The impact of ending practice boundaries?

What is happening?

April 2012 will see patients in parts of London, Manchester and Nottingham being able to choose to register or receive a consultation with a GP practice of their choice, without regard to practice boundaries.  The pilot is set to last one year, but it is difficult to see how this can be reversed or stopped once patients have developed a relationship with a different practice.

Why is this happening?

Competition in public service is central to changes in education, health and other public sector areas.  Removing practice boundaries is as Andrew Lansley said, “…just the beginning of a range of measures… to make the NHS truly patient focused”.

Clearly there are different views about whether abolishing boundaries will improve choice and quality.  A recent Patient Association poll found that 92% of people would like to register with a GP practice of their choice, rather than just a local practice.  The LMC, however, feel that these changes will ‘put a nail in the coffin for local and personalised care’.  Whatever your view, it is clear that increased choice will be rolled out countrywide and that practices need to act to meet these challenges.

Benefits Issues
  • Patient choice
  • Improved access
  • Competition will drive up standards?


  • Home visiting
  • Continuity of care
  • Funding
  • Public health
  • Emergency and community care services

Who will benefit?

Like all competitive markets, informed consumers who are able to change providers will benefit.  They will ‘shop about’ for the practice that best suits their needs.  Most patients are willing to travel to a good practice, just as they are willing to travel to see a dentist they like and trust, or one who has been recommended by a friend.  Mobile patients will register with practices who they believe offer good patient experience.  This will be decided by looking at existing patient feedback on websites like NHS Choices, talking to friends, family and neighbours and seeing how accessible the practice is.  Much has been made about statistics on clinical outcomes; however, research shows that personal recommendations and patient stories have a more powerful impact than statistics in helping us decide what health services we use.

Who will lose?

It is likely that elderly, vulnerable and less mobile patients could be negatively impacted if changes are made with regard to home visiting responsibilities.  Equally practices that have lost patients will have fewer resources to improve services and patients could find themselves trapped with a deteriorating practice.  ‘Difficult’ patients could find themselves passed from one practice to another across a much wider area, rather than have their care provided by a small number of practices.

What is the impact on practices?

Undoubtedly the government’s intention is to create a competitive market. Practices which cannot keep or attract patients will go out of business, others which attract new patients may well be incentivised to grow. An immediate impact of greater choice, is that practice-patient turnover will increase.  If we look at NHS Choices alone, this receives 350,000 visitors every month, that’s 4,200,000 visitors a year, which is equivalent to more than half of London’s population, for an average 6.5K practice that’s just under a 1,000 of all registered patients.  Most visitors look at patient comments and ratings.  If a practice has mixed or poor reviews this will inevitably mean patients will not choose this practice unless friends and family have found their experience to be different.  Again this highlights that it is patient satisfaction and reputation management which will be key to survival.

The Survivors The Strugglers
  • Practices with a good reputation
  • Practices with good patient experience
  • Practices delivering good customer care
  • Practices with a good reputation near large offices and schools
  • Practices offering and promoting a wide range of services for patients which are easy to access
  • Super Practices’ that can obtain economies of scale
  •  All practices with reputation issues and/or poor patient experience
  • Suburban practices with a poor reputation
  • Practices with unexplained poor clinical outcomes

What is the solution?

All practices will need to adapt to become more focused on patient experience, marketing and reputation management.  With improvements in these areas practices will be less vulnerable to population changes and will be able to maintain a healthy list size.

Every practice will have to find solutions which fit their individual service as each practice’s population needs will be different.  For example, if patients like the practice because of the personal nature of the service offered, then it is important this is strengthened and reflected in any practice marketing. There is no one size fits all.

Your reputation really is the key to your success.

For tailored advice and support on how to improve your service so that it is more competitive, please get in touch with me. The services I offer will save you money, improve patient experience and reputation.

What do you think? What do you believe will be the outcome from changes to practice boundaries?