GP practices abandon boundaries to widen choice for patients

BMJ 2012; 344 doi: (Published 05 April 2012) Cite this as: BMJ 2012;344:e2600
  1. Ingrid Torjesen
  1. 1London

Patients in areas of London, Manchester and Salford, and Nottingham will be able to register with a GP practice away from where they live for the first time from the end of April as part of a one year pilot scheme.

The Department of Health wants to make it easier for patients to register with a practice of their choice, so participating GP practices will no longer operate traditional practice boundaries. Patients will be able to register with a practice remote from their home or choose to see a GP at such a practice where they are not registered on an ad hoc basis.

The aim is to make it easier for people who cannot easily attend their local surgery during weekdays, such as commuters, to see their doctor. The scheme will also enable people who are moving house and want to remain with their previous practice to do so.

Two mechanisms are being tested. In the first, out of area registered patients, people living outside the practice’s area, will be registered and able to access all practice services except home visits and urgent care, which the primary care trust will take responsibility for. In the second, out of area unregistered patients or “day patients,” people living outside the practice area, will be able to access services at the participating practice and details of any treatment provided will be passed back to their registered practice near their home. Practices will be paid a £12.93 (€15; $20) consultation fee by the primary care trust for seeing two day patients, with a maximum of five fees paid per patient. The BMA’s preference is for the second option.

Laurence Buckman, chairman of the BMA’s GPs committee, said: “We look forward to seeing the results of these pilots to see what works best for patients. There will undoubtedly be lessons that need to be learned and it will be important for all sides to do that before there can be any further developments.”

GP practices based in primary care trusts in Westminster, City and Hackney, Tower Hamlets, Manchester, Salford, and Nottingham City are able to sign up to the scheme on a voluntary basis. Most of the areas have been selected because they have a high number of commuters (BMJ Careers, 5 January.

Ruth O’Hare, chair of Central London clinical commissioning group, said many commuters were forced to take time off if they needed to see a GP. “A much simpler solution would be to allow them to register with a GP practice who has signed up to deliver this service, close to their work, where they could pop out for an hour and then go back to work.”

However, a spokeswoman for the Royal College of General Practitioners pointed out that the benefits to patients of operating practice boundaries, in terms of continuity of care and improved outcomes, had been widely documented.

“If patients can register freely with any GP it will be more difficult to have accurate local health needs assessments, which could have an impact on the commissioning of services,” she told the BMJ. “There are already a number of solutions in place for commuters who would like to access a GP close to their place of employment, including temporary registration or telephone and electronic consultations.”

Health secretary Andrew Lansley said: “I know from speaking to patients that they are frustrated that they are only allowed to go to the GP nearest their home rather than the one that best suits their needs.

”This is part of a range of measures we are introducing to shift the NHS to put patients’ interests and desires at the heart of services.”


Cite this as: BMJ 2012;344:e2600