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Boundary pilots need more time


In 2003, for instance, then-health secretary John Reid was talking dual registration. In 2005, the community health white paper was expected to end GPs’ right to set boundaries. In 2006 it was Patricia Hewitt’s turn, then Lord Darzi’s. And in 2009, Andy Burnham finally set in motion the plans that have resulted, belatedly and under a new Government, in the current practice boundary pilots.

Those pilots, reluctantly agreed by the GPC as part of the 2012/13 contract deal, have been slow to get off the ground. They were supposed to begin in April, then LMCs in east London announced a boycott. Almost three months on the whole project is in disarray, with four of the six pilot areas yet to begin and three still to persuade a single GP to
take part.

In the meantime, official hyperbole has continued unabated, with NHS research predicting 120,000 commuters could choose to register in the City of London alone. So far, somewhat bathetically, the six pilot areas between them have registered just 12.

Why are practices so wary? Most GPs are not against the notion of offering choice – they just doubt it’s something patients want a cash-strapped NHS to prioritise. But on boundaries, they are cautious – because they know the devil is in the detail. Who will cover urgent care and home visits? How and where will patients be given access to community-based services? Who will pick up the prescribing and secondary care costs for ‘day patients’? And how will commissioning budgets be affected? These are the kind of complex but crucial questions the pilots haven’t even begun to thrash out.

Currently, the DH is vague on exactly when the pilots will be evaluated. The official Patient Choice Scheme directions underpinning the pilots state they will end on 1 April 2013, although this week the DH insisted it wanted to learn from practices that joined late, and suggested the deadline could be in doubt.

Judging by the progress so far – or lack of it – concluding the pilots next April is simply not realistic. Last week the Government reluctantly pushed back its deadline for the rollout of the 111 urgent care number. Now it must do the same on practice boundaries.

If ministers are to press ahead with a national rollout, it will be vital to have properly trialled the policy first and worked through the small print. After a decade or more of waiting, a further delay of six months or a year will be time well spent.

But it may also be that once the pilots are completed, the DH realises the policy it has been so doggedly pursuing is neither practical nor cost-effective. The pilots must determine not just how boundaries are abolished – but whether it really makes sense to abolish them at all.