The Government has announced it is to abolish ‘open but full’ GP practice lists as it set out further details of how it will road-test the removal of practice boundaries and expansion of patient choice – including an outline of how home visits will be delivered.
New DH guidance reveals legislation will be introduced to ensure there are ‘no incentives for practices to seek to declare “open but full” lists and so that there is a shorter default period for a closed list’.
‘A practice’s list of patients must be either open or closed,’ the document states. ‘A practice with an open list can refuse an application only where it has reasonable, non-discriminatory grounds for doing so.’
Under the plans, practices that wish to close their list will have to make a written request to their PCT setting out their reasons for doing so. PCTs will be required to explicitly consider the effect of the list closure on patients, and there will no longer be provisions to allow lists to reopen and close according to rises and falls in list sizes.
Practices with closed lists will retain their right to deliver additional and enhanced services.
The controversial revamp of the existing system will require all GPs across England to agree with their PCT an outer boundary where they will retain, where clinically appropriate, existing patients who have moved into the outer boundary area and want to stay with the practice.
In addition, patients in three pilot areas in London, Manchester and Nottingham will be able to register or receive a consultation with a GP practice of their choice from April 2012, even if it falls outside their traditional catchment area.
The latest guidance says PCT clusters will be expected to discuss appropriate outer boundary areas with each practice, with contracts amended accordingly once these have been agreed. In cases where a patient lives within the outer boundary area of a practice, that practice would retain responsibility for home visits.
When discussing outer boundary areas, the DH advises clusters to ‘take the opportunity to work with GP practices to review any existing (inner) boundary areas with a view to improving equity for patients and practices’, to address ‘significant and unwarranted variation’ in the size of some catchment areas.
Practices where people choose to register as an ‘out-of-area patient’ with a participating practice in the pilot areas would not be required to provide home visits. Instead, PCT clusters where the out-of-area patients live would be expected to provide alternative arrangements.
The DH said PCT clusters in the pilot areas would need to put in place ‘a coherent 24/7 urgent care service’ as soon as possible to meet the needs of patients who register away from home.
It said such services could be provided by ‘the GP practice with which a patient was previously registered, groups of practices (possibly building on examples of existing collaborative arrangements for home visiting), a GP-led health centre, walk-in-centre or urgent care centres, an out-of-hours service or ambulance services’.
Where patients in pilot areas are registered away from home, the practice where they are registered will be expected to offer the patient the choice of using community health teams attached to the practice, or being referred to community services that cover the area they live in.