This site is intended for health professionals only


Managers delay publication of practice boundaries pilot evaluation once again



The publication of an independent evaluation of pilots that removed practice boundaries in certain cities has been delayed once again by NHS England, despite the policy being rolled out nationwide later this year.

The report by researchers at the London School of Hygiene and Tropical Medicine was due to be published last year, but NHS England told Pulse it will now be released ‘before the end of March’.

The evaluation looked at the GP Choice Pilot, which allowed commuter patients to register out of area in four areas of England.

The GPC said that they had yet to see the final findings from the pilots and that they had requested NHS England publishes the report.

In December, NHS England said the report would be published ‘before the end of the year’ and later on in the month ‘late January’.

A request for a copy of the report under the Freedom of Information Act submitted by Pulse in January was also refused.

As part of the 2014/15 GP contract, practices will be allowed to take on patients from outside their boundary zone from October, but the scheme will be voluntary.

Pulse recently reported that the majority of GPs intended to keep their practice boundaries intact despite the new policy.

The pilots, which begun in April 2012, suffered from delays and a lack of patients and practices signing up. All GP practices in two out of six PCT areas chosen for the study refused to participate and a Pulse investigation revealed that just 514 patients had registered with an out-of-area practice and 129 people had made use of being treated as a ‘day patient’ by early 2013.

An NHS England spokesperson said: ‘NHS England is working with the Policy Innovation Research Unit to make final preparations on the report before publication.  We are expecting that publication of this report by the London School of Hygiene and Tropical Medicine will be before the end of March.’

Dr Chaand Nagpaul, chair of the GPC, said it was important to ‘share the lessons of the report’.

He said: ‘I have no idea why they are holding it, you would have to ask those that are delaying its publication. But I think even without the evaluation we know that the uptake was extremely small in these pilots. We know that there is really not a major need for this change amongst the population. That is what I can say without seeing the report itself.’

‘We have been involved in regular meetings with the evaluation team, but the final version I have not seen.’

GPC negotiator Dr Beth McCarron-Nash said: ‘We have requested that they publish the report on the pilot.

‘Obviously best practice is to pilot something, see if it works and then make changes according to the result, but they are actually going ahead with this without any evidence that it is actually even necessary.’

In September, lead researcher Professor Nicholas Mays, professor of health policy at the LSHTM, admitted that his team had been unable to do a robust evaluation, including of the economics, because of the lack of people coming through the scheme within the short timeframe they had to work with.

Where is the practice boundary pilot report?

April 2012: One-year pilot, dubbed the GP Choice Pilot, begins, but GPs in two out of six areas decide to boycott the trial.

September 2012: First delay hits the project as the DH is forced to extend the pilot by six months, until September 2013, because of the ill-fated slow start to the project that saw just 12 patients signed up to the pilot by June.

January 2013: Pulse investigation shows just 500 patients register with out-of-area practices as most GPs shun boundary pilots.

July 2013: LSHTM gives an interim report to the Government, which is not published.

November 2013: Draft final report is submitted to the DH and NHS England, but is not shared publicly.

5 December: NHS England says the report will be available on the LSHTM website ‘before the end of the year’.

20 December: Without giving a reason, NHS England says it is now ‘expecting the report to be published late January’. 

6 January: A Pulse request to see the draft of the final report, plus accompanying correspondence on the GP Choice Pilot, under the Freedom of Infomation Act from NHS England is refused.

7 March: An NHS England spokesperson says the report is now expected by the end of March.