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Scrapping practice boundaries would require new funding formula, GPC warns

By Ian Quinn

Government plans to scrap practice boundaries would make existing GP funding arrangements null and void, the GPC said today.

The warning came as it produced a report detailing a minefield of obstacles to the Department of Health’s pledge to scrap boundaries by October – and setting out an alternative vision for how practice boundary reform could be made to work.The BMA said the Department of Heath’s proposals – which are also broadly backed by the Conservative party – would effectively make the Carr-Hill formula for funding GP practices obsolete.It warned the plan to allow patients to see any GP of their choice risks a ‘commuter shift’, with healthy patients changing practice to those nearer their work, while older and chronically ill patients may would stay with their existing surgeries, leading to massive inequality of funding.The Carr-Hill formula, it said, was nowhere near sensitive enough to reflect large movements of healthy patients ‘Complete free choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them,’ said GPC chair Dr Laurence Buckman.’However, we don’t want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities.’Instead the GPC has proposed making national changes in the ‘temporary resident’ arrangements, which would allow unregistered patients to be treated by a distant practice on an ‘ad hoc’ basis. Funding would be given to the second practice via payment by results, from either the patients’ own practice or their host PCT, while their normal GP practice would still oversee patient care. In its paper Reforming General Practice Boundaries, the GPC also raises a raft of other problems to the Government’s plans, including how to reform the home visiting system to protect continuity of care for patients, how the embattled patient electronic record project would cope and how practices with full lists and lack of spare capacity would take on more patients.Dr Laurence Buckman: Scrapping boundaries needs new funding mechanism Dr Laurence Buckman: Scrapping boundaries needs new funding mechanism