There is no cover in London for out of area patients; how many other areas affected?





My email to Jeremy Hunt on a significant risk with the GP Choice scheme


Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I sent you three successive emails (7/9/13; 13/10/13; 11/1/14) warning of the risks of your government’s flagship policy to abolish GP practice boundaries. I received 3 non-replies from the Department of Health (see links below).

I am now writing to bring to your attention not potential future risks but a significant current actual risk. As you may know, the policy was rolled out (very quietly) on 5 January 2015. The intended start was for October 2014 but this was postponed until 5/1/15 because, in the words of a spokeperson for NHS England in September 2014.

‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’

I have discovered that there are no ‘robust arrangements’ in place in London; in fact there are no arrangements. I have sampled three separate NHS 111 London sites and none of them were aware of the policy having been implemented, and none of them had a list of local GPs who had signed up for the out of area Enhanced Service. I was told that a patient not registered with a local GP would, if they needed to see a doctor in hours, be advised to go to an urgent care centre or to A+E. If the patient was too ill and needed a visit, one of the supervisors told me, they would have to use SOS Doctor Direct and then bill the patient’s GP surgery for the cost.

This is an unsafe situation. Why has this been allowed to happen? I have emailed NHS England about this but have not had a reply.


Incidentally, in 2 of my emails to you I asked a number of quite specific questions about the alleged benefit of parents registering near their child’s school; the Department of Health did not answer these questions. I have now created a video illustrating how this proposal, which might sound attractive on the surface, simply does not work and would actually create problems for a family. That you, the Department of Health, and NHS England should be encouraging people to sign up to something fundamentally flawed is truly surreal.

I do not expect you to do anything about this; I expect, at best, a ‘non-reply’ from the Department of Health. But I am writing so that it is at least on the record.

Yours sincerely,

George Farrelly

The Tredegar Practice
35 St Stephens Road
E3 5JD




1 My emails to Jeremy Hunt and Department of Health non-replies

2 NHS Choices webpage on Choose Your GP

3 My video on the consequences of registering with a GP near your child’s school



My emails to NHS England about the new GP boundary-free policy implementation


[Names have been redacted to protect the innocent]

From: Farrelly George (NHS TOWER HAMLETS CCG)
Sent: 09 January 2015 18:26
To: ***** (NHS ENGLAND)
Cc: Farrelly George (NHS TOWER HAMLETS CCG)
Subject: out of area patient registration

Dear ****,

I am a GP in Tower Hamlets. At present, on the NHS Choices website, there appears to be no clear guidance as to which practices are actually opting into this service. Unless I am missing something, patients have no way of knowing which practices are offering this without ringing practices one by one.

We are not offering this because we do not feel it is workable, but if patients approach us we would like to have something to offer them in the way of signposting participating practices.

Best wishes,


The Tredegar Practice
35 St Stephens Road
London E3 5JD


From: ****** (NHS ENGLAND)
Sent: 15 January 2015 09:33
To: Farrelly George (NHS TOWER HAMLETS CCG)
Cc: ****** (NHS ENGLAND); ***** (NHS ENGLAND)
Subject: FW: out of area patient registration


Dear George

Thank you for your e-mail and please accept my apologies for the delay in responding to your query.

We currently don’t hold a central list of those practices that have expressed an interest in delivering out of area registration for patients, however, area teams have been provided with information via the e-declaration of those practices that indicated an early interest in the scheme so you may wish to contact NHS London who should be able to provide you with further information of local practices who may register patients out of area.

If I can provide any further assistance please do not hesitate to contact me or one of my colleagues.

Best wishes


******NHS England | 4E60| Quarry House | Leeds | LS2 7UE

High quality care for all, now and for future generations



Email George Farrelly to NHS England, London; 23/1/15; 08:22


Dear NHS England London (North East Area Team),

I sent the following email (see above) to NHS England and you can see from this email thread that they have suggested, for the situation in London, that I contact you. I have a number of reasons for wanting to know how patients are to find practices that are signed up to registering patients who do not live locally (one is to direct patients who enquire).

“I am a GP in Tower Hamlets. At present, on the NHS Choices website there appears to be no clear guidance as to which practices are actually opting into this service. Unless I am missing something, patients have no way of knowing which practices are offering this without ringing practices one by one.

We are not offering this because we do not feel it is workable, but if patients approach us we would like to have something to offer them in the way of signposting participating practices.”

Do you have a list of London practices (or north east London practices) who have expressed an interest or have signed up to registering patients who live out of area?

You can reply to this email, or if you prefer my mobile is ***** *** ***.

Best wishes,



Email George Farrelly to NHS England, London; 23/1/15; 09:08

Dear NHS England London,

I now have an additional question which relates to the other side of the coin: that is, patients who are resident in Tower Hamlets but have registered with a practice in, say, Ealing near where they work.

If that patient gets ill and is stuck at home on Tower Hamlets, the new arrangement is that they access a Tower Hamlets GP who is providing an enhanced service to these sorts of patients. But who is providing this in Tower Hamlets? (A recent Pulse article has suggested that the Out of Hours service might be called upon to provide this service, but that would mean they would have to be operating In Hours as well….). I will be speaking to our out of hours service shortly….[I spoke to the Tower Hamlets out of hours service; they had not been approach to provide in hours cover]

My understanding is that NHS 111 would have that information.

I have just rung NHS 111 covering Tower Hamlets but the helpful nurse advisor I spoke to was unaware of the new policy; she could only suggest that a Tower Hamlets resident without a local GP would have to go to a walk in centre or to A+E. She spoke to her supervisor who was also unaware of the new policy and where such a patient might be directed.

Can you help? (Can I say I sympathise with your situation: you did not dream up this policy but you have been given the task of implementing it….).

Again, my contact number is ***** *** ***.

Best wishes,




15/2/15: I have not had a response from NHS England London.

I have since contacted NHS 111 for Islington where I live and they also did not know about the policy and they gave the same answer as NHS 111 for Tower Hamlets. I then rang NHS 111 for central London (this includes Chelsea and Westminster, Camden, Hammersmith, and others); they too are were unaware of the new policy and did not have a list of local GPs who could offer In Hours care for patients not registered locally.


12/6/15 update: I still have not had a reply from NHS England. I emailed Jeremy Hunt about this problem as well. The Department of Health gave a characteristically evasive and meaningless reply, but noted that I had written to NHS England.

A few days ago, I checked again with NHS 111 for Central London. The supervisor did not have an accurate understanding of the GP Choice Policy, and said there was no infrastructure in place to provide primary care services to local residents not registered with a local GP. They were not in a position to arrange visits to those requiring them, or consultations with local GPs. They would be advised to go to a Walk In Centre or to A+E.


Warning to GPs & public about ‘Choose Your GP Practice’ scheme


The ‘Choose Your GP Practice’ scheme started on 5 January 2015. Under this scheme GP practices can register patients who do not live in their practice area. This is voluntary. The practice does not have to visit or care for these patients if they are sick at home and unable to get to the practice. According to the scheme, NHS England area teams will have put in place cover for these patients local to where they live for in hours urgent care.

In London, this does not seem to have happened. I spoke to 3 separate area NHS 111 teams and none of them were aware of the new scheme and none of them had a list of local GPs that would offer patients not registered locally. Their advice to patients in this situation is to go to a walk in centre or A+E. One of the supervisors said that if someone required an urgent home visit that they would call SOS doctors (a provider I have not heard of) and send them; they would have to pay for this service and they would charge the registered GP practice for this call. This did not seem likely, but it gives you the idea of the shambles we are in.

So if you are thinking of registering out of area patients, make sure they check if there is robust cover where they live, otherwise they will be left without primary care cover if they are ill and unable to access their registered practice.

See my opinion piece in Pulse.

See my video on this issue.

Is it a good idea to register with a GP near your child’s school?




My introductory video on GP practice boundaries



A curious & significant finding


When the Pilot looking into the boundary-free model of general practice was launched at the end of December 2011, the Department of Health press release quoted a Westminster GP as follows:

“This initiative will mean that commuters working in the heart of London will in future have far greater flexibility around their choice of GP, enabling some to choose to see a GP closer to where they work.

“I welcome this exciting initiative which the Department of Health is resourcing as it offers patients greater access to NHS care at a time and place that is convenient to them.”

I subsequently contacted this GP and asked a few questions; she responded to my email, but avoided answering my questions.

Yesterday I noticed that her practice was not offering to register patients outside their practice area. I rang to check and was told that if I did not live in Westminster I would not be able to register.

Screen Shot 2015-01-10 at 15.02.10

Everyday work


Yesterday morning, Friday, I visited two patients at home. Both were housebound. They lived within 2 minutes walk of each other. Seven minutes brisk walking from the practice. Two birds with one stone…

In the afternoon, a carer came to the practice to thank me for my involvement with a patient with dementia over the past few years who has died. This person lived 90 seconds’ walk from the practice. This made it possible to visit frequently, and to support the patient, carers, family.

The proponents of the abolishing GP practice boundaries ignore this issue of proximity to the practice. For them geography does not matter. Morons, I say. Andy Burnham, Andrew Lansley, the Department of Health, NHS England, The King’s Fund, The Patients Association, and all the journalists who repeat their spin.


How do we know which practices are registering out of area patients?


The new flagship policy to register patients outside a GP practice area was launched earlier this week, on 5/1/15.

I have tried to find out which practices are offering this option, but have not managed to do so. This is the NHS Choices page I have found on this issue.

So I have sent NHSEngland London a message on Twitter.



5 + 47 + 3 + 17 = 8? Not in the world I work in


How to cut through the Kafkaesque Government smoke and mirrors to get at what is wrong with their flagship policy to improve the NHS by giving patients the ability to choose their GP practice, anywhere in England? This was to have come into effect in October 2014 and is now due to start on 5 January next.

5 + 47 + 3 + 17 = 8: this is one way of getting to the heart of the problem. The politicians, health ministers, the Department of Health, & NHS England will tell you that 5 + 3 = 8. This is true enough. The only problem is that the numbers that need to be added up are 5 + 47 + 3 + 17; in the material world I work in these numbers do not add up to 8.

When I have pointed out to the Department of Health that they have got their sums wrong, they in essence reply by saying 5 + 3 = 8. NHS England have done the same.

Others also behave as if they are unable to do basic arithmetic: the King’s Fund, the Patients Association, health editors at the mainstream news outlets, the BBC, even the Health Services Journal.

In the world I work in you really have to respect the numbers. Ignore the numbers and the building falls over.

Watch this space.