GPC member and Birmingham LMC executive secretary Dr Robert Morley also said the situation could present a risk to patient safety.

He said: ‘Yes, potentially it could, and as yet I don’t believe that any practice could possibly be in a position to feel that the situation definitely is safe.

‘The very low sign-up rates to the new enhanced service clearly speak volumes about the understandable concerns that GPs have about signing up to this. Most have seen the extreme unattractiveness of an enhanced service that is funded at only about £15 for a consultation with a patient registered elsewhere, whom they won’t know, who is not well enough to travel to their registered practice and without access to their medical records.

‘It’s difficult to say for sure of course whether there will be sufficient capacity to provide safe and adequate care without knowing how many patients are going to sign up and what the capacity of the signed-up practices is to do the work, and also what sort of geographical footprint their practice areas might cover. All in all though, it’s very concerning and I would say presents significant risk that there may not be adequate GP cover in place to meet the needs of patients.’

Dr Morley said GPC guidance has clearly stated that any practice considering registering out-of-area patients under the new regulation ‘has a professional responsibility to assess whether there will be adequate arrangements in place for their care if they are unable to attend their surgery’, adding: ‘The information presented here clearly suggests that there will be massive uncertainty over that; I would expect therefore that most practices will be extremely reluctant to register out-of-area patients.’

The GP choice scheme has been met with a huge amount of scepticism from the profession and the pilot was held up by both boycotts and delays. Pulse has already revealed that one whole LMC area in central London is planning to boycott the scheme when it goes live, and a survey of GPs across England in September showed two-in-five had decided not to abolish boundaries while one-third were undecided.

NHS England has admitted that it only expects 0.4% of the population to use the new patient choice scheme.

NHS England was not able to provide a full statement, but did say that ‘patient safety is paramount’.

Enhanced service take-up by area team

Lancashire – 41 out of 230 (18%)

Derbyshire and Nottinghamshire – 57 out of 275 (21%)

Arden and Worcestershire – 32 out of 207 (15%)

Leicestershire and Lincolnshire – 57 out of 247 (23%)

North Yorkshire and Humber – 34 out of 234 (15%)

South Yorkshire and Bassetlaw – 29 out of 216 (13%)

Cumbria, Northumberland and Tyne and Wear (37%)

Durham Darlington and Tees – 46 out 169 (27%)

Source: NHS England