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Plans to scrap boundaries “require much more thinking through”

18 September 2009

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Plans to abolish practice boundaries, announced by the health secretary yesterday (17 September 2009), “require much more thinking through”, said the British Medical Association (BMA) chief.

Commenting on yesterday’s speech on the NHS in England by Andy Burnham (see related story below), Dr Hamish Meldrum (pictured), Chairman of Council at the BMA, said: “Doctors are always happy to discuss ways of improving quality and choice for patients.

“However, some of the aspirations announced require much more thinking through. Abolishing practice boundaries would mean a major change in the way GPs and other healthcare staff provide their services.”

Judging by comments posted on Management in Practice, many practice managers have serious concerns over the proposals, which they say could create difficulties around home visits, continuity of care and the monitoring of Quality and Outcomes Framework (QOF) points.

Dr Meldrum echoed these sentiments, saying: “Ending the current system, where everyone’s family doctor is close to where they live, would make home visits more difficult and costly for the NHS to fund.

“The loss of large numbers of young, healthy patients could affect the funding of many practices in rural and suburban areas, threatening their future existence.”

He added: “The government could both deliver efficiency savings and win back the good will of healthcare staff by pursuing policies based on a vision of the NHS as a publicly provided service, rather than a marketplace of competing providers.

“Ditching independent management consultants from the NHS, and ending poor value contracts with private companies running independent sector treatment centres, would be a welcome start.”

Dr Mark Hunt, Managing Director of Care UK Primary Care, the largest independent provider of healthcare to the NHS, welcomed Mr Burnham’s announcement, saying the ending of catchment areas was “great news for patients and the NHS.”

Dr Hunt said: “Allowing patients to choose their GP combined with the publication of GP performance data will mean patients can make a more informed choice on quality and not just have to go to the nearest GP.

“Being able to register with a GP near work will dramatically improve convenience, as patients don’t have to take half a day off work just to attend their GP. It will also provide a mechanism for good practices to grow and expand services to a greater number of patients.

“Most importantly, because patients will now have real choice, GPs will have to be responsive to their needs. Patients will benefit from longer opening hours, more personalised care and improved performance across the board. It is this kind of choice and competition that needs to be extended across as many areas of the health service as possible.”

The proposals were also welcomed by Niall Dickson, Chief Executive of healthcare think tank The King’s Fund, who said: “The vast majority of patients are more than happy with their GP, but the restriction on where they can register is an anachronism and the government is right to sweep it away. There are details to be worked out, but it should not be impossible.”


Care UK

The King’s Fund

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

Practice boundaries should be scrapped, says Lansley

Your comments (terms and conditions apply):

“Patients already have the right to be seen as immediate and necessary patients in any GP practice where they happen to be.  Funding to practices would be too complex and compromise patient care. How would home visits work?” – Name and address withheld

“We have a practice that is extremely popular but we do not have the capacity to take on patients from just anywhere. Home visits would become a thing of the past and probably be managed through a similar system to the out-of-hours model. We all know how the cost of that was miscalculated! In reality, I think few patients will choose this option if they have a GP that they know and trust. Those practices that perform badly won’t survive but why haven’t they been identified and dealt with anyway? It’s yet another ‘big idea’ going nowhere” – Name and address withheld