• Potential gaps in care for more than 14,000 people registered with GP outside their area
  • National policy means GPs are not responsible for home visits for registrants beyond their boundary
  • CCGs covering 14,000 out of area people could not provide details of home visiting services
  • GP says potential gaps may be a safety risk

There may be gaps in primary care for more than 14,000 people who are registered with GP practices outside their area, HSJ has found.

The commissioners responsible for these patients told HSJ they had not commissioned or were not aware of any home visiting services for them, a situation the British Medical Association said was concerning.

The GP choice policy allows a practice to register people who do not live within its boundary – and means the practice is not responsible when home visits are needed, as it is normally.

Commissioning responsibility for alternative home visiting services for out of area patients is now unclear, and HSJ has uncovered apparently substantial gaps.

NHS England, which had responsibility when the policy was introduced in 2015, told us it held no information about the services and to contact clinical commissioning groups, most of which have taken on delegated responsibility for general practice.

Across all 207 CCGs in England, as of October, there were a total of 82,620 people who were registered with a GP outside of their home area.

Of these, in response to freedom of information requests, 16 CCGs – covering 3,036 out of area people – told HSJ they had commissioned no home visiting service.

A further 23 CCGs – covering 11,167 people - said they held no information about it.

The remaining 64 CCGs – covering 19,892 people - said they had commissioned or were aware of a home visiting service for their area.

The remainder, 104 CCGs, did not respond in time for publication.

The news follows the launch in November of GP at Hand – the GP practice with several central London clinics, which makes extensive use of digital consultations and encourages registrations from across a wider area. It has registered thousands of people in recent months, who are unlikely to be covered in HSJ’s 82,620 figure.

GP at Hand is required to only register people who live within 45 minutes travel of its clinics. Prior to its launch, NHS England raised concerns about home visiting services for its patients, and in response it agreed it would provide visits for people on its list - an anomaly under the current GP choice policy. Its home visiting service is provided by another company.

BMA GP committee chair Richard Vautrey told HSJ: “As more patients are being encouraged by some providers to be registered under out of area arrangements, it is concerning that so many CCGs have failed to put in place home visiting services to provide safe care for these patients should they be too ill to travel to their new practice.

“If commissioners are going to support providers that are using the out of area registration arrangement to rapidly expand their lists they must also ensure a comprehensive coverage of home visiting arrangements across the whole of the country.”

George Farrelly, a GP in Tower Hamlets who raised concerns about home visiting under the choice policy, told HSJ: “What [NHS England] were trying to set up was a train wreck right from the beginning… of course it is unsafe.

“[It is unsafe] where you have people who are unwell at home and are unable to get to a walk in centre. In some situations, they might have to dial an ambulance where it is not a wholly appropriate thing to do.”

NHS England was approached for comment.

In a separate problem with provision for people registered outside their area, HSJ revealed last year that NHS England had acknowledged that people in that position may not be referred to the correct services when they call NHS 111, due to a “flaw” in its systems.