From: Beds & Herts LMC
To: All practices in Bedfordshire, Luton and Hertfordshire
Date: 5 th December 2014
Re: Out of Area Registration / Choice of GP
You will have received information from the area team about out of area registrations. The information sent to you included:

A “contract change – practice decision form" about whether or not you intend to register out of area patients.

An enhanced service specification to provide emergency home visits or surgery consultations.

A 49 page guidance document

A covering letter from Lynn Dalton.
We hope this letter will help you consider the issues and decide on the way forward for your practice.
It is important to keep separate the two aspects to this. Your decision whether or not to register patients who do not live in your area is completely separate to your decision whether or not to sign up to the DES.
1.
REGISTERING PATIENTS WHO DO NOT LIVE IN YOUR CATCHMENT AREA.
The GP contract has been changed to allow practices to register patients who do not live locally, without being obliged to visit them at home. You don’t have to sign up to anything to be able to do this. The contract allows you to do this – it does not compel you to do it.
N.B. This only applies to new registrations. This does not apply to existing patients who move away and want to stay registered with you. If one of your patients moves away and wants to stay registered, and you agree that it is clinically appropriate that they are registered with you and not with a practice near where they live, then that patient would first have to be removed and then reregister as an out of area patient. (See page 46 of the guidance for more information).
The LMC is concerned that there are risks in registering out of area patients. For example you would be responsible for arranging community care for a patient registered with you even if they live way outside your CCG area (see pages 16-18 of the guidance). However, it will always be the practice’s decision, and there may be occasions where you consider it to be clinically and practically appropriate to register a patient who does not live in your area.
The “contract change – practice decision form”
The area team has asked you to complete and return a form called “contract change – practice decision form”. This asks you to answer “yes” or “no” to indicate your decision as to whether or not you will register out of area patients and a date from when you will start registering. This form is intended to give the area team some idea of whether practices think they might register patients who don’t live in their area so they can respond to media, FOI or patient enquiries.
The LMC thinks that it is confusing and unnecessary that they have asked you to fill in this form because this is not something you have to sign up to or that you can opt in or out of – it is a contractual mechanism that you can use as when you think appropriate. However, in some ways it doesn’t really matter whether you say “yes” or “no” to this. Even if you say “yes” you are still not obliged to register patients who do not live in your area (it is always up to the practice to decide on a case-by-case basis and on clinical and practical grounds) and even if you say “no” you can still change your mind and register someone if that seems to be the right thing to do.

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The LMC is concerned that the area team might keep a list of those practices that have ticked “yes” and may use this to direct patients who contact the area team to ask about registering as an out of area patient. Even though you would not be under any obligation to register a patient (even if you have ticked “yes”), if you refused to register a patient directed to you by the area team it could be quite stressful for staff to explain this to the patient.
2.
ENHANCED SERVICE “OUT OF AREA REGISTRATION: IN HOURS URGENT PRIMARY MEDICAL
CARE (INCLUDING HOME VISITS) ENHANCED SERVICE”
The area team has to have arrangements in place to ensure patients who are registered out of area can see a GP locally if they are sick and can’t get to their registered practice. One way for these arrangements to work is for the area team to pay – via a DES – local practices to see these patients.
A practice can choose to sign up to the DES, under which they would be paid to see (either in the surgery or at the patient’s home) a patient who is not registered with their practice. It is optional for
practices to sign up to this. The LMC can’t advise you whether or not to sign up to an enhanced service; it has to be a practice decision but as always we would suggest that you think very carefully about what it would mean for your practice. Some things to consider are whether and how your practice would cope with being asked to see additional non-registered patients in an emergency or go out to visit them at home, bearing in mind that this work would be unpredictable, and you would be expected to see these patients without any notes.
WE WOULD URGE YOU TO READ THE NHS ENGLAND GUIDANCE DOCUMENT, PARTICULARLY THE
FAQS ON PAGES 46-48. This is available on the Hot Topics section of the LMC website home page.
We hope this information is helpful. Do please contact the LMC office if you have any questions, or contact the area team as detailed in Lynn’s letter.
Yours sincerely
Rachel Lea
LMC Liaison Manager (Herts)