According to MDDUS, serious concerns are being raised for doctors regarding accountability and continuity of patient care, as a result of a government pilot scheme to eliminate practice boundaries in an attempt to increase patient choice. The plan allows individuals to choose a GP closer to their work or children’s school, while still being registered at a practice close to their home.

The pilot scheme will be launched in England and will operate in parts of London, Nottingham, and Manchester, in April 2012.

According to the UK-wide medical indemnity organization, individuals suffering with complex health problems could encounter difficulties.

MDDUS medical adviser Dr. Barry Parker believes that although it seems reasonable to allow patients to register with a GP closer to their children’s school or where they work than the area where they reside, the initiative could affect doctors and their ability to provide continuity of care.

Parker explains:

“The flexibility of the proposal would work well for patients who normally enjoy good health and those looking for short-term intervention for something straightforward, such as an ear infection.

However, patients with complex health problems undoubtedly benefit from having a single source of care provided by a dedicated practice team that knows them well.

Doctors are focused on the day-to-day practicalities of providing care. The government proposals raise concerns, which could jeopardize the quality of that care given to patients. By relaxing practice boundaries, there are potential consequences for both doctor and patient.”

One option would be to allow patients to have consultations as a “day” patient at another practice while still being registered at a practice close to their home, while another option would be to register as “out-of-area” patients. By registering as “out-of-area”, patients would have to rely on their local practice when out of hours or at home. However, these two options both present a considerable challenge to continuity.

Dr. Parker says:

“One of the main advantages of receiving care from your local GP is that there is no doubt as to who is responsible for treatment and follow up care of patients.

A local GP is also more likely to be able to build up a relationship with their patient and understand the social context and environment of the patient and their family.”

According to Dr. Parker, it is vital that communication channels must be very efficient and comprehensive where care is split between two sources.

Dr. Parker explains:

“Actions such as prescription of drugs, treatment plans and referrals must always be co-ordinated to avoid confusion, or duplication. Otherwise patients could inadvertently be prescribed medicines that interact with each other, or receive excessive supplies.

Referrals and investigations could be initiated in one practice, but with no clear agreement on who is responsible for ensuring follow up.”

The current guidance from the Department of Health on the GP practice boundary pilot says:

“We anticipate that people who register further away from home under the pilot arrangements will typically be working-age adults without complex health problems, who are less likely to require home visits. The NHS nonetheless has a clear duty of care to people who fall ill at home and need urgent care. All PCT clusters will need to ensure they have arrangements in place to meet these needs.”

Dr. Parker concludes:

“Most patients value their relationship with their local GP and it may well be that they are unlikely to change if given the choice. GPs in participating practices should remain alert to the various continuity challenges that may arise.”

Written by Grace Rattue