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Two in five GPs will not open up practice boundaries

Two in five GPs will refuse to open up their practice boundaries when the Government’s flagship policy comes into effect in January 2015, with many saying they do not have the capacity to take on more patients, a Pulse survey has found.

A survey of 482 GPs in September, before the delay to the policy was announced, showed nearly 40% planned not to accept out-of-area patients under the new arrangements, while nearly a third (32%) had yet to make up their minds.

The results tallied with a previous Pulse survey in March, which showed that nearly three-quarters of GP respondents disagreed with the Government’s plans to dilute GP practice boundaries when it was first floated in the 2014/2015 GP Contract.

The policy in which GPs can register patients who live outside their catchment area but do not have to provide home visits, was scheduled to roll out on 1 October but at the eleventh hour, NHS England announced it would be delayed until January 5 next year to be ‘completely assured that robust arrangements are in place across the country’.

The Government’s aim with the scheme has been to widen patient choice by allowing people to register with the GP surgery they think is most suitable for them, regardless of where they live. Yet NHS England’s ‘choice of GP’ pilot showed there was little demand from patients or practices for the scheme, with more than a third of the participating surgeries failing to register a single patient from outside their practice boundaries.

Many respondents to September’s survey said that their practices were already under pressure from existing patients and did not have the capacity to take on more from outside their catchment areas.

GP partner Dr Kathryn Carter said: ‘Our list is increasing already; we are not allowed to close it, and we are already struggling with the increasing workload.’ Meanwhile salaried GP Dr Elizabeth Foster wrote: ‘We are struggling to cope with the locals, especially as with an APMS contract the money only goes up in tranches!’

Dr Charlotte Ferriday, a GP partner in Plymouth, also said that her practice had ‘no more capacity’ for patients as it was. She added: ‘We worry that out of area patients may be more challenging and shopping around for the “right solution” to their problem. It is worrying the NHS England have not sorted out how we should cover in hours visits.’

Several other respondents also highlighted the issue of how they would be expected to arrange and finance home visits to out of area patients under the new arrangements. Despite suggesting earlier this week that GPs are likely to be reimbursed for out of area home visits to the tune of £40 per visit, NHS England is yet to publish guidance on the new commissioning framework area teams will use to deliver care for out of area registered patients at home.

It has told Pulse that an enhanced service specification that area teams will use to commission at-home services will be published in October, alongside general guidance for GP practices, NHS England area teams and Clinical Commissioning Groups on the new arrangements.

However Tower Hamlets LMC in London has warned constituent practices that the Government’s strategy may divert funding to young people and the ‘articulate worried well’ at the expense of more vulnerable patients, such as the elderly and mentally ill.

Dr Jackie Applebee, vice-chair of Tower Hamlet LMC, said that she and her colleagues were concerned that the abolition of practice boundaries would make the ‘already dire’ situation in general practice worse.

She said: ‘In Tower Hamlets we have worked hard to improve outcomes, and now, in one of the most deprived boroughs in the country, we have some of the best immunisation rates and cardiovascular outcomes in the country. This work would be undermined if practice boundaries are abolished.

‘The buzz word of the day is “integrated care” [and] we cannot deliver this if we are to care for patients who live miles away from our surgeries.’

But not all GPs plan to boycott the scheme. Nearly 30% of respondents to Pulse’s survey said that they would accept out of area patients when practice boundaries were removed – although many suggested that they would restrict this to current patients who had moved away across practice boundaries.

Dr Jonathan Harte, a GP partner in Nottingham, said: ‘It’s a way to keep our list size up, with patients we already know and have a relationship with. We won’t offer visits to non-registered patients inside our practice area though.’

GP leaders have advised practices to exercise caution when considering whether or not to sign up to the new arrangament. GPC deputy chair Dr Richard Vautrey told Pulse that there were many ‘unanswered questions’ that needed to be resolved by NHS England before GPs sign up to the scheme or the new national enhanced service.

He added: ‘There’s still quite a fine timeline if they’re going to be able to begin in January. Every local area needs to commission a service that can care for patients should they be ill and unable to travel. That needs to be fully in place before any patient registered anywhere uses this new scheme.’

Survey results

Question: Will you accept out-of-area patients?

Yes – 28%

No – 39%

Don’t know – 33%

About the survey: Pulse launched this survey on 7 September 2014, collating responses using the SurveyMonkey tool. The 29 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 482 GPs answered the question.