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Little patient demand for abolishing practice boundaries, claims GPC

The Government is pressing ahead with the abolition of practice boundaries, despite the official evaluation of the pilots showing patients do not want to register remotely, claims the GPC.

Members of the negotiating team told Pulse that uptake of pilot schemes was so low that it ‘demonstrated there was no need to remove practice boundaries’.

Pulse previously reported that the lead researcher tasked with evaluating the scheme on behalf of the Government says the pilots have not been going long enough to evaluate the economics of the scheme, or estimate which patients might use it.

But the GPC says that the evidence they have seen does not indicate a great call for a choice of practice and that it would have been better to go with their proposal of ‘fuzzy’ practice boundaries.

Under the new contract deal for 2014/15, all GP practices will be able to register patients from outside their traditional practice boundary areas from October 2014 without any obligation to provide home visits for such patients. NHS England will be responsible for arranging in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

GPC negotiator Dr Beth McCarron-Nash, told Pulse that the move was a major part of the Government’s ‘agenda’, but that it was trying to fix a problem that doesn’t exist.

She said: ‘We have always been very clear that the removal of practice boundaries is not necessary, there has been a pilot but the number of patients who enrolled in that pilot is so small that, in our view it demonstrated there was no need to remove practice boundaries.

‘This is the Governments agenda, they feel it will improve choice but the evidence from the pilots shows, that actually patients did not choose to move, on the whole. The main reason patients in the pilot decided to register remotely, was in line with our policy which is fuzzy boundaries – patients who moved a street or two away from where they were currently registered.

‘So the number of patients registering remotely was very small, so that’s why I say this is the Governments agenda for a problem that doesn’t exist.’

Under the new contract, the Local Area Team will be responsible for arranging in-hours urgent medical care when needed at, or near home, for patients who register with a practice away from home.

The Department of Health told Pulse: ‘We believe that choice can be an important lever for raising standards. Not everyone may want to take advantage of the scheme but  it is important to offer people more say and flexibility of their care – for example there are people who move home a few miles and wish to stay with their GP, or those people who commute to work and so cannot access their local surgery during the times it is open.’

Dr Mike Ingram GPC member and a GP in Radlett, Hertfordshire, told Pulse that the pilots had been an ‘expensive failure.

He said: ‘It’s interesting that Jeremy Hunt’s continuity of care, old-fashioned doctors, your own GP – and in our practice it happens, we do run personalised lists. Then you’re going to have another GP who doesn’t know you, somewhere else, offering you other care.

‘It doesn’t sound very “coordinated”, “integrated”, “continuative care”, “your own GP”, Jeremey Hunt buzzword-type stuff does it? It sounds divides, and inefficient.

‘Now that we know that of the pilots, the uptake has been as close to zero as you can get. The take-up has been very poor so far.’

He continued: ‘It just really hasn’t taken off so far, the idea’s been there, and it’s proved an expensive failure. A lot of money’s been invested in it and not much take-up’