Removing all home visiting obligations from GP practices is one of four options the DoH has proposed to allow patients to register with practices regardless of where they live.
The DoH's preferred solution is to allow practices to make a distinction between local and non-local patients, and arrange home visits just for locals. But GPs may be required to arrange home visits for all patients, regardless of how far away they live, with a per-visit fee negotiated as part of the GMS contract.
The document also proposes tighter rules on closed lists, with popular practices offered grants to expand and those refusing to take on patients stripped of their enhanced services.
'Any practice with an open list should not be attempting to deter patients by saying it is "full", and in doing so is acting in breach of its contract,' says the consultation.
The GPC will respond to the paper in the coming weeks, having already warned the policy will be expensive and destabilise practice and PCT funding.
GPC chairman Dr Laurence Buckman said: 'We don't want to rush to any reaction. We want to take a proper look at this.'
GPC member Dr Nigel Watson, also chief executive of Wessex LMCs, said it was 'disingenuous' of the DoH to propose ideas requiring cash as PCTs look to make savings.
GPs should be resourced to remain in charge of home visits for all their patients, as the numbers involved 'would be so small it would be impractical for PCTs to organise', he said.
Dr Brian Balmer, chief executive of Essex LMCs, described the options for home visiting as 'varying degrees of insanity', and doubted PCTs would want to get involved. 'I don't think PCTs will get into this game. But GP practices have the ingenuity to get around this and make sure patients are covered.'
Health secretary Andy Burnham said boundary reform was 'the right move, at the right time'. He said: 'To make this work some changes will be needed, for example how we organise home visits.'
A DoH poll by IPSOS Mori found 6 per cent of patients would like to see a GP close to work and 18 per cent would like to register with a different GP in their local area.
The Four Options