Plans to abolish practice boundaries "fraught with difficulties"

Tuesday 26th January 2010

Plans to abolish practice boundaries are "fraught with difficulties" and would have a number of unintended consequences, says the British Medical Association (BMA), which has today (26 January 2010) proposed a solution to reform the boundaries system without, it says, the huge cost and upheaval that completely free registration would cause.

The government wants to abolish practice boundaries by October 2010 and the Conservatives have said they want patients to be able to register with the practice that best suits them (near their home or work). A government consultation on practice boundaries is to start shortly.

Dr Laurence Buckman (pictured), Chairman of the BMA's GPs Committee (GPC), said: "Complete free choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them.

"However, we don't want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities."

The BMA believes total abolition of practice boundaries could have a number of unintended consequences. It says examples of issues that would need to be addressed in advance of completely free registration include:

• Funding arrangements for GP practices would need to be reformed to ensure that, with increased movement and changing patient demographics, funding for all practices is fair and equitable.
• How to reform the home visiting system so continuity of care for patients, who are registered with practices far from their home, isn't affected.
• Current IT projects, such as the electronic patient record transfer project, would need to be accelerated so GPs could have access to full patient records in order to make safe clinical decisions.
• How to avoid widening health inequalities – this could happen if frail people or those without access to private or affordable public transport are not able to access practices further from their home, while others can.
• Systems would need to be put in place to protect and track "at risk" patients who could be vulnerable if they are regularly re-registered at practices not within their social services boundary.
• Popular practices that had reached the limit of physical capacity would need to be helped to improve their premises in order to match patient demand.
• PCT funding would need to be completely changed in a way that would take into account the impact on hospitals and social services. This would be extremely complex if the patient lived in one trust but registered in another.
• The GPC's solution is to combine a series of local improvements with a national change in the current temporary resident arrangements.

It says local solutions should include permitting the widening of the boundaries of all practices in an urban area so patients have greater choice, the introduction of videophone and webcam consultations and allowing patients who move outside a practice boundary the option of staying with their GP.

The GPC says changing the temporary resident arrangements would mean unregistered patients could be treated by a distant practice on an ad hoc basis whenever necessary, while their normal GP practice would still oversee their care.

It also argues that this would have the added benefit of encouraging patients, who might otherwise inappropriately attend A&E, to go to the nearest GP surgery instead.

Dr Buckman said: "Getting rid of practice boundaries altogether is fraught with difficulties. Having worked through various alternatives, we believe this solution is the best option for the health service at this point in time.

"Not only will it be the most cost-effective solution, it will also serve patients far better. They will get more choice and are less likely to be adversely affected by the new set of problems that total abolition would create."

BMA

Related stories:

Plans to scrap boundaries "require much more thinking through"

Practice boundaries should be scrapped, says Lansley

GP practice boundaries axed in search for "people-centred care"

What's your view? Do you agree with the BMA's proposals? Your comments (terms and conditions apply):

"Yes, I do agree with the changes proposed and to do it sooner, I'm one of those with a rare condition and no GP is going to pick up such a huge file, be able to deal with five lots of ongoing referals, medication issues, knowing my individual circumstances, what i've been through in the past and so on and so on, let alone the fact they would have to study such a rare condition in depth, they don't have the time to do this, I need to stay with my GP of 15 years to gain the correct treatment and not put extra pressure on a surgery to treat me.  For me this means the freedom to move near family for support and rest assured i get the treatment I deserve with no inconvenience to anyone in the pocess. It's simple: leave it at the surgery's descretion but give us all the option – surgery and
patients. Without this service option we're made prisoners of a catchment area. There are many in this situation. The doctor concerned must have the last say on whether it is a suitable for that patient" – Devon Miles, Suffolk

"The medical practice nearest to a patient's home is not necessarily 'the best.' Some patients suffer with rare disorders that are best treated by those GPs who understand these conditions best. It worries me to see "what nonsense" written by a health professional in connection with the proposal to abolish, or slacken, practice boundaries. This demonstrates a level of thinking based on 'what is best for administrative convenience of the surgery'; just the sort of bigotry that vulnerable patients need the opportunity AND RIGHT to avoid" – N Ashdown-Watts, Hampshire

"This is totally stupid – the IT infrastructure to say the least would need to be in place. The spine would have to be up and running and patients registering near their place of work, which could be several miles from home, would hit terrible problems after work and weekends. What nonsense" – Michele Fildes, Trent Meadows Medical Practice

"All this becuase an MP had a hissy fit – just demonstrates that most MPs have zero insight into general practice" – Name and address withheld

"A practice in Winchester, Hampshire has moved from the centre of the city to a location to the Western edge, meaning that you must travel across the city passing an empty site, which now may not be redeveloped for about three years and patients have a convoluted journey for young and old people. How sad" – Name and address withheld

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