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Dr Mark Hunt writes in Pulse for the abolition of GP catchment areas.

October 15th 2009

Across almost every aspect of our lives, the days when we gratefully took what we were given have gone. We can now choose, for example, who provides our electricity, gas or phones at home. The result is lower prices and better standards.

Over the past few years, people have begun to enjoy the same power over health services. With the help of their GPs, patients can now choose which hospital they have their operations in so they don’t have to wait a day longer than necessary. But choice over which GP practice to register with remains severely restricted. Most patients can choose, at best, from a couple of local practices. But often even
this choice does not exist, with practices shutting their doors to new patients. Abolishing practice boundaries will give choice to patients who are unhappy with their current practice or find it does not meet the needs of their lifestyle.

This doesn’t mean everyone will want to exercise that choice. For elderly patients with chronic disease, for whom continuity of care and proximity to their home are the most important factors, choice may not make a difference.

But the take-up of choice may well surprise us, even in the elderly. Patients with specific chronic diseases such as diabetes might move to a practice with a GP with a Special Interest in diabetes or one which offers a one-stop diabetic clinic.
Continuity of care is one of the most important features of good primary care, but the current system is rigid and doesn’t allow patients to achieve continuity where they require it. Just ask any patient who has had to register with a new GP because they moved one street out of the catchment area of their current practice.

For those who are concerned about what happens with home visits, there is already a system in place. Currently when someone goes on holiday and they need a home visit they contact the nearest surgery and are treated under an emergency treatment or temporary resident basis.

Lack of choice is part of the remnants of a healthcare system designed for doctors, not for patients. Frankly, it’s time it was changed. Patients will now be able to sign up with a GP practice near where they work rather than where they live.

For many people who work a long way from home, this is far more convenient. Taking time off work for a routine GP appointment is simply not realistic. Not everyone has a work schedule allowing such flexibility or a sympathetic boss and this inconvenience may cause some people to put off seeing their GP.

But the abolition of catchment areas will have a more profound impact on health services than simply improving convenience for commuters – after all, the majority of visits to GPs are from older, retired people. It will help drive up standards across the board.

By giving patients choice, all practices will feel a pressure to respond to patients. Otherwise they will simply go elsewhere – to a practice that opens from 8am to 8pm seven days a week, or one that offers the extra services they require. But choice only works well if patients have clear, accurate performance figures so they can make informed decisions, and the Government needs to ensure they are available.

The introduction of choice does mean some practices will struggle. We may see practices closing if they can’t keep their patients. But the NHS is run to provide care for patients, not employment for doctors. Choice will allow good practices to expand and lead to improved standards.

GPs are overwhelmingly independent-minded, innovative individuals who want to improve patient care, so I am confident increased choice will see practices developing and offering new and improved services. Choice is good for patients and all GPs should embrace it.

Dr Mark Hunt is managing director of Care UK Primary Care, the largest independent provider of healthcare to the NHS, and a GP in Frome, Somerset

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