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NHS England delays flagship policy to open up GP practice boundaries until January

Exclusive The changes to give patients more choice through the opening up of GP practice boundaries has been delayed until January next year, NHS England has told Pulse, after GPC warned that it should not go ahead for its proposed October launch.

The policy, which was part of the 2014/15 contract, will begin on 5 January 2015, after GPC told practices not to sign up until more details about the scheme.

NHS England has also told Pulse that practices who take on patients from out of area will be paid the same amount as for other patients, despite not having to provide home visits.

Local practices will be paid per home visit for patients who are registered at a practice outside of their area and need urgent in-hours care, NHS England confirmed.

Pulse exclusively revealed that the GPC had asked for a delay because several crucial details, including how much GPs would be paid for taking on out-of-area patients and what would happen about home visits for patients who are registered in a practice outside their area, had not yet been clarified.

In response, NHS England has told Pulse that it will be delaying the scheme until 5 January next year.

A spokesperson for NHS England, said: ‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’

GPC deputy chair Dr Richard Vautrey told Pulse: ‘It’s good that we’ve been listened to and that our concerns have been acknowledged. It’s important that we ensure that patient safety is paramount. No patient should register under these new arrangements until local services are in place to be able to respond to their needs if they’re ill at home and can’t travel to their new practice.

‘We need to ensure that the NHS England guidance relating to the arrangements is published as soon as possible, so that local practices and area teams are aware of what their responsibilities are. Every local area needs to commission a service that can care for patients should they be ill and unable to travel. That needs to be fully in place before any patient registered anywhere uses this new scheme. There’s still quite a fine timeline if they’re going to be able to begin in January.’

On the issue of payment for taking on patients from outside the area, Dr Vautrey said that even while practices will be paid the full amount, they will see their workload increase more than taking on standard patients.

He said: ‘We didn’t believe there should be any reduction in the payment that practices receive. In many ways, out-of-area patients may actually be more time-consuming and it’s quite likely that some practices will find their workload increase, with patients who need to see a GP more often. Ultimately there’s going to be an additional cost for NHS England in setting this service up.’

He added that there were still ‘unanswered questions’. He said: ‘[This] is why the guidance is so important and why that has be released as soon as possible, so that everyone can consider the consequences before entering into the scheme as proposed.’

The scheme has previously been criticised for being rolled out despite being insufficiently piloted, as the official pilot was dogged with delays and the final evaluation revealing that a third of surgeries failed to register a single out-of-area patient.

Pulse revealed last year that the pilot was struggling to get off the ground, with practices at two of the selected PCTs boycotting the project altogether and only 12 patients registering out of their area by June 2012, a number that was still only at 514 by the following January.