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New practice boundaries will be pointlessly complex



I know it shouldn’t come as a massive shock. After all, there must come a time when the DoH runs out of fag packets to scribble policy details on the back of. But this one really takes the HobNob.

There are now less than three weeks before the Next Big Idea – the Government’s Practice Boundaries Initiative, enabling patients to register with a practice near work rather than where they live – is launched. Yet, despite this being a potentially massive shake-up of how general practice is organised, with all sorts of ramifications, the degree of detail we’ve received so far has exactly matched the average GP’s enthusiasm for the project.

What we have heard is that ‘NHS managers have begun setting up a National Enhanced Service’ and that ‘discussions are ongoing’. Brilliant. They’ve had six-months-plus to reach this point and will doubtless dump the details on us six minutes before they trumpet it across the media.

And even then I wouldn’t guarantee that those key questions will be resolved. And there are quite a few. Like who’s doing the visits, and for how much, when punters registered near work fall ill at home? And what will we be paid for registering an out of area patient? And where’s the funding coming from? And what about patients currently registered with us who are already out of area? And do we sign up en bloc or can we pick and choose patients? And which referral restrictions do we apply, home or away? Which CCG coughs up the dosh for hospital treatment? And so on and so forth.

The conclusion is absolutely obvious: the plan should be delayed. Or better still, quietly consigned to the same graveyard that contains the squarial, the Betamax video and the Sinclair C5.

Unless, that is, I’m missing something. Maybe the ‘delay’ is just obfuscation. Maybe the Government knows exactly what it’s doing and realises that unresolved issues will leave us GPs with patients in our area but registered elsewhere who, come 1 October, need our attention.

And it would only take a tweak of ‘Immediately Necessary’ here and ‘Temporary resident’ there to solve the visiting/urgent treatment problem – for free.

Clever bastards, these politicians, eh? Well, bastards, anyway.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield