News reached us just under 2 weeks ago the GPC and Department of Health had reached an agreement about the issue of practice boundaries. There are two provisions: 1. practices will be encouraged to reach an agreement with their PCTs about an ‘outer’ practice boundary which will allow patients to remain registered should they move outside the ‘inner’ practice boundary, ‘where clinically appropriate’. 2. There will be two or three city pilots for commuter patients to register with a participating practice close to their work, and an independent evaluation will be carried out.
I have campaigned on this issue, having seen the orignal proposed policy (patients in England being able to register with the GP practice of their choice, ‘anywhere in England’) as quite mad and unworkable. I am pleased with this outcome, and the GPC is to be commended for having negoiated this. As should the GP body that resisted the proposal.
This current arrangement implicitly recognises that general practice is a local and community-based technology, which the previous proposal (which all 3 major parties subscribed to) ignored entirely. Even the commuters will need to register with a practice not far from their work.
Of course, there are significant practicalities which will need to be addressed: who pays for the costs of the commuters? How is this money transferred? How does this fit in with Clinical Commissioning Groups and commissioning? Certain areas, such as the Isle of Dogs in Tower Hamlets which hosts Canary Wharf and a commuter population of about 100,00, will be affected very significantly. And then, what happens when the commuter is ill at home, how does he or she access local help, especially if the illness needs more than one GP encounter?
It is absolutely vital that the ‘independent evaluation organised by the Department [of Health]’ be truly independent and honest and rigorous (that is, not on the model of the so-called ‘consultation’ on this issue carried out by the DoH in March-July 2010 which was PR exercise which misled the respondents and Parliament).
It must be said that the inner and outer boundary model is something that some practices have had in place for many years already. Under the agreed provision, practices will have the option of having an ‘outer boundary’ and clearly they will have to choose a boundary that allows them to deliver a functioning service. That is well and good.
It is very important that the politicians and DoH do not attempt to resurrect this mad idea in the future, and that we make it clear to everyone that UK general practice is at its core a locally based technology which simply does not work on the same model as McDonald’s and mobile telephones. It may be possible to make exceptions in certain circumstances (such as the commuter), but this is an exception rather than the thin edge of the wedge.
A large wooden stake needs to be driven firmly into the heart of this vampire. That is why I will continue to write to MPs and continue to write about this issue because I have not covered all the ground yet.