My latest email to Jeremy Hunt on #gpboundaryscam


Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I have emailed you on a number of occasions regarding the Government’s policy on allowing patients to register with a GP at a distance from their home. My last email pointed out that there are actual serious flaws in the way you have implemented this policy which went live on 5/1/15.

I have received a reply from the Department of Health, which was typical in that it does not address the fundamental issue of safety and avoided mentioning the rather large elephant in the room: that the policy simply does not work, and that for people who are actually too ill to get to their registered GPs it is unsafe. This is something the Health Select Committee should look into.

Incidentally, I complained to the Parliamentary and Health Service Ombudsman about the Department of Health’s wholly inadequate replies to my emails. They replied, politely, saying they are not able to deal with my complaint because, by law, they are prevented from investigating complaints about policy decisions taken by government departments.

In addition, I have an email exchange going with the NHS Choices website who are, understandably, reluctant to publish my comment on their webpage dealing with this policy.

So we have an interesting situation: successive governments have promoted this policy since 2009, apparently unaware of the foolishness of their claims and promises. My GP colleagues and I, as frontline workers who have to deal on a daily basis with the practicalities of delivering general practice services, have tried to warn you but you do not listen. And when you actually implement a policy which is operationally unsafe, I cannot find a way to make a complaint. I have of course emailed NHS England (two separate threads, click here & here) but I have had no reply.

Normally, under these circumstances, one might expect the media to pick up this story: ‘Government pushes through flawed policy by misleading the public’ etc etc. But the mainstream media seem to have singular approach to this issue: they will publish the Department of Health’s fanciful promises, but when it comes to the multiple flaws in the policy they are silent. They behave as though they have been paid off. Or perhaps it is the Emperor’s New Clothes dynamic. Strange.

I will close with a question which I am sure you and the Department of Health will not answer: if a citizen, a frontline worker, discovers a significant flaw or flaws, in a Government policy and the Government and the relevant civil service department (and the Health Select Committee?), pretend it is not happening; and if a complaint cannot legally be investigated; and if the media will not ask some awkward questions–what then is the citizen, the person on the ground, to do next?

Best wishes,


The Tredegar Practice
35 St Stephens Road
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.”  Richard Feynman, Physicist

A Question for the BBC


A question for the BBC, but journalists in England as well.

On March 20, 2014 a research team at the London School of Hygiene and Tropical Medicine, headed by Professor Nicholas Mays, published their report on the Government pilot on patients registering with GP practices at a distance from where they live.

The afternoon before I was contacted by BBC London 94.9 asking if I would comment on the policy the next morning. Here is the interview:



I said in the interview that as the policy was actually implemented the problems would become evident; I said that it would be ‘a mess’.

The scheme was meant to start in October 2014. At the last minute, NHS England announced that they were going to delay the implementation. Why?

A spokesperson for NHS England, said: ‘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.’  (my emphasis)

The policy was implemented (very quietly) on 5 January 2015. The only media report or comment I could find was a post on the ConservativeHome blog.

I subsequently found out that ‘robust arrangements’ were not in place across the country, and the worst affected was London where there are NO ARRANGEMENTS in place. For details, see my piece in Pulse, and a subsequent Pulse article.

I wrote to Jeremy Hunt about this, copied to various media outlets, including BBC London 94.9. And yet this story has not been reported in the mainstream press. I also wrote to NHS England and NHS England London, and the CQC, the King’s Fund, the Patients Association, and the Nuffield Trust. I have not heard from Jeremy Hunt, the Department of Health, or NHS England; in fact, I have not heard from anyone.

Since September 2009 when Andy Burnham announced this policy at the King’s Fund, the press has reported only the positive sounding spin coming from the politicians, entrepreneurs, and the Department of Health, and have been universally silent about the numerous problems inherent with this policy. It is as though there is a news blackout…


A question for NHS England (London) on GP boundaries and patient access


I have read a draft version of your Primary Care Commissioning Intentions for London 2014/15 London Region (v 1.1) and the following caught my eye:

….access to primary care services continues to be problematic for many Londoners. We are sure that the reaction and response to Call to Action will enable us to develop plans to improve access and the patient’s experience of access. Already, as part of the GP contract settlement for 2014/15, we will see a number of changes designed to improve access:

  • Choice of GP practice. From October 2014, all GP practices will be able to register from outside their traditional boundary areas without a duty to provide home visits. This will give members of the public greater freedom to choose the GP practice that best meets their needs. Area Teams will need to arrange in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

Can you explain how boundary-free general practice is going to improve patient access? Here in Tower Hamlets we cannot see how this will help.

Please leave a comment below.