Practice boundaries will not be scrapped under the deal agreed between the GPC and NHS Employers.
A statement from the BMA reveals that the two negotiating parties have agreed ‘that practices will agree with PCTs an outer boundary where they will retain, where clinically appropriate, existing patients who have moved into the outer boundary area’.
Plans for a pilot to extend patients’ freedom to choose which practice they register at have been announced.
The statement said: ‘The GPC and NHS Employers have agreed that there will be a pilot which will allow patients in two or three cities (or part of cities) to visit a practice either as a non-registered out-of-area patient or as a registered out-of-area patient in a number of voluntary practices in those areas. The funding to pay for patients who use surgeries on a non-registered basis will be capped at £2 million. The pilots will subjected to an independent evaluation organised by the DoH. The DoH has agreed that the results of that evaluation will be published.’
Prescribing indicators in the ‘quality and productivity’ domain added to the QOF in 2011/12 have been scrapped and will be replaced by targets for cutting unnecessary admissions to A&E.
Quality and productivity indicators for referrals and emergency admissions to hospital have been extended for a year, and a series of QOF thresholds have been increased.
The extended hours access directed enhanced service (DES) will remain in place until April 2013, with the terms of the deal unchanged from 2011/12.
Clinical DESs for alcohol and learning disabilities will also remain in place, unchanged for 2012/13, but the osteoporosis DES will be dropped as indicators for the disease are added to the QOF.
GPC deputy chairman Dr Richard Vautrey said: 'Most GPs were against the complete abolition of practice boundaries because of the potential negative impact on continuity of care, so we’re pleased that we have been able to agree this alternative which will help commuters as well as patients who move out of a practice’s boundary but want to stay registered. It will be important to learn from the results of the pilots.
'The NHS is operating in a difficult financial climate and while GPs, like other doctors, won’t get a pay rise, we’ve worked hard to ensure practices get some compensation for rising expenses and that the changes made are consistent with good clinical practice.'
In a keynote speech to the National Association of Primary Care’s annual conference in Birmingham on Wednesday, health secretary Andrew Lansley said on practice boundaries: ‘We will pilot ways in which patient choice of general practice can be achieved in ways that are understanding of the practical implementation and implications of it.
‘From that point of view across the profession we are going to pilot how it works and see how it can be implemented …to ensure it is entirely practical for patients. I think we can do that over the course of the year. ‘
Mr Lansley also said subject to the passage of the Health Bill the requirement for practices to be part of a clinical commissioning group (CCG) will be written into the GP contract.
Meanwhile, Mr Lansley said draft guidance on commissioning support will be released today by the DoH, which he said would help CCGs decide what support they could provide in-house, what they will need to buy in and what support functions could be shared with other CCGs across a locality.
But Mr Lansley also hinted that the government will advise CCGs that many support services should be provided by PCT staff.
He said: ‘There are lot of good people in the NHS, we don’t want to lose them. I hope that you will be able to develop relationships [with PCT staff] for partnerships in the future.’