All three of the main UK political parties favour the policy of people in England being able to register with any GP, regardless of where they live. At present, patients must register with a GP in the area where they live.
This idea of registering with the GP of your choice (anywhere in England!) sounds like a good idea, who would not wish it? Unfortunately, there are real problems with implementing such an idea. The way I look at it, there are 2 main problems with this proposal:
1. The first is that it will introduce additional levels of complexity which will make providing good quality general practice much more difficult in most cases with those patients living outside the practice’s area (more time consuming, less integrated, less efficient; in some cases unsafe). This will be worse when a patient is actually unwell and is unable to travel far to be assessed by their doctor. If follow-up is necessary, then the patient will need to return to see the doctor; if the journey is a lengthy one, then this is a barrier. What about tests (blood tests, xrays, scans)? Do these get done in the GP’s locality (in which case the patient may well need to return for this), or where the patient lives (in which case getting the results takes longer and is less integrated; for example, our blood test results come through electronically and are filed with a click of the mouse; not so for even neighbouring hospitals, let alone a hospital miles away: these take longer, might not arrive and then have to be phoned for, have to be entered in the patient record manually…). Who is going to pay for treatment (tests, drugs, referrals, psychology, physiotherapy)? At present, funds are allocated to a given area, a given population. If someone comes from outside that area, will his or her area of residence pay? If not, then the local health economy will have its own local (limited) resources depleted by non-residents. If the area of residence pays, then how will this be billed and paid? This is what I mean by levels of complexity. There are already very significant levels of complexity within our local health economy which make working often inefficient. If we add to this local complexity additional complexity which is beyond our control this will further tax the system. (This is just an overview, there are a myriad of complexities; see also separate post on examples of problems with patients outside practice area).
2. The problem of capacity. This will make the proposal unworkable. GPs are currently all working at capacity. There may be a few exceptions to this, but fundamentally GPs do not have spare capacity. What I mean is this: imagine you want to register with a doctor 5 miles away because a friend has said how good Dr Spencer is. It is most unlikely that Dr Spencer has spare capacity, that is to say available appointments for the patients outside her practice area. Of course, Dr Spencer’s practice can expand, and perhaps they will want to expand; but Dr Spencer herself cannot expand. She can only see so many patients. Of course, she can speed up her consultations: cut them from 10 minutes to 5 minutes. Ask Dr Spencer what she thinks of that, what she thinks that will do to quality. Ask Dr Spencer’s current patients what they think of that.
These issues are not complicated, they are not ‘rocket science’. But they are very real. The politicians do not seem to be aware of these issues, do not seem to be taking them into account. In New Labour’s consultation documents on this question there is no recognition of these difficulties. I wrote to Andrew Lansley about this in March 2010 (see link below); the reply I received made it plain that he and his team had not considered the risks of this plan.
Our practice would not be able to provide a service under these conditions. We are not able to register all the local residents who want to register. In addition, we are clear that to provide quality care for patients they need to be local to us, we need to be local to them.
You need to understand the ecology of general practice, how it ‘works’, what makes it ‘work well’. Then you will be in a position to judge whether this proposed policy will make it work better, or make it work less well, or badly.
For more on this issue: