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NHS paid private provider £165,000 for single home visit under GP Choice scheme

NHS England has paid £165,000 for a contract that has seen a private provider carry out just one out-of-area GP patient home visit and 18 phone consultations since last July.

The West Midlands local area team awarded a contract to health and social care provider Primecare in July last year to provide home visits to patients who are registered in practices outside of their area as part of the GP Choice scheme. 

The contract was worth £165,253 upfront, with an extra £80 agreed for each GP visit and £30 for phone consultations, NHS England confirmed.

But Primecare was only required to carry out a single home visit during that time, NHS England admitted, with the contract expiring yesterday.

GPs said that the GP Choice scheme was ’politically motivated’, and this contract showed what a ‘waste of money’ it was. 

The GP Choice scheme allows patients to register at a GP practice even if they do not live in its catchment area, which the Government said would benefit people who would rather see a GP near their place of work.

It was included in the 2010 Coalition Agreement, and practices were given the opportunity to take on out-of-area patients as part of the 2014/15 GP contract.

However, it attracted widespread criticism from the profession, which highlighted the safety concerns of patients who are signed up to out-of-area practices not being able to receive home visits. 

As a result, NHS England regional teams were told to ensure all areas had cover in case patients taking it up were too sick to travel to their registered practice.

NHS England in the West Midlands said it had to look to other providers after GP practices in the region had not been interested in signing up to the enhanced service aimed at covering such patients, under which they get paid £60 for a home visit or £15.87 for a consultation in their practice.

Primecare, whose contract covered Birmingham, Black Country, Solihull, Coventry, Warwickshire and Worcestershire, said its service included having ‘having two GPs readily available throughout the in-hours period Monday to Friday, providing a clinically safe service that meets the needs of both the patient and the commissioners’.

But Dr Grant Ingrams, a GP in Coventry and the former chair of Coventry LMC, said: ’At a time when the NHS is significantly underfunded, it is a travesty that money is being wasted on a politically motivated scheme which is not in the best interest of patients and puts a further nail into continuity which is the bedrock of high quality, cost efficient health services.

’This supports the scheme where practices can register patients who are out of their area, but do not have the requirement to provide home visits etc – i.e. when someone falls ill they will not be seen by a doctor who knows them – thereby not benefitting from continuity of care which we know improves patient care and decreases health costs.’

Birmingham LMC medical secretary and GPC member Dr Robert Morley said the fact NHS England had entered into the ‘appalling’ contract was ’an inevitable consequence’ of an ’ill-thought-through policy’.

He said: ’This is an absolutely disgraceful scandal but comes as no surprise. GPC has consistently pointed out the problems with the out-of-area registrations scheme, a politically-motivated gimmick which panders to the wants of the well at the expense of the needs of the sick…

’We advised practices against registering patients under the new regulations and it is clear that the overwhelming majority of practices agree with us, hence the very limited number of out-of-area patients registered. The scheme should be scrapped.’

Dr Morley said that NHS England had ’failed to make a proper assessment of the likely need and realistic cost of commissioning the service they required’ and had ’instead rushed into throwing a huge sum of tax-payers’ money at a private provider for delivering literally next to nothing’.

He added: ’Patients, the public and the profession will be very, very angry about this and heads in NHS England should roll.’

However lead director for primary care in the West Midlands David Williams said NHS England had ’a legal responsibility to deliver this service’ and that by awarding the contract it had ’fulfilled our obligations set out in [national] guidance’.

He said: ’NHS England (West Midlands) originally approached local GPs to provide this service. However with the exception of GPs in Herefordshire other local providers were not interested in delivering the service. With no local option we asked others for costed proposals for providing this scheme. Primecare offered the lowest quoted price for the service that needed to be delivered.’

But Mr Williams said that, given the informaiton NHS England now have ‘about patient demand’, the regional team was looking at replacing the contract at a reduced cost.

A Primecare spokesperson said: ‘Providing an important service such as this requires a number of factors to be put in place quickly and effectively.  It was the commissioner’s decision to pay the money for this contract up front. Primecare delivered the service on time so that it was available to all people visiting the West Midlands region.

’The contract value ensured that two local GPs were both available to make house calls or have telephone consultations five days a week throughout the period of the contract and although there were fewer service users than originally expected, the service was available for everyone registered outside their local area who may have needed a home visit or telephone consultation between July 2015 and March 2016.’

What is the GP Choice scheme?

GP home visit - out of hours - online

GP home visit – out of hours – online

Under the GP Choice scheme – hailed by the last Government as a ‘significant improvement’ for the NHS – patients can register at any GP practice they want, although it is voluntary for practices to decide whether they take part.

GP practices who do accept patients not living in their area do not have to do their home visits but are still paid as much per patient.

In order to ensure patients registered elsewhere could see a GP if they were too sick to travel from their home or home area, NHS England introduced the special enhanced service.

In areas where take up was poor regional teams instead had to look to other providers to ensure patient safety.

The scheme has attracted widespread criticism from the GP community since it was first floated, with the GPC being successful in delaying its rollout once on patient safety concerns but failing the second time.