My warning to Jeremy Hunt on policy to abolish GP boundaries: is it fraudulent?

07/09/2013

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I am writing to draw your attention to a policy which your government supports (as did the previous Labour government): the proposal to abolish GP geographical boundaries and to allow (encourage) patients to join practices at a variable distance from their homes. This patient ‘choice’ appears on the surface to be a welcome development. But as someone who has worked as a GP for over 25 years, it simply does not work: looking after patients at a distance from the practice introduces barriers to care; it is inefficient; it drains resources; it is at times unsafe. Moreover, it undermines the service to local residents. And this is just the tip of a very large iceberg.

Andy Burnham, when he was Secretary of State for Health, claimed that abolishing GP practice boundaries would transform the NHS from ‘good’ to ‘great’. To me this is a remarkably stupid statement.

And your government, in its Mid-Term Interim Review The Coalition: together in the national interest, refers to a pilot allegedly set up to test this policy as one of three examples of how the Coalition has improved the NHS:

“We have improved the NHS by: ….-allowing patients in six trial primary care trusts to register or receive a consultation with a GP practice of their choice.”

This sentence is wrong on a number of counts. The pilot in question allows patients in England to register with a  participating GP practice in one of six PCTs: the number of practices participating in this pilot is small (42 practices out of a possible 345 practices, or 12%). And the number of PCTs is in fact four because two of the PCT areas have boycotted the pilot due to concerns that it would be a drain on resources for local residents.

Perhaps as Secretary of State for Health you should find out why 2 PCT areas have boycotted the pilot, and why such a small number of GPs have agreed to take part in the pilot.

I have written to the Health Select Committee about this and you can access my submission here. I have published articles about this in Pulse (access here) and in a separate blog.

I have been following this issue for four years now. At first I thought the politicians and Department of Health were just remarkably stupid; but then I realised that the more likely explanation is that behind this policy was actually a financial one, profit for someone. And indeed it is organisations like Virgin Care who stand to gain from this policy, not patients, not primary care services.

And this is troubling because people say that you are a friend of these organisations. Is this true?

I will close with a quote from my submission to the Health Select Committee:

I am making what is a serious and unsettling charge. The people involved in promoting this policy (ministers from both Labour and Conservative parties, and policy makers at the Department of Health) are trying to implement a policy which by its very design will cause primary care services to malfunction and cause real harm. These people have not done an honest risk assessment. They have promoted the policy in a very biased and misleading way. The result is that they have misled Parliament, journalists, and the citizens of England. If this policy were a financial product, it would be deemed mis-selling. In some senses, it is fraudulent.

Yours sincerely,

George Farrelly

The Tredegar Practice
35 St Stephens Road
London
E3 5JD


Why GPs have practice boundaries

11/05/2013

[The following is an article published in BMA News, January 14, 2012, by Flora Tristan. It is no longer accessible online, so I am making it available here.]

We’ve been expecting this.

It’s Monday morning, I’m on call, and we are — as usual — a touch light on doctors. One colleague is consulting in addition to me, and a locum is booked to come in at 11am, though it’s not clear yet whether he will do any visits or scripts. At 8.50am a call for an immediate visit comes through, and it is all I can do not to say ‘I told you so’.

I establish that Alfie’s dyspnoea is not such as to justify a blue-light ambulance but is too serious to wait till later in the morning. My colleague assures me that she can deal with her surgery, probably the bulk of my surgery, phone calls, enquiries, immediate scripts, immediate collapses in the waiting room and immediate everything else, and I head out into the freezing sleet.

It takes me 40 minutes to get to Alfie. Partly, this is because I have to negotiate a road junction that is so notorious that it has frequently been a topic for debate in Parliament. But the main reason is because Alfie lives absolutely miles outside the practice area, and has done so for years. I pass five surgeries on my way, including the excellent practice opposite Alfie’s house.

When I get there, Alfie is in extremis with an exacerbation of COPD, and his daughter, Jane, who has learning difficulties and asthma, is crying.

‘He didn’t want to call you — said it was too far for you to come, doctor,’ she says. I wait with Alfie, and encourage him to use his oxygen while the ambulance comes. Then I get on to social services to arrange Jane’s care for the next few days. By the time I get back to the practice there are two complaints pending, 14 people are still to be seen, and my normally serene colleague is close to tears.

This morning was always going to happen. This is why I have been pushing and pushing in meetings for us to encourage Alfie and Jane to register locally. Not only has a single visit seriously impaired the care we can offer to other patients this morning, never mind causing substantial stress; Alfie’s care has also been affected by the distance he lives from the surgery, since he has been reluctant to call when he should have done so.

Today I am really not interested in the sentimental view of one colleague that Alfie should stay on our list as he has been with us for so long and he is frail. That is exactly why he would be better off with the practice across the road from his home. Nor am I inclined to ‘be flexible’, as the health authority suggests; it is only worried about the local press. We have practice boundaries for a reason, and this morning is it.

Flora Tristan is an inner-city GP