Last week's health White Paper, 'Our Health, Our Care, Our Say', said patients would be able to register further from their homes. This has led to questions over whether GPs would still have to offer home visits.
Currently GPs are obliged to carry out home visits if they are medically necessary.
However, the DoH has told GP that, although plans are only in early stages, two ways to end that obligation are being considered. A practice taking on patients outside its existing boundary might inform such patients that home visits would not be available.
The alternative approach would be to reach agreement with another practice closer to the patient to cover home visits.
A DoH spokesman said: 'Arrangements for home visits would be an issue for local negotiation.'
Dr Mark Reynolds, who has set up a community benefit society in Kent and Sussex, called On Call Care, believes mutual organisations such as his should be used for home visits. He said that although commissioning such a service would cost money, it would be expensive for GPs to perform their own home visits.
'There is no chance of PCTs paying for other groups to do your home visits,' he said. 'But for a large practice or groups of practices there are economic equations that they would have to do.'
He estimated that, as long as the visiting doctor was well used, the cost of such a service would be similar to employing a locum at about £70 per hour with small management and overhead costs. He added that accessing patient notes and 'ingrained attitudes' could be blocks to such a scheme, but could be overcome.
GPC chairman Dr Hamish Meldrum said that any solution would be subject to lengthy negotiations and require contractual changes.
He said that during the initial new GMS negotiations there had been some discussion about whether it would be possible to farm out home visits, but this had proved difficult.
Bolton GP Dr Krishna Korlipara said that his GP network organisation, CMEDS, would also be interested in doing home visits as well as its current out-of-hours and locum work.
Alternatives being considered by DoH:
- Make patients outside the boundary aware that a home visit is not available if they choose to register with the practice.
- Reach agreement with another GP practice closer to the patient to pick up home visits.