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GPs undermine DH scheme by refusing to extend practice boundaries

Exclusive: Scores of practices are refusing to extend the outer boundary for their catchment area by using a loophole in the Government's scheme to increase patient choice, Pulse can reveal.

PCT figures reveal that many practices are refusing to alter their boundary areas, despite the Department of Health insisting they can only do this in ‘exceptional circumstances'.

The move comes as Pulse can reveal that almost three-quarters of PCTs have failed to agree outer boundaries with GP practices by the Department of Health's deadline of the 1 July.

The figures are the latest blow to the Government's scheme to allow patients a greater choice of GP practice, with Pulse revealing last month that only 12 patients had decided to register out of area under pilot schemes in several cities.

All practices in England  were required under the 2012/13 GP contract to agree an outer boundary with thier PCT by the beginning of this month.

However, DH guidelines allowed practices with large boundary areas to exempt themselves, but only in ‘exceptional circumstances'.

Information from 25 PCTs responsible for 1,700 GP practices shows over a fifth - 21% - had agreed an outer boundary while almost three quarters - 73%- had still not reached an agreement with their PCT. 

To date, 81 (5%) practices have asked for an exemption on a new outer boundary for their surgery although in some areas they are putting pressure on practices to reconsider.

In Leeds, 18 practices have refused to provide a new outer boundary, and 46 are still negotiating with the PCT.

A spokesperson from NHS Leeds said: ‘18 practices have at this stage suggested they do not require an outer boundary as either their current boundary already covers a large geographical area and/or their outer boundary would consist entirely of green space.'

A spokesperson from Dudley PCT said seven practices had refused to extend their boundary.

He said: ‘The PCT is reviewing these seven practices which will involve further discussions with GPs.

‘If there was a difference of opinion, it would be escalated to the Black Country Cluster functions committee for further decision making.'

Dr Tim Horsburgh, medical secretary of Dudley LMC, said practices had valid concerns about workload from expanding their practice area.

He said: ‘Expanding the outer boundary isn't just a fuzzy extension to incorporate existing patients, they're actually just expanding GP practice boundaries.

‘Suddenly they'll have thousands of new patients with no provision or planning on how they're going to provide the extra service.

‘If you're fully staffed and can't fit another doctor into your building, then how is that going to work?'

Dr Richard Vautrey, a GPC negotiator, said it was unsurprising that so few practices had fulfilled the DH's request.

He said: ‘Both practices and PCTs have far more important things to be doing at the moment and so agreeing an outer boundary is not seen as a priority and so it is no surprise that many have yet to do this.'  

A DH spokesperson told Pulse that ‘GP practices and primary care trusts should have discussed and agreed their outer boundary areas by now.'

‘In exceptional circumstances if a GP practice already has a large boundary area then it may not be appropriate for that practice to establish an outer boundary area.'

 GP choice stalls

21% of practices have agreed an outer boundary with their PCT

74% of practices have not yet agreed an outer boundary

5% of practices have refused to a new outer boundary