Pic: John Blower
A controversial pilot scheme for the abolition of practice boundaries at doctors’ surgeries in Hackney and Tower Hamlets will be extended for six more months, the government has announced.The Department of Health said the “GP Choice” trial would go on until September 2013 after it was beset by delays, a local GP boycott, and low sign-up numbers.
Under the scheme, patients will be allowed to register for treatment at practices near their workplace as opposed to their residence. The government claims this will give patients choice, but local GPs say the change is disruptive and opens the door to privatisation.
Independent evaluators will decide after September whether the policy should be rolled out across the country.
A DH spokesperson said:”This extension will provide stability for existing patients who have chosen to register with a participating practice in the pilot scheme.
“We also believe this extension will encourage patients to continue to register with a participating practice over the coming months, which will further assist in the evaluation of the pilots.”
The government did not say specifically why the pilot had been extended but mentioned talks with the British Medical Association’s General Practictioner’s Committee, which warned last month that the pilot might not gather enough data for any conclusions before the previous deadline.
NHS City and Hackney and NHS Tower Hamlets are among the six health authorities across the country included in the pilot – but East End GPs have traditionally resisted the government’s health reforms.
Local Medical Committee members staged a boycott of the pilot over fears they would not be compensated for extra patients, while Tower Hamlets GPs were the first in the country to denounce the Health and Social Care Bill in February.
George Farrelly, a GP from Bethnal Green, called the proposals “grotesque stupidity.”
He said: “Those who understand how general practice functions can see quite quickly that removing practice boundaries is a nonsense, and that it cannot work.”
“Abolishing practice boundaries is a Holy Grail for some – it will ‘liberate’ English general practice for large for-profit companies, and allow an entirely different model of primary care provision.”
An investigation by GPs’ magazine Pulse found that by June only 12 patients in the entire country had taken advantage of the pilot to register at a GP near their place of work.
Louise Irvine, a Lewisham GP who chairs the borough’s British Medical Association chapter, told EastLondonLines the policy was “a complete dead duck.”
She said: “The government really is trying to find a solution to a non-existent problem – there’s not really a demand for it.”
“It’s destroying the whole notion of family doctors providing care to the community so that huge companies can run our GP services across the country. We are responsible for our neighbourhood, we know our community, we know their problems, and patients know that too.”
Practice boundaries are based on the widest area in which a GP could conveniently make a home visit to a registered patient, according to Irvine. She recounted the story of one patient who had asked to remain registered with her practice when they moved away but ended up needing a home visit – one hour away through heavy traffic.
Irvine claimed there were already adequate mechanisms by which people could get immediately necessary treatment while far from their homes and that the new rules would leave it unclear who was primarily responsible for which patients.
Much criticism from local doctors has focused on the possibility that rich inner-city practices could cherry-pick healthy patients and leave others to foot the bill. In the NHS, sick patients are essentially subsidised by healthy ones, on the basis that the healthy ones will then be subsidised in turn when they get sick.
But Stuart Bingham, a GP in Canary Wharf and co-deputy chair in the Tower Hamlets Clinical Commissioning Group, said the pilot could potentially help out practices in deprived areas.
He said: “The main potential benefit to Tower Hamlets, where I work, is that if we develop a more fit and healthy patient population by registering local commuters, those people will use less of their health budgets than, say, a patient with a long-term condition.”
The relaxation of practice boundaries is one part of the Health and Social Care Act which was received royal assent in March. Under the reforms, doctors will form groups to commission or buy services from English hospitals and care trusts – but commissioning for GPs themselves will pass to regional health boards.
