The DH guidance also contains a template for a local enhanced service (LES) to fund practices or out-of-hours organisations that provide home visits or consultations for patients registered with a practice far from home under the practice boundary pilots, who then fall ill at home.
It has also set out further detail on rules that will govern practices' freedom to declare their lists 'open' or 'closed'. If a PCT rejects a practice's request to close its list, it will be unable to reapply within three months. List closures must be for a set amount of time, between three and 12 months in duration.
Under an agreement that was part of the 2012/13 GP contract deal, each PCT will speak to individual practices to agree an outer boundary whereby if a patient moved into it, they can stay registered with the practice ‘unless it would not be in the patient’s interests to do so’.
However the guidance states that for practices with ‘a reasonably large boundary area’, it ‘may not be appropriate to establish an additional outer boundary area’. The DH said it expects this to be the ‘exception rather than the norm’.
It adds: ‘PCT clusters should work with GP practices to ensure that the arrangements are as fair and equitable as possible and that they serve patients’ interests.’
Practices will have to set out the outer boundary areas in leaflets and on their websites if they have one, and the DH says it expects this to be published on the NHS Choices website.
The guidance also states: ‘Whilst agreeing outer boundary areas, PCTs may wish to take the opportunity to work with GP practices to review any existing (inner) boundary areas with a view to improving equity for patients and for practices. In some areas, there is significant variation in the size of practice catchment areas, even allowing for differences in travel time.’
The guidance says: 'It is expected that, by 1 July, practices and PCTs will have discussed and agreed variations to contracts or agreements which will establish an outer boundary area.
Support for patients who fall ill at home after registering with a practice elsewhere in the country under the pilot scheme can be arranged as a LES with GP practices, by extending deals with walk-in centres or out-of-hours organisations, or with groups of practices, the DH advice says. No details of funding are set out in the document.
On rules governing practice lists, the DH advice sets out the process practices must go through to be able to close their lists. Practices remain barred from declaring their lists 'open but full' and will be allowed to provide enhanced services even if their list is closed. They will not be able to operate a 'ping pong' arrangement whereby a list closes and opens depending on rises and falls in practice list size.