Creeping practice boundaries.

One of the Party’s great ideas is that patients can register with any practice even if they do not live within that practice’s boundary area. For most patients this is not usually the rule. If you don’t live within the practice boundary GPs will not normally register you.

The main reason we suspect why this is still maintained is the fact that registered patients would expect a home visit from their GPs. Too large a practice area leads to a lot of time wasted traveling rather than doing medicine. We suspect that the above idea was fostered by a small group of about 600 patients to whom these rules do not apply. You can see what is provided for them here which we are sure will appeal to the 35 per cent of them from private schools.

When we did our basic GP training we were asked to find out which patient at a training practice lived or worked furthest from the practice area. One of our GP training group was at a practice which had the local MEP on their list so clearly a lot of time would be spent in Brussels or Strasbourg troughing up their expenses and so home visiting would be very time consuming and expensive for the practice. As would any chronic disease management e.g. obesity, increased blood pressure and idleitis sorry stress.

Now for some MPs and we can think of one recently retired prime minister who lives and works almost exclusively from home this will cause no problems. However a lot of MPs actually go to work at the Palace of Westminster and will be resident nearby so being registered at a practice in furthest Northernshire could pose some logistical headaches if they needed an urgent consult for say piles.

It is a little known fact among the British population, which means it will be unknown in the Palace of Westminster, that if you fall ill you can still see a GP even if you are not registered with them.

We get frequent phone calls at holiday times from patients who fall ill while away asking for treatment both in this country and abroad. The advice is always the same go to your nearest surgery and ask to be seen as a temporary resident and no we will not fax a prescription for the 500 benzos you mysteriously lost on your way to your destination but we are so pleased you didn’t lose any of your other usual medications.

So in theory if this little known fact were more widely known there would be no need for any change. However politicians know better and there is a “pilot” trialing the idea that you can be registered essentially where you work but not where you live. We believe that they may struggling to recruit practices for this pilot which is starting this April 2012.

Perhaps what is also not widely known, and this is always the way with Party/DoH pilots, is that the outcomes of such “studies” are already known before the study is completed.

So even though the “pilots” are not even completed, GPs via their local Soviets are being asked to redefine their practice boundaries into an outer and inner boundary. Have a little read here. Most of this document is telling us what is to come even though the results of the pilots are not yet in, for they have not yet started, but the outcome will be sitting already printed in a filing cabinet somewhere.

The title of the document is “Choice of GP Practice”. You notice the Party’s favourite little C-word which tells you that it has been written by a Mr. Hobson and how much of the C-word will be allowed to all those mentioned in Mr. Hobson’s little missive.

Practice boundaries were established for a reason and were agreed by professionals who determined them in the context of what resources they had available to them. The same is so of the open or closed lists system which the document also discusses. If you have a partner or two off sick and/or on maternity leave then you may not have the manpower to accept more patients so temporarily restricting service provision is a safety measure. However the Party does not do safety only policy and dogma by diktat.

The Party does not see this for it is declaring that all practices are to have open lists (i.e. infinite resources) regardless of boots on the ground real resources. Practice capacity can vary on a day to day, week to week, month to month and year to year basis but the Party cannot see this.

We know that the Party leads by example in that for every debate MPs at their place of work will have 100% turnout regardless of illness, maternity leave and any constituency area and they expect the same of the people they allegedly serve.

We do not see them telling a shopkeeper to open their supermarket if all of their staff fall sick. No that is the free market where professionals decide what they can and can’t do. The NHS market does not allow professional decision making it allows only those who couldn’t hack in the real world of commerce to make such decisions on a political whim.

This document does not take long to read but it is chilling reading if you are a GP in an underdoctored area unlike here in Northernshire where the hardest daily decision as doctors we have to make is which 4 doctors can go for a round of golf in the morning and which 4 in the afternoon while still covering the surgeries which are rarely full for we have ticked all the QOF boxes in the first month of each year.

Life is tough up North.

Praise be to the Party for consulting on and piloting more NHS “reform” which has already been decided upon.