Greater patient choice may create greater risk


For immediate release: Monday, 6 February 2012

A government pilot scheme to remove practice boundaries in a bid to increase patient choice raises serious concerns for doctors with regard to accountability and continuity of patient care, warns MDDUS.

The UK-wide medical indemnity organisation believes patients with complex health problems could face difficulties under plans to allow patients to choose a GP in a location remote from their home address.

The pilot scheme is being launched in England in April 2012 and will operate in parts of London, Manchester and Nottingham.

In theory, it may seem reasonable to give patients the choice to register with a GP near where they work or close to their children’s school instead of in the area where they live.

However, MDDUS medical adviser Dr Barry Parker believes the initiative could impact on doctors and their ability to provide continuity of care.

He says: “The flexibility of the proposal would work well for patients who normally enjoy good health and those looking for short-term intervention for something straightforward, such as an ear infection.

“However, patients with complex health problems undoubtedly benefit from having a single source of care provided by a dedicated practice team that knows them well.

“Doctors are focused on the day-to-day practicalities of providing care. The government proposals raise concerns which could jeopardise the quality of that care given to patients. By relaxing practice boundaries, there are potential consequences for both doctor and patient.”

One possibility within the initiative would allow patients to remain registered at a practice near their home and have consultations as a ‘day’ patient at another practice. The other option available would be to register as ‘out-of-area’ patients, meaning they would have to rely on their local PCT cluster for care when at home or out of hours.

Both of these patient choices present a significant challenge to continuity.

“One of the main advantages of receiving care from your local GP is that there is no doubt as to who is responsible for treatment and follow up care of patients,” adds Dr Parker.

“A local GP is also more likely to be able to build up a relationship with their patient and understand the social context and environment of the patient and their family.”

Dr Parker believes it is essential that where care is split between two sources, communication channels must be very efficient and comprehensive.

“Actions such as prescription of drugs, treatment plans and referrals must always be co-ordinated to avoid confusion, or duplication,” he says. “Otherwise patients could inadvertently be prescribed medicines that interact with each other, or receive excessive supplies.

“Referrals and investigations could be initiated in one practice but with no clear agreement on who is responsible for ensuring follow up.”

The latest guidance from the Department of Health on the GP practice boundary pilot states: “We anticipate that people who register further away from home under the pilot arrangements will typically be working-age adults without complex health problems, who are less likely to require home visits. The NHS nonetheless has a clear duty of care to people who fall ill at home and need urgent care. All PCT clusters will need to ensure they have arrangements in place to meet these needs.”

Dr Parker concludes: “Most patients value their relationship with their local GP and it may well be that they are unlikely to change if given the choice. GPs in participating practices should remain alert to the various continuity challenges that may arise.”

For more information, click on the link to the DH’s Choice of GP Practice.  


For further information contact Richard Hendry on 0845 270 2034 or 07976 272266, or email We are now on twitter. Follow us @MDDUS_News

Note to editors

MDDUS (The Medical and Dental Defence Union of Scotland) is a medical and dental defence organisation providing access to professional indemnity and expert medico- and dento-legal advice for doctors, dentists and other healthcare professionals throughout the UK. For further information on MDDUS go to

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