Plan could end practice registration monopoly

Patients could be allowed to register with A&E, walk-ins or urgent care centres for primary care 'as an alternative to a general practice', according to the NHS Confederation.

This would mean practices could be forced to compete with these organisations for patients. They could also be forced to pay when patients visit these services.

GP leaders reacted angrily to the proposals, which they believe would cut standards and undermine continuity of care.

The confederation's PCT Network director David Stout wrote in a document published last week that patients were 'voting with their feet' by presenting at A&E, walk-ins and urgent care centres instead of visiting GPs.

'Rather than trying to persuade patients to stop "misusing" A&E, maybe we should turn this on its head,' he wrote in 'Widening Primary Care Access'.

Mr Stout argued that PCTs paid twice for the same service. Practices received cash for registered patients through global sums and PCTs were billed additionally for A&E attendances.

Allowing patients to move from their GP and register elsewhere would be cheaper, he said.

Mr Stout also suggested increasing global sums and then charging GPs each time their patients visited other NHS services.

'This would give stronger incentives to practices to manage the urgent care system,' he said.

But GPC chairman Dr Laurence Buckman said the document was 'full of fantasy'.

'This would disrupt continuity of care and continuity of records, and reduce standards of care to those provided by A&E,' he said.

'It shows a misunderstanding of what patients want and what primary care is all about.'

Dr Buckman did not believe patients would be inclined to register elsewhere.

'Some managers think this is a way to take patients away from general practice, but patients recognise rubbish when they see it; they won't fall for this,' he added.

National Association of Primary Care chairman Dr James Kingsland said: 'Where people don't want to push the current agenda of trying to push general practice to show its worth and deliver more services, they are looking for soft solutions.'

He said that such suggestions from people who did not deliver healthcare would 'annoy general practice' and damage patients if implemented.

Alternative registration plans

  • Allow patients to register with A&E, walk-in centres or urgent care centres instead of GP practices.
  • Increase global sum and charge practices for each attendance at A&E, walk-in or urgent care centres by patients on their lists.
  • Allow patients to register with practices far from home by freeing practices from duty to provide home visits in return for reduced fee.

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