Government-led pilots removing practice boundaries threaten GP accountability and continuity of care, it is warned.

Medical indemnity organisation MDDUS claims patients with complex health problems could face “difficulties” under plans to allow patients to choose a practice several miles away from home.

Pilot schemes in parts of London, Manchester and Nottingham are due to be launched in April 2012.

“The flexibility [practice boundary abolition] would work well for patients who normally enjoy good health and those looking for short-term intervention for something straightforward, such as an ear infection,” said MDDUS Medical Advisor Dr Barry Parker.

“However, patients with complex health problems undoubtedly benefit from having a single source of care provided by a dedicated practice team that knows them well.

“Doctors are focused on the day-to-day practicalities of providing care. The government proposals raise concerns, which could jeopardise the quality of that care given to patients. By relaxing practice boundaries, there are potential consequences for both doctor and patient.”

The new initiative will allow patients to hold dual-registrations with one practice near their home and the other allowing them to have consultations as a ‘day’ patient.

People can also opt to register as an ‘out-of-area’ patient – meaning they would rely on they home practice when at home or out of hours.

Both options present a “significant challenge” to continuity, Dr Parker claims.

“[If no appropriate communication channel is put in place] referrals and investigations could be initiated in one practice but with no clear agreement on who is responsible for ensuring follow up,” he said. 

The latest guidance from the Department of Health on the GP practice boundary pilot states: “We anticipate that people who register further away from home under the pilot arrangements will typically be working-age adults without complex health problems, who are less likely to require home visits. The NHS nonetheless has a clear duty of care to people who fall ill at home and need urgent care. All PCT clusters will need to ensure they have arrangements in place to meet these needs.”

Your comments (terms and conditions apply):

“Does every patient who registers both at home and out-of-area appreciate that unless they give their repective GPs a detailed and accurate report of the treatments they have received at their “other” practice then they are at personal risk?  he NHS should come clean and tell patients that there is no shared record system in place that would allow their two practices to know what each other may have done – so that they can be given the right treatment by a GP with knowledge of any inter-related issues.  I can see no practice agreeing to a consultation with a dual-registered patient unless they sign a detailed questionnaire about what other treatment they have had before they get in front of a clinician. It’s all about covering your backside these days” – Name and address withheld