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Practice boundaries: Andy Burnham and the King’s Fund

On September 17, 2009, Andrew Burnham, then Secretary of State for Health, travelled to health think tank, the King’s Fund.

The visit was trailed in press articles the day before. Andy Burnham planned to say in his speech: ‘In this day and age, I can see no reason why patients should not be able to choose the GP practice they want. Many of us lead hectic lives and health services should be there to make things easier.’

He was also planning to say that ‘under current rules patients can only sign up with a GP within defined boundaries close to their home. This means that less well-off patients are forced to sign up with surgeries in deprived areas, and are barred from using doctors in more affluent areas unless they live in a mixed-income area.’

The speech to the King’s Fund gathering lasted about 22 minutes, and covered a number of different issues. About one minute was given over to the plan to abolish GP practice boundaries.

Burnham said: ‘I want the best to be available to everyone, not according to where they live. This means extending choice within primary care. Too often, people’s choice is unnecessarily limited by practice boundaries. So, with the profession, I want to open up real choice in primary care. Within the next twelve months, I want to abolish practice boundaries for patients to allow people to register with the surgery of their choice.’

At the end of the speech, there was a panel discussion. As far as I can make out, the GP boundary issue was not discussed. In his summing up, the then King’s Fund CEO Niall Dickson (now chief executive of the GMC), was quoted as follows: ‘The vast majority of patients are more than happy with their GP, but the restriction on where they can register is an anachronism and the government is right to sweep it away. There are details to be worked out, but it should not be impossible.’

I was bewildered when I read all this. In our experience, looking after patients at a distance from the practice just did not work, and was at times dangerous. We had, in essence, been carrying out a pilot on this for over 20 years. It was clear to me that UK primary care is a complex technology that is locally based. Geography plays a very central role in its ecology. In a myriad of ways, on a daily basis, it was clear that it functions because it is local.

What was wrong with these people, this man who was Secretary of State for Health, this man who was CEO of a respected thinktank? What was wrong with this thinktank that it could let these assertions go unexamined, unchallenged? Had they left their critical faculties at home on that day? What was wrong with the journalists, who appeared so credulous and uncritical?

There are two very basic facts that make this policy quite foolish. First, the fact that looking after people at a distance does not work. No amount of spin, of smoke and mirrors, can change this. Oh, yes, it will work for people who are well and do not need attention, but for those who are ill, distance is a barrier to care. Second, GP practices are working at full capacity already. There is not significant spare capacity to absorb people who want to take advantage of Burnham’s offer of ‘real choice’.

And this is just the tip of an enormous iceberg.

By December 2011 the opposition health spokesman, Burnham, remained fully behind abolishing practice boundaries and chastised the Government for being too slow to implement the policy. I have tried, with some persistence, to arrange an interview with Mr Burnham, but without success. What is he afraid of?

Dr George Farrelly is a GP in East London

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