GPC unveils roadmap for practice boundary reform

The GPC has published a roadmap for reforming practice boundaries in England in a way it believes will cause less disruption than current DoH plans.

Dr Buckman: the abolition of boundaries has consequences
Dr Buckman: the abolition of boundaries has consequences

The report proposes an overhaul of temporary resident arrangements to enable patients to 'seek the full range of GP services on an immediate basis when they are away from their registered practice more effectively than at present'.

Under the plans, GPs would 'offer to treat all unregistered patients on an ad hoc basis as well as a temporarily resident one, with a "payment by results" funding mechanism to ensure practices are rewarded for each episode of care'.

A series of local solutions would also boost access, such as making boundaries more 'fuzzy' and using technology to provide remote consultations.

Health secretary Andy Burnham announced plans to scrap practice boundaries to boost patient choice and access to GPs last year. The Conservatives have similar plans.

But the GPC report warns: 'If practice boundaries were to be abolished or relaxed, politicians would have to find ways to tackle the potential consequences of ... home visiting arrangements, patient funding, health inequalities, premises and other elements.'

The report suggests scrapping practice boundaries would require 'significant reform' of the GMS contract, and pose 'considerable logistical difficulties for IT in practices', particularly in relation to the QOF.

GPC chairman Dr Laurence Buckman said it would mean the 'whole of the financial arrangements of the NHS will have to change'.

The report says it would force an overhaul of the Carr-Hill formula for GP pay.

Dr Buckman said: 'We don't think politicians understand the full implications.

'What we have to do is to provide a basis for discussion between the profession and the government.'

A DoH spokesperson said it was exploring how it can best allow patients to register with a GP practice of their choice, and that the DoH will be launching a wider consultation shortly.

What the GPC proposes

  • Reform temporary resident arrangements.
  • More remote consultations.
  • PCTs work with practices to resolve 'open but full' list reforms.
  • More flexible 'fuzzy' boundaries.
  • Highlight benefits of federations and small rural providers.

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