Practice boundaries should be widened to ensure patients have a choice of multiple practices but should not normally be extended beyond the borders of a commissioning group to ensure GPs retain responsibility for a geographical area, NHS Future Forum chair Professor Steve Field has suggested.
The abolition of practice boundaries is expected to form a key battleground in this year’s contract negotiations, with ministers having pledged to give patients a ‘far greater choice of GP practice’ from next April and GPC negotiators staunchly opposed.
Professor Field’s intervention comes as the NHS Future Forum’s work enters its second phase, with part of its remit to look at ways to improve access to primary care and reduce variations in quality.
In an exclusive interview with Pulse, Professor Field said he believes practices will have to be ‘flexible’ in defining the geographical area they cover.
‘I believe it is really important to have responsibility for a population and that would normally be a geographical population within a commissioning group,’ he said.
If patients wanted choice of practice beyond the confines of one commissioning group then other possible solutions included making increased use of electronic records or enhancing the temporary residents scheme, he said.
In his former role as RCGP chair, Professor Field was strongly opposed to the scrapping of boundaries, and in 2009 received a standing ovation from RCGP conference delegates when he warned ministers outright abolition would be ‘crazy’.
But Professor Field said the practice boundaries agenda had ‘moved forward’ in the past two years, and warned GPs must ‘raise their game’ on access.
‘Most weeks I find examples where patients can’t access GPs,’ he said. ‘I’ve seen examples going round the country, in rural areas, where patients don’t have a choice of practice because there is only one surgery in that area and the boundaries are drawn as such.’
He added: ‘I know exactly how much David Cameron values general practice. People should be seeing this as a very positive thing about the role of a GP that people want more and more access.’
Dr Paul Charlson, chair of Conservative Medical Society and a GP in east Yorkshire, said he ‘cautiously supported’ the abolition of boundaries.
‘The lack of competition at the moment creates a huge variability in provision in some areas,’ he said.
But Dr Clare Gerada, Professor Field’s successor as RCGP chair and a GP in Kennington, south London, said while she believed some alternative measures such as enhanced temporary residence could be considered, it was ‘vitally important’ GPs remained responsible for a ‘local community population’.
‘There is no compromise on this – we absolutely must maintain practice boundaries,’ she said. ‘This is part of the NHS that has fundamentally worked.’