Since January 2015, GP practices have been able to register patients who live outside the immediate practice area without being obliged to provide home visits.
Participation by practices is voluntary. NHS England remains responsible for providing in-hours urgent medical care for out of area patients if needed near their home.
Practices who consider registering out-of-area patients will need to think about their ethical duties to patients, and the possible medico-legal risks involved. Some practices may wish to advertise that they accept patients from outside the area although it is important that the information published is factual, verifiable and does not exploit patients’ vulnerability or lack of medical knowledge.
Five key questions
Here are five key questions that every practice should ask before accepting a patient from outside the area.
1. Is it in the patient’s best interests?
Each application from a patient registering from out of the area will need to be considered individually, based on the patient’s individual circumstances and medical history. For example, you may need to consider if the patient has any chronic conditions which might require urgent care, and how much time they spend in the practice area. Get the person’s consent if you need to obtain further information from their current practice.
2. Does the patient understand the options?
Patients registering from out of the area will need to understand the implications. For example, if the practice can’t provide home visits, how will the patient access urgent medical care in-hours if they cannot attend the practice?
NHS England will be responsible for providing this service, and although the practice is not obliged to do so, it would be advisable to check that the necessary arrangements are in place where the patient lives before allowing them to register.
3. Are there clear lines of communication?
You may need to find out what services are available in the patient’s home area and how to access them. This could include referring patients to secondary care for tests, for community health services and following up any screening programs.
Services like physiotherapy, midwifery or district nursing may be provided by organisations local to the patient’s home. Good communication between these organisations and the practice is vital in order to avoid any harm to the patient. If the patient’s immediate family members are registered elsewhere, consider the implications for child and adult safeguarding.
4. What happens if the registration needs review?
If an out-of-area patient’s circumstances change or turn out to be different to those initially understood, you may need to discuss this with the patient and ask them to re-register nearer their home. NHS England guidance suggests that a patient who has consulted four times in 12 months in their home area, or needed two home visits, should be reviewed. The practice will be notified of the contacts by the urgent care provider .
5. What is our procedure for declining an application?
If you have no capacity to accept the patient, or feel it is not clinically appropriate to register them, you may decide to decline a patient’s application. However you will need to explain why. The patient has no right of appeal, but they can complain via the NHS complaints procedure. As long as the practice can justify refusal on clinical or practical grounds this will not be viewed as discriminatory.
Registration of out-of-area patients is ultimately a voluntary decision by the practice, and the implications need to be considered carefully before offering the service. You should only proceed if it is in the patient’s best interests, and if the patient understands and accepts the potential implications.