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Patient choice scheme guidance for all PCTs published

April 2012

The patient choice scheme document publishes guidance to all primary care trusts (PCTs) on the broader aspects of the policy on widening patient choice of GP practices.  It sets out the new provisions in legislation relating to practice boundaries and the revised list closure procedure.

The “Patient choice scheme guidance reiterates the aspects of the patient choice pilot scheme which apply to all PCTs, as well as the aspects of the patient choice scheme which could affect PCTs in those areas not participating in the piloting arrangements.

The documents published in the annexes of the “patient choice scheme guidance will be of interest to PCTs , and practices and for those involved in enhanced services.

The Patient Choice Scheme will be implemented from the 30 April 2012. It has been set up to assist those people who are away from their local practice area during the day, such as commuters, and for any other person living outside of a participating practice’s boundary area, who wishes to access GP services in the areas under the Scheme, either by registration or being seen and receiving treatment as an unregistered patient.

The PCTs participating in the Patient Choice Scheme are

• City and Hackney Teaching PCT
• Tower Hamlets PCT
• Westminster PCT
• Manchester Teaching PCT
• Salford PCT
• Nottingham City PCT

Definition of New patients Types

NEW Out-of-area registered patients

These are people, living outside the practice’s area, accepted as registered NHS patients by practices participating in the Choice of GP Scheme. Such patients are able to access all services provided by the practice, except home visits, immediately necessary and emergency treatment needed whilst they are outside the practice’s area. Patients who, for example, live in London for part of the week will be able to register under this arrangement or as a temporary resident patient.

NEW Day Patients

These are people, living outside the practice’s area of a practice participating in the Choice of GP Scheme, who are present in the practice’s area for less than 24 hours, to whom the practice provides treatment. These patients will not be registered with the participating practice, and details of their treatment should be passed back to their registered practice. Participating practices will receive a fee – up to 5 per patient per annum –

Commissioning Issues

Where a patient registers with a practice in the scheme, the PCT covering the area in which the patient has registered will become the responsible commissioner of healthcare services for that patient. The PCT covering the area in which the patient lives will continue to be responsible for securing any necessary primary medical services for when the out-of-area registered patient is at home.

Under the NHS allocations system, changes in the distribution of patient registrations are taken into account in calculating target allocations for PCTs (or, in future, CCGs) for future years, but do not result in any in-year changes to allocations. For the pilot year, 2012/13, there will not, therefore, be any adjustments to unified allocations to reflect the secondary care costs arising from Patient Choice Scheme.

PCTs are already the responsible commissioners for a number of patients who live outside the PCT area but register with GP practices inside the area (there are already some 2.6 million patients who cross PCT boundaries in this way). The pilot arrangements are likely to increase at the margins these cross-border flows, but do not alter the principles of the existing ‘responsible commissioner’ guidance.
The prescribing and treatment costs associated with ‘day patient’ consultations will be the responsibility of the PCT holding the contract with the primary medical services contractor with whom the patient has consulted. If the patient is to receive repeat prescriptions following the day case consultation, then the associated costs should be the responsibility of the patient’s registered practice. Any commissioning costs will continue to fall to the PCT where the patient is registered.

Services Available to Out-of-Area Patients at Participating Practices

Patients registering with a pilot GP practice must receive the full range of primary medical services (essential services, additional and enhanced services) in the same manner as other patients on the registered list unless the services are required urgently, involve a home visit or for some other reason the provision of the service would also be clinically or practically inappropriate.

When a participating practice accepts a patient who lives outside its practice area onto its registered list then it will receive the same global sum funding, and other payments Choice of GP practice
such as Quality and Outcomes Framework, Directed Enhanced Services and Local Enhanced Services payments, as it would for any other registered patient.

GP practices undertaking day patient consultations should be eligible for any associated enhanced service payments from their PCT where the enhanced service does not relate to patients on the practice’s registered list.

For the full PDF text click here

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