Exclusive GPs in areas trialling the Government’s relaxation of practice boundaries have complained of a ‘farcical’ lack of detail about how the plans will work, with LMC leaders predicting delays of at least three months and just a handful of practices so far expressing interest.
The Department of Health recently announced plans to test the controversial policy in parts of London, Manchester and Nottingham. Commuters will be able to use an alternative practice near where they work, either as a non-registered out-of-area patient at any practice within the pilot, or as a registered out-of-area patient in a number of volunteer practices.
Across the three PCTs able to provide figures, so far just 33 out of 194 practices have expressed an interest in taking part. The three other PCTs are still in the process of gauging GP interest. None of the six PCTs have yet received any funding or information about how much money they will receive.
A spokesperson for NHS Nottingham City said: ‘So far, there has been no indication of what, if any, funds will be made available to pilot sites.’
NHS Manchester said it had received 18 expressions of interest from practices about the pilots and NHS Salford said it had had 12. NHS Tower Hamlets has received three, while NHS Westminster, NHS City and Hackney and NHS Nottingham City said they were still determining the level of interest.
Chris Locke, secretary of Nottinghamshire LMC, said he expected the pilots in his area to be delayed until July, after reports from a recent meeting attended by 14 local practices.
He said: ‘They had a meeting with the PCT and somebody from the DH, and the view I got from the people that were there was that the thing was slightly farcical because they realised there were so many unanswered questions and the whole thing is not very practical.’
Mr Locke said GPs were also concerned about which clinical commissioning group would foot the costs of any hospital treatment required, and how funding for walk-in patients would work.
‘They are limited to four consultations a year in terms of payment, so after the fourth time the patient’s been in, there’s no more money for them in respect of that patient,’ he said. ‘So there was a bit of concern about that.
‘My understanding was in Nottingham that the start might be delayed until 1 July because they have still got lots of practical issues to resolve and they haven’t worked it out.’
Dr John Hughes, secretary of Manchester LMC, said: ‘The difficulty at the moment is the guidance so far is so vague and non specific. Some people are expressing an interest but I suspect when the proper guidance and the actual money is clearer a lot of those may well decide not to proceed.’
‘The problem is the funding is £2m for all three pilots so when you spread that out it’s actually a pretty tiny amount of money. It might cover a couple of months but certainly nothing longer, and there’s absolutely no clarity as to what happens when that initial funding runs out. Most of the proposals are going to be totally unworkable without vast amounts of money.’
The DH said participating practices would receive global sum funding in the normal way for registering out-of-area patients, but that arrangements for treating non-registered patients were still to be finalised. It said it did not propose to make adjustments to existing PCT allocations to take account of the scheme.
A DH spokesperson insisted the pilots were still on course to start ‘from April’.
‘GP practices in these areas will be able to join the scheme on a voluntary basis and the pilots will be subject to a full and independent evaluation,’ he said.
How the Government is revamping GP choice
– In the three selected pilot areas, boundaries will be relaxed in two ways:
– Out-of-area patients will be able to visit any practice within the pilot area on a non-registered basis
– They will also be able to register as an out-of-area patient at a number of volunteer practices
– In the pilot areas, funding to pay for patients who use surgeries on a non-registered basis will be capped at £2 million
– In addition GPs across England will 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.