Hackney GPs reject Andrew Lansley’s “register where you work” NHS pilot

Plans by Health Secretary Andrew Lansley to introduce a controversial pilot scheme enabling commuters to choose a GP close to their work are due to be rolled out in Hackney in April. However, they have been branded a “disaster” by GPs in the borough, who have voted to reject it.

The year long trial, which is also set to trial in Westminster, Tower Hamlets, Manchester and Nottingham, will see patients registering or receiving consultations without worrying about practice boundaries.

Mr Lansley said the pilot was just the beginning of a range of measures the government wanted to introduce to make the NHS “truly patient focussed,” so people weren’t “restricted by geographical boundaries” and can choose a GP practice that “suits their lives.”

But doctors in Hackney are sceptical, and say continuity of care would be sorely affected.

“It’s a disaster,” said GP Nick Mann, who is based at the Well Street Surgery.

“This is a scheme which will suit and would potentially work for healthy young commuters with no medical history, for simple things like contraceptive requests or walk in coughs or colds.

“But what it won’t work for is joined up medical care, so if you need midwifery, physiotherapy or mental health services, these things can’t be coordinated in an infinite number of geographical districts.

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“It’s silly to think that someone living in Essex would have all their maternity appointments in Hackney and go back and deliver in Essex.

“It’s unworkable in terms of service provision, yes it works in terms of private patchwork provision - but as part of the bigger bill we don’t want patchwork provision.

He added that the scheme could also prove to be dangerous.

“The holes in the safety net would be so wide,” he said.

“Treating people without full histories there could be gaps in the service, partly because the communications structure is so poor, there is an issue about sharing notes, and results not being passed from doctor to doctor.

“For chronic care or for those who need multiple services it can’t work safely.

“It looks like a sop and a vote winner rather than a service improver, because it’s pandering to the consumer driven desires of young healthy people who haven’t got old and don’t understand what it means to need ongoing care for chronic conditions.”

Dr Gary Marlowe, from the De Beauvoir Surgery in Hertford Road said he envisaged a scenario where private providers like “Virgin Health” would set up surgeries in the City or Docklands looking after mostly young and fit people.

“The surgeries where they live rely on the cross-subsidy they provide to provide continuing care for their older relatives and other members of their community with complex and chronic illnesses,” he said.

“This will mean those “traditional” surgeries will struggle to provide and will slow wither away.

“Hurrah for the market system where those with the most need lose out but those who can shout loudest win.”

Deborah Colvin, GP Partner at The Lawson Practice in Nuttall Street, Hoxton, added GPs were concerned where money will come from to fund the scheme, at a time when funds are scarce.

“The cost will have to come from providing care to other patients and means money will flow from the costs looking after the unwell to pay for looking after the fitter members of society,” she said.

The City and Hackney division of the British Medical Association has voted to oppose participation in the pilot until their opinions are canvassed and a proper explanation is given as to how it would work.

Meanwhile a Department of Health spokesman insisted the pilots were still on course to start ‘from April’.

None of the six PCTs have yet received any information about how much money they will receive and there remain many unanswered questions.

Although 30 GPs are signed up in Manchester, in Tower Hamlets just three have expressed interest, while NHS Westminster, NHS City and Hackney and NHS Nottingham City are “still determining the level of interest.”

Alice Benton, Assistant Director of Primary Care Commissioning for NHS East London and the City said it was establishing the potential demand for widening GP choice with local authorities, and would then determine how best to meet demand.

“After this we will ask our NHS GP practices whether they wish to participate in the pilot,” she said.

A Department of Health spokeswoman said it believed extending choice of GP practice would reduce health inequalities.

“Often patients in more deprived areas have little or no choice of GP practice, and have poorer health because of it,” she said.