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Fresh blow for DH ‘patient choice’ strategy as one in three practices refuses to set outer boundary

Exclusive One in three GP practices have refused to follow Department of Health recommendations to widen their catchment areas - and some have even shrunk their practice boundaries - a Pulse investigation reveals.

The DH successfully pushed for a clause to be inserted into the current GP contract last April compelling practices to discuss outer boundaries - areas slightly larger than their catchment areas for patients who have moved house but wish to stay with the same practice - with PCTs by 1 July 2012 (see box below). The BMA agreed to the clause on the proviso that GPs could opt out of the clause if they could successfully argue that their catchment area was already large enough.

The initiative formed a key part of the Government’s drive to extend choice for patients along with six pilots which trialled the abolition of practice boundaries altogether.

However a Pulse investigation covering 26 PCTs and 1,387 practices has shown that 31% of practices have not set an outer boundary, with or without the blessing of their PCT. Just over half of practices - 54% - went along with the DH plans and agreed an outer boundary, while discussions are still outstanding for 15% of practices.

Related stories

Map of practices participating in outer boundary pilot

Case study: ‘My practice shrunk its catchment area’

The clause inserted into the GP contract also included a provision for practices to review their core boundary, with 2% of practices amending their catchment areas. However, this has the unintended outcome that some PCTs have even agreed for practices to shrink their catchment areas in some cases, setting the old catchment area as the outer boundary. The SHIP cluster, formed of Southampton, Hampshire, Isle of Wight and Portsmouth PCTs, said three practices had shrunk their core boundaries.

PCTs appear to have taken wildly different approaches to the scheme. In the Birmingham and Solihull cluster area, which covers four PCTs and 239 GP practices, not one has set an outer boundary.

A cluster spokesperson said: ‘Our interpretation of the legislation is that it is up to GPs to decide, in a voluntary undertaking, whether they wish to set an outer boundary. We asked practices to name an outer boundary, however it is for them to decide and they can opt out if they wish.’

‘To date, no practices have confirmed that they wish to set an outer boundary to their catchment area and we have received no applications from any practice to extend or reduce their boundaries.’

A spokesperson for the Derbyshire cluster, where 39 practices agreed to set an outer boundary and 67 declined, said that: ‘The door remains open to those practice declining or who have yet to make their decision.’

Dr John Canning, a GPC member and a GP in Middlesborough, said the DH has largely lost interest in pushing the policy.

He said: ‘Everybody had to look at their outer boundary but it was not appropriate to extend it for everybody. If you are an inner-city practice which already covers a large area, extending that area becomes very difficult to work with.’

‘It was a stick they [the DH] were wielding to solve a problem, but there really wasn’t much of a problem to solve so they have moved onto other things.’

But a DH spokesperson said: ‘It is a 2012/13 Operating Framework requirement that primary care trusts work with their GP practices where they want to establish an outer practice boundary - as agreed with the BMA as part of discussions on changes to the GMS contract.’

‘The department expects strategic health authorities to ensure PCTs meet their requirements in this area and manage their practice contracts.’

It comes as a recent Pulse investigation revealed that just over 500 patients have opted to register with an out-of-area practice under the Government’s flagship scheme to test the abolition of GP practice boundaries.

The £2m GP choice pilot, which was intended for six PCT areas but was boycotted by practices in two of them, comes to an end next month (31 March) with the London School of Hygiene and Tropical Medicine set to evaluate its success and report in July this year. In the meantime, the health secretary has set out an interim extension of the scheme, which means registered patients do not have to deregister while awaiting a decision on whether or not the scheme will be extended.


What the 2012 guidance says

‘It is expected that, by 1 July, practices and PCTs will have discussed and agreed variations to contracts or agreements which will establish an outer boundary area. All PCTs should therefore be working with their GP practices to agree and establish outer boundary areas so that patients who move home within these areas can stay registered with the practice if they wish, unless the practice believes it would not be in patients’ interests to do so.’

Source: Department of Health guidance to PCTs