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Practice boundaries: the consultation felt like a PR exercise

In March 2010 the New Labour Government of the day, with Andy Burnham as Secretary of State for Health, started a 12-week ‘consultation’ called Your Choice of GP Practice. This was addressed to the population of England (Scotland, Wales, and Northern Ireland were managing their own affairs).

In his foreword to the main ‘consultation’ document, Burnham wrote: “Last September I announced our intention to abolish the current system of practice boundaries altogether. Now this consultation is looking at how we should go about doing so.”

So this so-called consultation was not really about whether practice boundaries should be abolished, but once they had been abolished how should the boundary-free system be structured.

If you examine the documentation (a poster, patient leaflet, the summary and full document), what you find is a very rosy picture painted of a boundary-free world, as opposed to the constraints of a boundaried one. It is a biased and one-sided pitch: the documentation ignores or minimises the practical problems which will arise if patients live at a distance from their practice, and paints a glowing picture of the merits of being able to choose whichever practice you wish.

Having presented this in a biased and misleading way, the reader is then asked to respond to the questionnaire. One question asks for the respondents’ view on abolishing practice boundaries: “Should people be allowed to register with any GP practice they choose unless it has reached full capacity and cannot take on any more patients?”

The summary and results of the consultation were published by the Department of Health in October 2010.

On page seven we find that on the question just quoted: ‘77% of the public (1840 respondents) supported the principle that people should be able to register with any GP practice with an open list; 70% of healthcare professionals (801 respondents) did not believe that people should have free choice over where to register.’

Interestingly, over 1,600 people did not give a specific answer to this question, but raised questions about the logistics. Now I must say that I am surprised that 23% of the public respondents were against unfettered choice, given the information that had been laid on by the authors of the documentation. In essence, the Department of Health was offering a free lunch with seemingly no strings attached: what was not to love about his policy?

The Executive Summary ends with this:

The responses show that the majority of the public support the aim of enabling them to have the choice to register with any practice willing to provide them the care and services expected. The consultation does identify a number of related issues that will now need to be worked through and discussed with the NHS and GPs. That will be the next stage of action, with a formal Government response setting out the changes necessary to secure the care and services wanted by the vast majority of the thousands of respondents to the public consultation Your choice of GP practice.

The facts are these: combining all respondents, 61% of 3,534 opted for unfettered choice, 38% not. This is not a ‘vast majority’, nor would I describe this as ‘thousands of respondents’.

The Department of Health does not seem to understand the complexity of home visits. Currently, home visits are either carried out by the patient’s registered practice if it is in hours, or by an out of hours service if at night or weekend. The home visits for patients registered at a distance from their home will involve all hours, daytime and out of hours. And then this: currently, most of the out of hours GPs’ notes end with something along these lines: ‘see your GP Monday morning’, or ‘to be reviewed if necessary by own GP’. In this new system, there will be no GP to hand back to. The scope for things going wrong is considerable.

This consultation was not a true consultation, but a PR exercise. The authors knew what answers they wanted, and they designed the content and the questions so as to steer the customer in the desired direction. And then they used the results to justify their cause. I call this dishonest and misleading. That politicians tell untruths and mislead we have come to take as normal; that the Department of Health should engage in this duplicity as well is to me shocking.

Dr George Farrelly is a GP in East London

For further documentation, see