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Saturday 1 October 2016
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BMA 'skewed list' warning over boundaries

The abolition of practice boundaries could destabilise general practices in local areas, claims a British Medical Association (BMA) representative.

The government's White Paper, Equity & excellence: Liberating the NHS, has committed that by April 2012, every patient will have a clear right to choose to register with any GP practice with an open list and without being restricted by where they live.

Seventy-five percent of patients who responded to a government consultation last year backed the policy and said they wanted greater ability to register with a practice of their choice.

Dr Richard Vautrey, deputy chair of the British Medical Association's (BMA) GPs committee, argues the majority of such respondents require the flexibility to choose a general practice in their local area.

This would be "within a few miles of where they live and not, as the government suggests, where they work - which could be 50 to 100 miles away from their home," said Dr Vautrey.

While he claims the government is listening to GPs concerns over the controversial policy, he told Management in Practice he is forced to continually warn the government of the many risks involved.

"If large numbers of commuters are coerced into registering at a GP near their workplace, this could potentially have huge implications for the practices they leave behind," said Vautrey.

"If you end up with skewed lists, this will result in destabilising general practices in local areas."

The policy may seem superficially attractive to patients, argues Dr Vautrey, but the long-term consequences could mean higher costs to the NHS. For example, he says patients may turn to A&E departments instead of GPs when they fall ill because their GP is too far away from their home.

"The vast majority of patients told us that they want to be able to register with a GP practice of their choice in our consultation on practice boundaries," said a spokesperson for the Department of Health.

"We aim to give patients far greater choice of GP practice from April 2012."

The spokesperson went on to tell MiP that the government is currently discussing its proposals with GP representatives.

"Any changes that might need to be made to the General Medical Services contract will be negotiated in the usual way between the BMA's GPs committee and NGS Employers on behalf of the Department of Health," said the spokesperson.

The BMA has proposed 'safer' alternatives to the widespread abolition of practice boundaries. These include: the widening of temporary resident arrangements and an increase in the flexibility of practice boundaries.

Dr Vautrey is hopeful that a compromise can be reached. "We hope that our proposals will be taken onboard and we hope common sense will prevail," he said.

"Those officials within the government that understand the knock on consequences of pursuing this policy are very supportive of our position and believe in the need to be cautious."

Your comments (terms and conditions apply):

"As a semi-rural practice, the majority of our working patients travel to areas some distance away.  If they were to register where they work our list size will reduce and capitation reductions will result in loss of staff and doctors.  This would mean difficulties in responding to "temporary residents" who might want GP services near home.  We already suffer with a large number of university students etc coming home for summer calling on us for med requests etc." - Graham Daniel, Doncaster

We too are a semi-rural practice. I can see this from the other
perspective also, where patients from a nearby town want to register with us because we offer a traditional family doctor service with relatively small numbers of patients on our list, to the majority of whom we are able to dispense. If we are obliged to accept any patients we will not be able to cope with the influx and the way the service currently runs will not be 

feasible. The very service that patients want will be changed to the sort of service that they don't!" - Name and Address Supplied

"This word - "choice" will be the end of the NHS if we aren't careful. The question of offering  choice is the most overrated and dangerous one we face today and comes with an astronomical cost attached. We've seen this with the private sector such as directory enquiries and energy companies (to name but two).  The outcome of these being that services are now offered by a multitude of providers, but at a price way above the original "non-competitive" one. So why must the NHS go the same way?  Take choose and book -effectively leaving the decision of where to be treated to the least informed person in the process.  As a patient, I want to express my health beliefs to my GP and have him tell me the best course of action.  This how and where to proceed.  If I can't trust my GP to do that, I ought to be seeing somebody else.  I do not want my GP offering all the options, leaving it to me to
make a decision just so they can demonstrate that they have offered choice.  The focus ought to be on me - the patient, not PCT or NHS policy. Patients will understandably choose a practice out of convenience, but when they are more seriously ill, their previous choice based on this will appear calamitous. What they need is high quality, patient focused care, close to where they live." - C Woodroffe, London