title: Potential impact of removing general practice boundaries in England: a policy analysis.
abstract: In 2015, the UK government plans to widen patient choice of general practitioner (GP) to improve access through the voluntary removal of practice boundaries in the English NHS. This follows a 12-month pilot in four areas where volunteer GP practices accepted patients from outside their boundaries. Using evidence from the pilot evaluation, we discuss the likely impact of this policy change on patient experience, responsiveness and equity of access. Patients reported positive experiences but in a brief pilot in four areas, it was not possible to assess potential demand, the impact on quality of care or health outcomes. In the rollout, policymakers and commissioners will need to balance the access needs of local residents against the demands of those coming into the area. The rollout should include full information for prospective patients; monitoring and understanding patterns of patient movement between practices and impact on practice capacity; and ensuring the timely transfer of clinical information between providers. This policy has the potential to improve choice and convenience for a sub-group of the population at lower marginal costs than new provision. However, there are simpler, less costly, ways of improving convenience, such as extending opening hours or offering alternatives to face-to-face consultation.
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mays
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: Stefanie.Tan@lshtm.ac.uk.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Tan
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eastmure
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Bob
authors.initials: B
authors.lastname: Erens
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Mylene
authors.initials: M
authors.lastname: Lagarde
authors.affiliation: Policy Research Unit in Policy Innovation Research, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Wright
mesh_terms: D002755:Choice Behavior; D004739:England; D058006:General Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D017060:Patient Satisfaction; D011050:Policy Making; D013222:State Medicine
keywords: General practice; NHS; Patient choice; Practice boundaries; Primary care