A consultation is underway at the moment to see if we should get rid of practice boundaries and be able to register with a GP wherever we like. I can see this being helpful to commuters and people who tend to get 'one-off' problems where continuity of care is not really an issue. My concern is that the proposals do not recognise continuity of care as a key element of general practice. I think one of the reasons for increasing A&E use and hospital admissions is that general practice is becoming more and more fragmented through part-time working, and too much choice of provider coupled with protocol-driven working, which does not allow common sense or managed risk to strike a balance. I generally encourage people moving outside the practice area to register more locally, mainly because of home visiting. If a home visit is required 20 miles away, it reduces the amount of time I have for other people living locally and takes me outside the practice area (where I normally respond to emergencies on behalf of the ambulance service).
I would be happy to expand the patient list in principle, as this will attract more services to be hosted at the practice and therefore provide more local care for people, but I would be cautious about agreeing to proposals which would require home visits miles away from the practice and have destabilising effect on continuity of care.
Further info:
http://www.theyworkforyou.com/whall/?id=2009-12-16a.268.0
http://www.bma.org.uk/images/reformgpboundaries_tcm41-193919.pdf
Have your say: http://www.gpchoice.dh.gov.uk/
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I think choice is vital as it encourages continual improvement. Your point about home visits is well made. A way forward might be to retain the existing practice boundaries with a presumption that all within may register whilst those without may register at the doctor's discretion with excessive distance being a valid reason to exclude.
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