Exclusive NHS managers have begun setting up a national enhanced service for practices to take on home visits and urgent in-hours care for patients who have registered outside of the area, in the first indication about the details of the Government’s practice boundaries initiative.
The enhanced service, revealed in a letter from an NHS England local area team, will see GPs sign up to providing home visits, urgent treatment in-hours and post-hospital discharge follow-up care to patients making use of the Government’s flagship practice boundary removal policy set to launch 1 October.
However, there is still no detail about how much practices will be paid for taking on the enhanced service, or for registering patients from out of their area as part of the practice boundary scheme.
GP leaders said discussions on the enhanced service were ongoing, but have warned that the scheme should be postponed because of the lack of detail around the practicalities of the initiative.
Under the practice boundaries policy, GPs can register patients who live outside their catchment area but do not have to provide home visits, although the Government has not said how much funding GPs will receive per such patient.
Now the Darlington primary care commissioning team for NHS England has written to local practices informing them that there is ‘a national enhanced service specification in development for the delivery of urgent in-hours consultations and home visiting’, but did not include any information on how much money GPs would get for providing the service.
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It added that it was ‘awaiting a national letter to launch the initiative’ for practice boundary removal, which it understood to be ‘imminent’.
The local area team also said it was ‘awaiting the publication of a national framework and guidance to support services for out-of-area registered patients when at home’ but that it understood this ‘has been delayed’ and is now expected around 14 September.
The letter said: ‘In light of the timescales in commissioning services for this cohort of patients we felt it prudent to highlight the contractual changes to practices and to request information as to whether practices would like to express an interest in: registering patients who reside outside of their practice boundary post 1 October 2014 [or]; delivering services under a national enhanced service for urgent in-hours consultations and home visiting to out-of-area patients who live in their area.’
The news comes as GP leaders have urged NHS England to delay the removal of practice boundaries because of concerns that GPs and local area teams still do not know how the scheme will work in practice.
GPC deputy chair Dr Richard Vautrey said: ‘NHS England are talking to us about the arrangements relating to the choice of practice scheme, including details about what will happen when patients registered as an out of area patient are unable to travel to their new practice. Discussions have not yet concluded.’
It comes as one London LMC is leading a boycott of the policy, which they said would disadvantage the most vulnerable patients and divert funding to the ‘articulate worried well’.
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