Will Scrapping Practice Boundaries Improve Patient Care?

All the major political parties have made it patently clear that they are intent on removing practice boundaries which is no surprise given it is such an election grabbing policy. On paper it sounds excellent, remove practice boundaries and give patients the choice to register wherever they want. However the problem with any headline grabbing policy is in the detail and this is where this policy falls flat on its face.

There are three broad problems with this proposed policy. These are responsibility of home visits, organising community services and lastly funding.

1) Who picks up the responsibility of home visits?

This is the first and main stumbling block of the proposed policy. As we all know as things stand the patient's registered practice is responsible for home visits at all times and the way this has naturally been managed is through reasonable practice catchment areas, i.e. none of us would register patients 20 miles away (except maybe for some very rural practices) as we simply know we could not conduct home visits. However over the years most of us could probably give a few examples of patients who would have liked to remain registered with us despite the long distance, but the real problem here is that these are the patients with the most medical demands, i.e. long term chronic disease patients, possibly palliative care patients staying with relatives etc. The consultation being carried out by the government puts forward the following options with regards to who should be responsible for organising home visits:

a) the patient's registered practice, regardless of the distance from the patient's home

b) the local PCT of the patient's home address should be responsible for commissioning this service (possibly by paying for each home visit done)

c) patients could be allowed to have two concurrent registrations, i.e. one registration with your preferred GP and another one primarily for home visits close from home

All three of these options present their own logistical problems and are undoubtedly going to put yet greater burden on already stretched NHS resources at a time when we we are being told to tighten our belts.

2) Organising community services

Organising community services for patients living far from their registered practice presents a similar if not more complicated logistical problem than home visits. We all know the stark differences in the provision of community services, i.e. some areas operate a Community Assessment Unit (CAU), while others rely more heavily on the local HART team, it is safe to say that community services vary greatly across the board from chiropody to social services. We all find a way of operating in our local area and know when and how to get things done, such as a quite word with a PCT manager to get things moving if we can't get the district nurses to visit one of our patients. I'm sure a GP in Southend will be able to get the McMillan nurses in Lewisham to arrange regular support to one of their patients, but at what cost and stress to all involved?

3) Cost to the NHS

It is pretty clear that a logistical change of this magnitude is going to create an additional cost which was simply not there. This will mainly come in the form of commissioning additional services for home visits, community services and Out of Hours cover. It is also conceivable that a dual registration will be introduced which simply means two GP surgeries will be paid for looking after the same patient. At a time when we talk of consolidating local resources to offer an excellent local service to our patients with the introduction of 'Darzi' centres why o why are we talking of removing practice catchment areas.

It seems we are being forced to implement a solution to a problem which never existed. However we shouldn't take this lying down, we have an opportunity to voice our concerns via the DH consultation which you can access on the link below and raise concerns via the various channels we have such as the BMA, GPC, RCGP, LMCs and other GP leaders:

http://www.gpchoice.dh.gov.uk/