Questions sent by DoH director of primary care Ben Dyson to the National Association of Primary Care (NAPC), reveal issues likely to be discussed in a consultation on scrapping practice boundaries, expected later this month.

Mr Dyson asks how GP practices should organise mental health and community services for 'out of area' patients when boundaries are scrapped.

He also asks who should fund and be responsible for urgent care and home visits for patients registered far from home.

The GPC has warned that the most popular practices, or those closest to large workplaces, may soon have to close their lists, and may need extra funding or new premises to keep them open (GP, 29 January).

Mr Dyson asks: 'Can we define a limited set of circumstances where a GP practice could decline to register a patient?'

He also asks how the quality of services for patients who do not move can be 'safeguarded' amid fears that practices losing patients will have to cut services.

The NAPC response says the DoH should strive to improve 'all GP services', rather than drive patients to move.

The NAPC's preferred option is to let PCTs develop local services to meet local needs.

Existing practices could provide clinics at remote locations, closer to where people migrate to during the working day, or walk-in services could be set up near commuter hot spots.

NAPC chairman Dr Johnny Marshall said it was unclear how many patients would exercise choice and move practices.

The NAPC also proposes an option in which a local 'practice of primary responsibility' (PPR) registers patients, and a 'practice of secondary responsibility' (PSR) offers in-hours services closer to work.

But the NAPC warns this would disrupt practice budgets and the PSR would have to be paid a fee for each visit, like a walk-in centre or an A&E clinic.

GPC chairman Dr Laurence Buckman dismissed the idea as 'dual registration', adding it would be prohibitively costly.