Exclusive LMC leaders across three areas trialling the removal of practice boundaries have warned the pilots face a ‘wave of apathy’ from GPs amid predictions some inner-city practices will be overwhelmed with commuter patients.
The Department of Health announced just before New Year it will road-test its controversial policy in parts of London, Manchester and Nottingham, with an independent evaluation after one year to determine the feasibility of wider plans to abolish boundaries across England.
Commuters within the three pilot areas will be able to use an alternative practice near where they work, by attending either as a non-registered out-of-area patient at any practice or as a registered out-of-area patient in a number of volunteer practices, with funding for patients using surgeries on a non-registered basis capped at £2m.
A DH spokesperson said it was unlikely practices would receive a higher level of funding per patient for out-of-area patients but said further guidance would follow.
The pilots will cover NHS Westminster, NHS City and Hackney, NHS Tower Hamlets, NHS Manchester, NHS Salford and NHS Nottingham City.
But LMCs said practices had not been consulted on the pilots and had shown no enthusiasm to sign up.
Dr John Hughes, secretary of Manchester LMC, said: ‘We’ve had no enquiries to the LMC about it – so far there has been a deafening silence. We are still rather low on detail, and £2m is not a great deal of money. What will happen when the money runs out?’
‘There was absolutely no discussion with the LMC about volunteering. These things are happening without the input of GPs on the ground. I think there’s a massive wave of apathy about this. Most of us are doing fuzzy boundaries anyway. That is the pragmatic solution.’
Dr Kambiz Boomla, chair of City and East London LMC, said relaxing boundaries had ‘appalling’ implications for health inequalities, and predicted a huge capacity problem if patients choose to register close to work, warning practices in the deprived borough of Tower Hamlets could be overwhelmed by Canary Wharf commuters: ‘We have a shortage of premises in Tower Hamlets and a rising population. You can’t just pile in more doctors into existing premises, there isn’t room. Unless the Government funds two or three more centres, I see this ending in tears.’
Chris Locke, secretary of Nottinghamshire LMC, added: ‘We are not aware of there being significant numbers of patients commuting into Nottingham, and we have a GP walk-in centre, and a nurse-run walk-in centre, so it seems bizarre. Statistically, there may not be enough patients to form any valid conclusions.’
But Dr Trevor Mills, medical director of NHS Nottingham City and Nottinghamshire County PCT Cluster, said: ‘This is an exciting scheme which has the potential to provide a more relevant and efficient service for thousands of patients. We welcome the fact that the pilots are not focused only on huge city areas.’
Outside the pilots, all GPs in England will be expected to agree with their PCT from next April an outer boundary within which they will retain, where clinically appropriate, existing patients who have moved further away but want to stay with their practice.
A DH spokesperson said: ‘The funding issue hasn’t been sorted out yet. But I don’t think they would receive more [than the standard payments to practices] as it wouldn’t be fair.’