Practice boundaries back on the agenda
New initiatives often come onstream at the start of a new year, but 2012 has seen an old idea taken off the shelf, dusted down and re-introduced. The idea of abolishing practice boundaries and injecting competition into primary care was floated some time ago. The approach ties in with the dogma that, in a modern consumer society, the focus in healthcare should be on the patient.
I daresay some practices could improve their service, and the theory is that patients will move to those with better reputations if boundaries are abolished. With this in mind, the government has launched a pilot scheme to test the viability of altering practice boundaries. As reported in the univadis GP News service (click here), pilot schemes will run in three cities in England from April this year. One group that may benefit is commuters, who will be able to consult a GP closer to their workplace.
We should give the government credit for running a pilot scheme, rather than simply introducing a major change without testing the implications. It will be interesting to see the scheme in action but my prediction is that it will not be a change for the better. This is not to defend practice monopoly, but simply to consider the logistics.
The main problem I forsee with abolishing practice boundaries is the delivery of home visits, which can be offered only within a well-defined local area. Yet enforcing the contractual obligation to offer home visits as a basic service may be open to interpretation, which could lead to disputes. Nevertheless, politicians will not necessarily be deterred from meddling with boundaries because of the potential populist appeal.
Interestingly, one area testing the changes is Nottingham, where the LMC was "bemused" to be included, saying that the city does not have a great need for commuters to register and is therefore unlikely to contribute meaningful data, according to the GP News article.
Perhaps, then, this pilot will not end the debate on practice boundaries. Despite the political keenness to break practice boundaries, practically speaking it could prove a very difficult problem to solve.
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown