BMA wants tech to save boundaries

The introduction of videophones and webcams in GP surgeries would be a better way of improving patient access than scrapping practice boundaries, according to the British Medical Association.

The doctors’ union has recommended a series of local solutions plus changes to the national ‘temporary resident’ system as an alternative to government plans to remove practice boundaries by October this year.

The BMA’s solution, set out in the paper Reforming General Practice Boundaries, states that the twin objectives of providing patients with greater choice of GP practice and improving access could be achieved without the universal removal of practice boundaries.

The paper adds that “one of the simplest approaches” would be to employ telephone, videophone or webcam consultations that would enable patients to access their registered GP when they were outside of their local area.

The paper adds: “The technology already exists to provide such services, while it is part of the current government’s wider technology agenda to increase the UK’s capability in this area.”

Other local solutions that could be adopted include permitting the widening of the boundaries of practices in an urban area, so patients have greater choice, and formally allowing patients who move outside a practice boundary the option of staying with their GP.

The BMA said primary care federations also had the potential to offer patients a variety of access points to a network of GPs, but argued that investment in IT infrastructure would be necessary.

The BMA wants to see changes in the ‘temporary resident’ arrangements so that unregistered patients could be treated by distant practices on an ‘ad hoc’ basis whenever necessary, while their normal GP practice would still oversee their care.

Dr Laurence Buckman, chairman of the BMA’s GP committee, said: “Complete freedom of choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them.

"However, we don’t want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities.”

The BMA argued that if practice boundaries were scrapped it would be “crucial” that GPs had access to patient records to make safe clinical decisions and said the GP2GP record transfer project would need to be accelerated.

It also argued that practice boundaries would pose “considerable logistical difficulties” for IT in practices, particularly in relation to the Quality and Outcomes Framework and use of the new General Practice Extraction System.

The paper added: “The recent announcement that NHS IT funding is to be significantly cut means that it is essential that the IT logistics be resolved before any practice boundaries are removed. Without appropriate IT systems, it is not clear how this proposal could be administered safely or practically.”

Other areas that would need to be addressed include reforms to the home visiting system, arrangements to track ‘at risk’ patients, GP payment arrangements and premises funding.

The government is due to launch on consultation on practice boundaries shortly. The Conservative Party have also said it wants patients to be able to register with the practice that best suits them near home or work.

Links: Reforming General Practice Boundaries