Changes to GP practice boundaries

Under the new GP contract for 2014/2015, there will be an abolition of practice boundaries from October 2014 to offer improved patient choice and encourage competition. The move to full competition between GPs allows patients to register with a GP outside the area in which they live, for example, if they choose to register with a practice close to work. GP practices will be able to register patients from outside their traditional practice boundary areas with no obligation to provide home visits to them, with NHS England taking responsibility for arranging all home visits to out of area patients.

However, a snapshot poll of 360 GPs conducted by Pulse following the announcement of the 2014/2015 contract deal indicated that 73% of those GPs were unhappy with the removal of practice boundaries. In the Pulse article, Dr Coral Jones, a Hackney GP, expressed concern about the removal of practice boundaries, commenting that: “This will be the end of general practice which is able to provide comprehensive care for every person registered in the UK for about £140 per year. This is incredibly good value. Abolishing practice boundaries is just a gift to the private sector to sweep away more of the NHS.”

 

What did pilot schemes indicate?

The removal of practice boundaries form October 2014 extends the pilot schemes to encourage choice for patients, which have been running since April 2012, across England. However, an article by Pulse suggests that there has been little patient demand for registering out of area. The GPC told Pulse that the uptake of pilot schemes was so low that it demonstrated there was no need to remove practice boundaries.

GPC negotiator Dr Beth McCarron-Nash told Pulse that: “We have always been very clear that the removal of practice boundaries is not necessary, there has been a pilot but the number of patients who enrolled in that pilot is so small that, in our view it demonstrated there was no need to remove practice boundaries. This is the Government’s agenda, they feel it will improve choice but the evidence from the pilots shows, that actually patients did not choose to move, on the whole. The main reason patients in the pilot decided to register remotely, was in line with our policy which is fuzzy boundaries – patients who moved a street or two away from where they were currently registered.”

The Department of Health told Pulse: ‘We believe that choice can be an important lever for raising standards. Not everyone may want to take advantage of the scheme but  it is important to offer people more say and flexibility of their care – for example there are people who move home a few miles and wish to stay with their GP, or those people who commute to work and so cannot access their local surgery during the times it is open.’ Dr Mike Ingram,

Pulse had previously reported that the lead researcher evaluating the pilot scheme, Professor Nicholas Mays, professor of health policy at the London School of Hygiene and Tropical Medicine, had said that the pilot schemes had not been going long enough to evaluate the economics of the scheme or estimate which patients might use it. A Pulse investigation in January this year showed that nine months into the pilot, only 514 patients had signed up across the four big-city region trial areas in England.

 

Cautions about the scheme

In a Pulse article, the BMA and RCGP are reported to have submitted statements to Monitor warning against extension of the pilot schemes. The BMA said that although patient choice was important, patients valued continuity from GPs. The RCGP further warned that GP practices would be destabilised by a removal of practice boundaries because it would be more difficult to plan to meet demand, which could especially be to the detriment of the most vulnerable patients.

Dr Howe, honorary secretary said: ‘It is likely that a number of rural practices would become unsustainable, as they would face losing significant numbers of their patients - typically younger, healthier commuters - and would be left caring for a greater proportion of patients lacking mobility and/or with complex, long-term conditions.‘This imbalance would rarely be viable in the long term and would thus ultimately reduce choice in rural communities, to the detriment of the most ill and vulnerable.’

In a Pulse article, Dr Mike Ingram GPC member and a GP in Radlett, Hertfordshire, told Pulse that the pilots had been an ‘expensive failure. He said: ‘It’s interesting that Jeremy Hunt’s continuity of care, old-fashioned doctors, your own GP – and in our practice it happens, we do run personalised lists. Then you’re going to have another GP who doesn’t know you, somewhere else, offering you other care. ‘It doesn’t sound very “coordinated”, “integrated”, “continuative care”, “your own GP”, Jeremey Hunt buzzword-type stuff does it? It sounds divides, and inefficient. ‘Now that we know that of the pilots, the uptake has been as close to zero as you can get. The take-up has been very poor so far.’

He continued: ‘It just really hasn’t taken off so far, the idea’s been there, and it’s proved an expensive failure. A lot of money’s been invested in it and not much take-up’

A recent Guardian article pointed out the potential pitfalls of the scheme, suggesting that those with complex health problems or chronic mental health problems may find it harder to find a GP.

 

BMA survey warns that CCGs are failing to involve GPs and deliver improvements in care (Practice Buisness, 24 June 2014)

Just 500 patients register with out-of-area practices as most GPs shun boundary pilots (Pulse: 24 January 2013)

GP leaders hit back over claims patients need better choice of GP practice (Pulse: 4 September 2013)

Decision on extending practice boundary pilots to be made without 'robust' economic data (Pulse: 24 September 2013)

The 2014 GP contract deal: what we know so far (Pulse: 14 November 2013)

Little patient demand for abolishing practice boundaries, claims GPC (Pulse: 15 November 2013)

Backlash from grassroots GPs as survey highlights fears over contract compromise (Pulse: 18 November 2013)

Any GP you want: so long as you're healthy (The Guardian: 19 November 2013)

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