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Pushing the boundaries
£60 per home visit
Back in January I blogged that, as part of the new GP contract for 2014/2015, practice boundaries would be abolished in October this year, to offer improved patient choice and encourage competition. GP practices would be able to register patients from outside their established practice boundary areas with no obligation to provide home visits to them. NHS England would take responsibility for arranging all home visits to patients who live out-of-area.
However, the specification released this week states that GP practices will be paid £60 per home visit to patients registered with an out-of-area practice. The specifications for the new enhanced service also state that GPs will be paid £16 for conducting appointments in practice with a patient registered elsewhere, which is more than had been previously expected.
At the eleventh hour
The scheme to abolish boundaries hasn’t been received positively by GP practices, with pilot schemes showing that patient demand was so low that removing practice boundaries is not necessary. One third of practices involved in the pilot didn’t register any additional patients, and only a minority of inner-city practices signed up large numbers of patients. The abolition of boundaries was due to be implemented at the beginning of last month but, at the eleventh hour, NHS England announced that the scheme would be delayed until 5th January 2015, to be ‘completely assured that robust arrangements are in place across the country’.
What will happen to integrated care?
Although patient demand may not initially be high, I believe that opening practice boundaries may divert care from those who really need it. It is possible that more vulnerable patients who actually live within the catchment area, such as the elderly, mentally ill and those with complex multi-morbidity, will be pushed out. I highlighted that these patients may find themselves in even greater competition for the ‘golden ticket’ - an appointment with a GP of their choice, on a day and at a time to suit them.
Tower Hamlets LMC Vice Chair, Dr Jackie Applebee, has recently said: “GPs are concerned that the abolition of practice boundaries will compound the already dire situation in which general practice finds itself. The buzz word of the day is ‘integrated care’. This means locally based, multi-disciplinary team working. We cannot deliver this if we are to care for patients who live miles away from our surgeries.”
This is certainly food for thought, and maybe even the beginning of the pay per patient/visit era?