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Boundaries pilots may not yield meaningful results, GPC warns

Exclusive: Pilots testing the abolition of practice boundaries may not be producing reliable data due to the small number of practices opting to take part and the short timescale for completion, the GPC has warned.

Some 42 practices across six areas of England have now signed up to the Government’s practice boundarypilots, negotiated as part of the 2012/13 contract deal to allow patients to either register with or attend as an out-of-area patient at a surgery closer to their place of work.

But there is huge variability in interest from practices, with two pilot areas boycotting the scheme entirely due to uncertainty over funding arrangementsand others signing up just a fraction of local practices, leaving the scheme behind schedule.

Although some areas have now started the pilots, the GPC has cast doubt on whether theywill be able to yield meaningful data by the end of the one-year duration, suggesting GP leaders may seek to extend the trial.

The Department of Health did not rule out an extension, but said it would need to be negotiated with the GPC as part of contract negotiations for 2013/14.

All practices in NHS Tower Hamlets and NHS City and Hackney have boycotted the pilot, after protestations that the extra work incurred by practices would be unfunded.

In Nottingham, just seven practices out of 64 have signed up to the pilot scheme. NHS Nottingham City could not provide information on whether any patients had switched practice since the scheme went live on 23 July.

Eight out of 101 practices in Manchester – and nine out of 56 practices in Salford are taking part in the pilots, fewer than the number who initially expressed interest in the scheme.

NHS Manchester said no patients have signed up in its locality to date.

But the scheme has proved more popular in Westminster, with 18 practices taking part in the pilot and 34 patients taking part.

Dr Peter Holden, GPC negotiator, and a GP in Matlock, Derbyshire, said it was unlikely data from the pilots would be useful given the low number of practices involved and the short timeframe between pilots going live and the end of the scheme.

He said: ‘If there aren’t very many participants and it doesn’t run for a very long time, then you can’t be sure the data accurately reflects the truth. You can’t be sure it isn’t a fluke.’

Dr Deborah Colvin, chair of City & East London LMC, said fears over funding and the validity of data meant it was unlikely practices would now join the scheme in Tower Hamlets or City and Hackney.

She said: ‘They wouldn’t be any extra commissioning money. We decided we weren’t going to take part. The knock-on effect on the overall health economy was too great. We also wanted to know what data they were going to collect and whether it would be valid. It’s all very well to talk to the commuters who’d say it was lovely, but they needed to talk to local patients to get their views on whether appointments had been pushed back. We never got any reassurances and so couldn’t take part.’

A DH spokesperson said any extension of the pilots would need to be negotiated with the BMA as part of next year’s GP contract: ‘We will work closely with all GP practices involved in the pilots to ensure we get the best possible information and knowledge about how we can give patients greater choice of GP practice. How we gain this data will evolve over the course of the year and the results of the evaluation will help us plan for the future.’