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Winners and losers when boundaries are abolished



Next January, the Government is set to implement a new policy that will allow GPs to take on patients outside their boundaries – rolling back the deadline originally set for this month. At the same time, NHS England said practices that take on out-of-area patients will receive the same funding as for their local patients, even though they will not have to offer home visits. There will be varying fortunes for practices under the scheme.

The losers

Practices in commuter towns are most likely to suffer, as patients look to register near their workplace.  

While the relatively young and fit may not bother to change practice, they may do so if they cannot get urgent appointments. Some younger patients might also have practical objections, such as distance from their home, poor public transport or lack of parking space. 

University practices might also lose out, since students might stay registered at their family practice.

Such practices should consider setting aside an emergency fund of around 2% of income. Once the scheme has been running for a while, you will be better placed to know how your list will be affected by the scheme. Review your financial strategy and adjust doctor and staff structures at this stage if needed. On the upside, if practices find younger patients leaving and their patient list ageing, practices may appreciate the higher funding older patients bring. 

The winners

For some practices the changes might bring benefits.  

Patients might move from a town practice to a country practice, attracted by good availability of appointments and free, plentiful, parking. 

Capitation figures are adjusted quarterly, so expect a delay of three or four months before funding changes materialise. Practices where the list rises by 100 or so should be able to manage this gap, but if the list grows by more, and keeps climbing, it could become difficult. 

And there may be other opportunities to boost practice income for those in unpopular areas. NHS England says practices will be paid per home visit to see patients who have registered out of area (although no figure has been confirmed).

Bob Senior is chair of the Association of Independent Specialist Medical Accountants and head of medical services at Baker Tilly.