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Lansley backs away from complete abolition of practice boundaries

The Government does not plan to entirely abolish practice boundaries and may restrict patients to registering only with GPs covered by their local commissioning group, health secretary Andrew Lansley has said.

In his keynote speech to the RCGP Annual Conference this weekend, Mr Lansley said he wanted to extend patient choice when practice boundaries are relaxed from next April - but pledged that clinical commissioning groups would ‘preserve responsibility' for the health of their population.

His speech - which ‘softened his stance completely' on practice boundaries, according to GP leaders - backs suggestions from NHS Future Forum chair Professor Steve Field revealed in Pulse earlier this month that practice boundaries will not normally be extended beyond the borders of a commissioning group to ensure GPs retain responsibility for a geographical area.

In a bid to win GP backing for his reforms, Mr Lansley told delegates that although the issue of practice boundaries was ‘very controversial', he was looking at ways to work around the issues without abolishing them entirely.

He said: ‘I'm clear that whatever we do, general practice must always remain rooted in local communities. We need to think carefully about how to manage home visiting, about how patients who don't live locally to their practice can receive urgent care, and about how information is shared.'

‘We will make sure it is done in a way that will preserve the responsibility for CCGs for the health of their local population.'

When pushed to clarify his position, Mr Lansley said:‘I am not abolishing, or about abolishing, practice boundaries. I am intending to extend patient choice.'

In the speech, he defended the NHS reforms, but also said the Government would ‘happily' amend the health bill to allay fears over the secretary of state's accountability for the NHS and slow the introduction of any qualified provider and said he was ‘very sympathetic' to the need for enhanced GP training.

GP leaders welcomed Mr Lansley's comments.

Dr Clare Gerada, RCGP chair and a GP in Kennington, south London, said: ‘We heard four concessions today.'

‘Mr Lansley didn't make an enormous song and dance about it but I think they were concessions and he softened his stance on practice boundaries completely. He has changed the line to one of "patient choice" rather than removing practice boundaries.'

‘But there are still grave concerns about the bill. What amazed me is that I did not hear enough acknowledgement from Mr Lansley of the need to address our concerns. There are so many people in the medical profession saying the same things and we are not all lemmings. I would quite like some acknowledgement that there are issues.'

Two years ago Mr Lansley, then shadow health secretary, labelled practice boundaries ‘a solid wall of defence' against patient choice, and proposals to open up GP lists remain a key plank of the Government' vision of NHS modernisation.

The health secretary's defence of his NHS reforms failed to win over all GPs. In a heated Q&A session, just one GP spoke in support of Mr Lansley, as delegates told him he was ‘patronising' the profession by claiming GPs ‘misunderstood' key elements of his reforms, and attacked claims that doctors back the bill, which they said was ‘plainly not the case'.

Dr Pete Deveson, a GP in Surrey, told Mr Lansley:‘You've repeatedly claimed you're not privatising the NHS, but surely that depends on how you define privatisation?'

‘Your intention to maximise the number of private providers will inevitably bankrupt the single payer, necessitating the introduction of fixed funding, of co-payments, of insurance, which surely is a privatised system.'

Dr Stuart Sutton, a GP trainee in London, said:‘A lot of us have tried to read the bill Mr Lansley and it's a little bit patronising to say we don't understand it.'

‘I think there is a complete problem in the fact that all the staff in PCTs, SHAs, are all sleepwalking to oblivion as well. We're trying to save £19bn as well as delivering the best care as we possibly can to our patients, but all we see is complete chaos.'

In a fiery exchange on privatisation, Mr Lansley rejected claims that he wanted to drive the NHS towards a US-style insurance based health system. Pushed on the topic, the health secretary said he defined privatisation as patients having to pay at the point of use, and said the NHS reforms did not allow this to happen.

Delegates, including RCGP chair Dr Clare Gerada, questioned the scope of Mr Lansley's definition of privatisation and said many GPs had wider concerns over the bill extending private sector influence in the provision and commissioning of care.