Hi,

This is another example of health policy being driven by the well (i.e. 30
something political advisors to number 10 or Health Ministers) who probably
haven't consulted with their GP on more that an handful of occasions and are
very unlikely to need a home visit any time soon.

What they and their friends want is 

1) a slightly less rigid approach to boundaries, than is found in some
areas, to give them a choice of practice (in many places this already the
case) but other than as below they don't want to register more than a short
journey from home.

2) the option to register with a GP near where they work, particularly if
they are have a need for regular, but non-urgent contact, contraception,
pregnancy, diabetes, asthma etc and work away or a long way from home (which
can make being at home during surgery hours very difficult). People in this
group would almost certainly accept that they are not going to get home
visit from their registered GP and are not going to major consumers of other
health and social care.

Both of these requirements seem reasonable and could be met with little
difficulty with some tweaking of the rules and some lateral thinking.
Politicians are making a mountain out of a mole hill.


Ewan Davis - Director - Woodcote Consulting
                     
See our website at www.woodcote-consulting.com

[log in to unmask] Voice +44(0)8456 170100 Mobile +44(0) 7774
272724

Treasurer British Computer Society - Health Informatics Forum 

Member of British Computer Society Primary Health Care Specialist Group
Visit... www.phcsg.org for membership details

-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Julian Bradley
Sent: 17 September 2009 21:11
To: [log in to unmask]
Subject: Re: Loss of Practice Boundaries.

At 18:43 17/09/2009, you wrote:
>Other funding issues relate to the effect on practices like mine with a 
>mixture of social class and demand for healthcare.  If a lot of our 
>wealthier, middle-class patients decamped to the nice quiet posh 
>practice down the road it would seriously undermine our ability to care 
>for the needy.
>
>Visiting is less of an issue now that home visits are becoming less 
>common, but I agree boundaries for these would need to be retained.  I 
>heard a suggestion today that in a few years they could be done by 
>paramedics with additional training, reporting back to the patient's GP 
>by 'phone.
>
>Typical healthy, middle-aged, middle-class grey-suited politicians 
>reinventing the NHS to suit themselves.


The full speech is at
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4123677&c=2
and there is no reference to more details anywhere.

The issue of home visiting is acknowledged but not addressed.

The issues of communication, policies and funding are not addressed - and as
various people have said these include:

Child protection
Education and Social services Liaison
Referral pathways and priorities panels' decisions.

I'm no fan of PBC, but if you have patients registered whose funding comes
from 20 different PCTs how is that going to work?

In cross SHA practices we already have the PCT using boundaries as a reason
for reluctance to commit additional funds for patients outside _their_
catchment area.  We also have problems with patients stuck in hospital
because the discharge support services don't communicate or don't exist in
their home area.

In summary this is a promise that has nothing to do with health
(preventative or curative).  Whether it is used to cause chaos after the
next general election or not implemented at all because of the election, it
is wholly political.

The most cynical might say that it has double benefit for the politicians.

Firstly they feel it's a good sound bite and secondly they may rightly
believe that any implementation could chip away further at the trusting
relationship between GPs and their patients and those patients' communities.
This has long been something that many politicians cannot help but deeply
resent and envy.  For years they may have felt unable to do anything except
work with the grain of public opinion.  Now, with the growing power of spin
and the waning power of the BMA (despite trust in individual GPs) they are
looking to grab any opportunity.

J