Radical reform suggested in DoH practice boundaries consultation

PCTs could take over responsibility for all home visits under proposals for the abolition of practice boundaries in England.

Removing all home visiting obligations from GP practices is one of the options the DoH has proposed to allow patients to register with practices regardless of how far away they live.

‘Dual registration,' allowing people to register with two separate GP practices, is another option proposed in a new DoH consultation on how to abolish practice boundaries.

GPs could also be required to arrange home visits for all patients, regardless of where they live, or just those within a reasonable travelling distance, the document says.

The DoH's proposed solution is to allow practice to make a distinction between local and non-local patients, and arrange home visits just for locals.

The DoH is committed to abolishing practice boundaries, claiming ‘a significant minority' would like to change their GP and their choice should not be limited to the geographical boundaries which currently determine where patients must register.

Other proposals in the consultation suggest that GPs would be paid on a per-visit basis agreed as part of national contract negotiations.

Rules on the closing of lists would be tightened and the most popular practices will be offered grants to expand and take on more patients, the document says.

The GPC warned removing practice boundaries will be expensive, with patients with transport flooding the best practices, while the frail and housebound remain unable to exercise choice.

Visiting a practice in Wandsworth, south London, health secretary Andy Burnham said the controversial policy was ‘the right move, at the right time'.

‘We know that to make this work some changes will be needed, for example how we organise home visits for those people who choose to register with a practice further away from where they live.

‘That's why we would like to hear from patients, GPs and practice staff with their views on how the new system should work and how we ensure patients have a wider and more meaningful choice of GP practice.'

Home visiting arrangements after practice boundaries are abolished:
  • Option A: to allow people to register with any practice in England with an open list, but to have a simple set of rules or principles to distinguish between patients who are registering locally (for whom the local practice should retain the duty to provide or arrange home visits where necessary) and patients who are registering further away from home (for whom the PCT covering the patient's home would be responsible for providing home visits)
  • Option B: to maintain the requirement for GP practices to provide or arrange home visits for all patients on their list, regardless of where they live
  • Option C: to allow people to register with two separate GP practices (‘dual registration')
  • Option D: to remove all home visiting obligations from GP practices and make PCTs responsible for establishing home visiting arrangements.

The consultation runs until May 2010.

Video - 'Primary care reform must go on', says Andy Burnham

Video - Mike O'Brien on the abolition of practice boundaries

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