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Testing the Boundaries
At a presentation of the new GP contract for 2014/2015, it was announced that practice boundaries would be abolished in October 2014 to offer improved patient choice, and encourage competition. GP practices will 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.
Pilot schemes having been running for almost two years now and early indication has shown that patient demand has been so low that removing practice boundaries is not necessary.
Be careful what you wish for
Although patient choice is important, in my experience patients prefer continuity with a particular GP who they have built a rapport with and who knows so much more about them than just their medical conditions. Practices could be threatened if boundaries are to be removed because it would be even more difficult to plan patient demand for services. I am sure there are many who back this scheme but don't realise that this could be damaging to the most vulnerable patients, such as those with complex health conditions and mental health problems who need regular access to services. 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.
How do we manage it?
It's difficult to determine exactly how much this scheme will truly impact on Practices but I expect it to be similar to the very few numbers of Romanian and Bulgarian nationals who actually arrived in the UK on 1st January 2014 who wished to work here. Most GP's carry out home visits for patients who are housebound or very ill and often by the GP who knows the patient best. If the Practice boundary is unlimited but the visiting boundary is a set distance, and different to the previously agreed boundary, there is no doubt that continuity of care will be compromised when these patients are visited by other care providers.
I travel almost an hour from home to work and I can see some benefits of being able to register at a Practice where it would be much easier for me to get a convenient appointment with my own GP, instead of having to ask for one first thing in the morning or last thing in the evening, and probably with a GP or healthcare professional I've never seen before. However, like the majority of patients I'm very happy with the Practice I am registered with and my family are also registered there so I have no desire to go anywhere else. It will be interesting to see what impact the scheme really has when it comes into force but it's important to remember that clear policies will need to be in place to reflect the changes.