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GP practice boundaries axed in search for “people-centred care”

17 September 2009

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A new focus on “people-centred care” will mean patients being able to register with any GP they choose regardless of where they live, according to Health Minister Andy Burnham (pictured).

He is due to say that removing existing practice boundaries will make life easier for everyone and improve the “patient experience”.

He will also tell The King’s Fund healthcare charity that treating patients with compassion and respect is essential if the health service is to become “great”.

Thus the NHS will no longer get paid for poor treatment, he will say. But hospitals which achieve higher rates of “patient satisfaction” will be paid “significantly more”.

Mr Burnham will say: “In this day and age I can see no reason why patients should not be able to choose the GP practice they want.

“I want them to be able to do this while ensuring that access to home visits won’t be affected, wherever someone ends up registering.”

Copyright © Press Association 2009

The King’s Fund

Related story: Practice boundaries should be scrapped, says Lansley

Your comments (terms and conditions apply):

“How does Andy propose to manage when the popular surgeries have to close their patient lists when reaching their maximum capacity? Seems very ludicrous to turn away a potential patient from the same street due to the fact that you have taken out too many patients who live many miles away! The PCTs are also instructed to block certain freedom to practices that close their lists as a deterrent, yet this will certainly then not be a fault of their own so surely could not be penalised. I believe Andy should do a lot more research before announcing this sort of change , which clearly patients would welcome but practically would be unworkable” – Jane Gamble, Coventry

“What will happen to home visits? If a patient lives in, say , Birmingham, but sees a GP in Cheltenham because he chooses to, when the patient is ill and at home, and wants to see his chosen GP (the one in Cheltenham), what structure will be in place to cover the GP in Cheltenham having to go to Birmingham to visit his patient? Also, how will current services from district nurses, health visitors etc link into this new regime? Has anyone considered that issue?” – Name and address withheld

“Naive springs to mind – great sentiment but, when will the government wake up to the fact that you cannot run general practice like a commercial business? How many commercial businesses operate on the basis that the more they see their  “customers” the more it costs them off their bottom line!?” – Name and address withheld

“Another career politician with little understanding of the way primary care works pretending that we can all have whatever we want from the NHS. This cash limited service will crumble under the weight of gimmicks like this. Still, what would that matter because by then Mr Burnham be into the next phase of his political career and able to blame someone else for the problems” – Name and address withheld

“Mr Burnham’s plans are fatally flawed … presumably the freedom to choose (which in principal is a good thing) will probably mean that patients seek to choose care from practices  they consider ‘better’ than the ones they are currently with. The possible influx of new patients into ‘the better'(?) surgeries will be unsustainable and will lead to ALL patients in those surgeries getting a poorer service. In my opinion, registration should be based uponproximity of a practice to your residence. If you don’t like the service then you should have a right to complain and those complaints should be investigated and if/where practices fail continually, they should be challenged to improve” – Steve, Hove

“I agree with Malcolm Wallace [below] – I have worked within primary care for 25 years; there have always been boundary problems, now even more so, in the area I work district nursing and maternity also have boundaries. I hope these problems will be resolved prior to patients being able to register wherever they like. If they are not, there will be extra work for practice staff who are already stretched to the limit. We see patients as immediate necessary or temporary residents, but I have heard that some GPs no longer provide this service because direct payments have been disbanded and the money now arrived in the global sum!! Maybe if GPs got paid directly for temporary registrations as they did way back, they would provide the service. In that way patients would be able to see a GP anywhere without registering and be registered at home” – Anna Richardson, Essex

“Another headline-grabbing tactic which will raise expectation and add risks to management of patient care” – Name and address withheld

“How is Mr Burnham going to ensure that by registering with a GP near their place of work, which is say 20 miles away from home, it won’t affect their request for a home visit should it be required? Does he have hands-on experience as to the impact on general practice? I don’t think so, which leaves us with a problem!” – Name and address withheld

“Bit worrying as to how home visit requests will be affected and how they will impact on the day-to-day running of the surgery.  We currently have a legal obligation to provide home visits to our registered patients, and already have an extended practice area, which impacts on time allocated to visit further afield. Doesn’t this also create a two-tier GP system? The less popular falling behind in patient registration numbers and, as a consequence, income will drop, which will impact on the ability to invest in improving service” – Di, Staffordshire

“Continuity of care could be affected for the patient – who will take responsibility for cytology recalls, immunisation recalls etc. And QOF – how will that be affected if patients are registered with more than one GP? For patients who work away from their home during the week there are walk-in centres they can access; patients can be seen as temporary patients. As a practice, we have discussed this and many issues have been raised. Another key problem would be keeping patient medical records up to date. Who would take responsibility/ownership of the patient if there were any problems either legally or medically?” – Janice Brook, Coventry

“I can’t see any way that patients can register where they please and not have it affect home visits. We will all become completely dysfunctional if we are expected to do home visits out of our existing practice areas. As a rural practice, our area is already fairly wide as we have some remote villages within our boundary and HVs take a significant part of our day already” – Jean Henderson, Gloucestershire

“In search of people-centred care it may be, but what about the time-wasted and access lost through GPs in search of addresses in unfamiliar areas when asked to do a visit? Or are we to have two tiers of patients: those who live near enough to get a visit and those who do not? If so who will set the boundaries? Another headline-grabbing anouncement demonstrating a total lack of insight into reality, another weapon for the gutter press to attack GPs with. Why am I not surprised?” – Name and address withheld

“Fascinating, how does Mr Burnham ensure access to home visits then? Maybe the home visits should be done between 8pm and 8am? After all those greedy GPs don’t need sleep like real human beings do they?” – Katie Power, Golborne

“What happens when we reach capacity, ie, our GPs can see no more patients? Is the choice not then subsequently taken away from new people in the area who wish to register? We are still going to be turning people away in the long run are we not?” – Amanda Cullum, North Lincolnshire

“Whilst I can see the point of this, he has to complete the circle and ensure that cross-border issues are sorted out and that finance follows patients. Currently there are always battles with community, secondary and tertiary care when dealing with patients registered with a practice in one PCT area that are resident in another. In my 13 years with my current practice I should imagine that, on average, every six months or so we have to address this issue which has never been properly addressed by PCTs, SHAs or the DH” – Malcolm Wallace, Halesowen

“Mr Burnham can register with one of my practices in Western Cheshire anytime he wants and travel either from central Lancashire, where his constituency is, or London, where I guess he spends a lot of his time – but don’t expect any of the GPs to travel to see him there, at least not under the present Access  regime. I would also require him to have a telephone number local-rate to us for telephone consultations; attend surgery when the clinicians need to prescribe or do any of his regular monitoring under QOF; provide contact details for whatever social services, district nursing and other services he might want to use; and heaven-forbid he might decide to beat his children because there is no way any GPs here could possibly be expected to be aware of it so far away. The whole idea is not exactly impossible – but perhaps it needs to stay in the ‘too hard’ box quite a bit longer?” – Alan Moore, Cheshire

“Twit” – Robin Moate, Portsmouth