NHS to abolish 'boundaries' for GP lists

Patients in England will be able to register with any doctor under a move to abolish catchment areas, the Health Secretary said today.

Andy Burnham said people's choice of GP practice was "unnecessarily limited" by current boundaries related to postcode.

The move is likely to net popular GPs extra cash, as money is tied up with how many patients are on a practice list and they will be able to expand to meet demand.

"Within the next 12 months, I want to abolish practice boundaries for patients to allow people to register with the surgery of their choice," Mr Burnham said.

"That may mean a practice near work, or in their local neighbourhood from which they are currently excluded by dint of their postcode.

"But it means that their practice is based on their own needs, not by lines on a map or what is easiest for primary care trusts."

In a speech to the health think tank the King's Fund, Mr Burnham also said the next phase of NHS reform will focus on providing a good "patient experience".

He said: "Today's 'good' NHS can sometimes focus on delivering services where it's best for the provider.

"A 'great' NHS would deliver services where it's best for the patient - for example, by giving people receiving chemotherapy or renal dialysis control over where they receive their treatment: in a hospital, in their local community or in the comfort of their own home."

He said hospitals where doctors and nurses display a pleasant bedside manner and where wards are clean and attractive will be paid more money.

"I want to see payment linked to levels of patient satisfaction through a powerful, new financial framework that rewards people-centred service and care.

"At the moment, quality is only faintly recognised in the tariff.

"In the future, we'll progressively link a much bigger proportion of a Trust's income to quality and, importantly, levels of patient satisfaction.

"This is a big culture change for the NHS, which has traditionally been paid by volume.

"But my judgment is that the service and its staff are ready to make this change."

Mr Burnham attacked the Tories, saying Labour was the party to take the NHS forward.

"In the last 10 years, we have expanded the traditional model of delivering healthcare," he said.

"And it's Labour, the party who created the NHS, who rescued it from appalling, systematic neglect under the Tories and who rebuilt it, it's only Labour who can be trusted to take the service forward."

When it comes to spending in the NHS, Mr Burnham said: "I know there is some uncertainty in the service about what the future holds, particularly on funding.

"It is true that the era of large catch-up funding growth is over. But that doesn't mean going backwards."

Mr Burnham said savings could be made while also driving up quality.

"Winning the war on hospital infections through higher quality services has saved the NHS up to £260 million.

"So 'quality cuts costs' is more than a soundbite; in healthcare, it happens to be true.

"We won't dictate to people how to make savings, these decisions are better made on the ground.

"But, by giving NHS organisations time to plan, we hope to avoid knee-jerk measures that destabilise a local health economy."

Shadow health secretary Andrew Lansley said: "We've always argued that it was ludicrous for the Government to talk about giving people a choice of GP when they restricted that choice based on their postcode.

"That is why we announced plans to abolish practice boundaries two years ago."

He continued: "We need to remove the perverse disincentives that currently exist which dissuade doctors from taking on new patients.

"We also need to give GPs much greater responsibility for managing their patients' care when they refer them on for hospital treatment, including control of the money that funds that treatment."

Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said: "We are open to discussing ways of improving choice for patients, and most GPs would be comfortable with flexible boundaries.

"The idea of getting rid of practice boundaries altogether has been discussed many times in the past, and we are happy to discuss it again.

"However, major logistical barriers would need to be overcome for patients to be able to register with practices a long distance from home.

"Home visits with a GP a long way away would become difficult, and costly for the NHS to fund.

"Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability.

"Meanwhile, city centre practices would be inundated with requests for appointments at lunchtime and evenings, which would effectively limit patient choice.

"All district nurses, hospital services, and social services operate within defined boundaries, and these too would have to change if patients were to be able to access them.

"These problems are not insurmountable but will need a lot of careful thinking if they are to be solved."