GP catchment areas look set to become a thing of the past after Health Secretary Andy Burnham announced plans to scrap practice boundaries by this time next year, marking another rung up the government’s choice agenda.

The move will allow the public to sign up with any GP in the country regardless of where they live instead of being confined to areas close to the home, giving patients more power to decide where to go for healthcare and playing on the element of competition to boost the quality of primary care services.

Supporters of the move argue that removing practice boundaries will make primary care services much more accessible to the public, as patients will be able choose GPs on the basis of their own needs, such as near their place of work. According to Burnham: “Many of us lead hectic lives and health services should be there to make things easier”.

In addition, leaving GP practices to battle for patients should help to improve services overall, and unrestricted access to family doctors could also reduce health inequalities as patients living in more deprived areas of the country will be able to visit surgeries based in more affluent parts, which may have better services on offer.

However, the opposition fears that the move could destabilise many practices in the country and affect continuity of patient care. A potential exodus of patients from rural surgeries into more conveniently-positioned city-based ones, for example, could leave one struggling to cope with less funding - patients equal cash after all - and the other with an impossible demand for its services.

Dr Hamish Meldrum, Chairman of Council at the BMA, welcomed any attempt to improve service quality and patient choice, but he cautioned that abolishing practice boundaries would mean “a major change in the way GPs and other healthcare staff provide their services”.

“Ending the current system, where everyone’s family doctor is close to where they live, would make home visits more difficult and costly for the NHS to fund, [and] the loss of large numbers of young, healthy patients could affect the funding of many practices in rural and suburban areas, threatening their future existence,” he warned.

According to Niall Dickson, Chief Executive of healthcare think tank The King's Fund, however: “The vast majority of patients are more than happy with their GP, but the restriction on where they can register is an anachronism and the government is right to sweep it away. There are details to be worked out, but it should not be impossible”.

In his speech to the King’s Fund last week, Burnham also stressed that the National Health Service must now position itself for a new era in which the key focus is on quality, set against a backdrop of tough financial and productivity challenges.

To raise the quality bar and make sure it attracts a higher level of attention throughout the Service, patient satisfaction will be measured service-by-service in each hospital and published on a regular basis, encouraging the system to “concentrate more on how things look through the patient’s eyes”, Burnham said.

Culture change
In what he described as “a big culture change for the NHS”, the health secretary said payment will be linked to patient satisfaction through “a powerful, new financial framework that rewards people-centred service and care”. In the current climate, he explained, quality is only faintly recognised in the tariff, but in future it will be linked to “a much bigger proportion of a Trust’s income to quality and, importantly, levels of patient satisfaction”.

Commenting on the proposal, Steve Barnett, the chief executive of the NHS Confederation, welcomed the suggestion that payments should better reflect patient experience, but also stressed that payment structures are “only one way of encouraging these behaviours and not the whole solution”, and that “managers, doctors and nurses at a local level need the freedom and flexibility to deliver the best possible patient care”.

Barnett voiced concern about whether the plans would restrict service commissioners from quickly switching services to alternative providers where there is clear benefit to patient care and value for money for taxpayers. “At a time of great financial pressure on all public services it is even more important for the people who commission services to be able to choose the most appropriate provider - we will want to see much greater clarity about what this means in practice,” he said.