Out of Area Registrations and In Hours Urgent Primary Medical Services (Enhanced Service)
Choice of GP Practice
NHS England released guidance on the new out of area patient registration (choice of GP practice) arrangements in November 2014, click here to access this.
What does this actually mean?
Within the guidance was issued it identified 2 elements to this scheme which were:
- Out of area registrations – Changes to the GMS contract enables practices to have patients with a registration status of ‘out of area registration’, with no obligation to offer home visits or urgent care. Practices do not need to opt in to provide this it will be the choice of the practice as to whether this option is offered to patients when registering. The GPC has stated that it is important that practices must not register any patient under these new arrangements (out of area registration) until they are certain that a safe and adequate service is available if patients are too ill to travel to the practice. GPs have a professional (not contractual) responsibility to ensure this is the case i.e. that there is a practice, covering the area where the patient lives, offering the service as below.
- In hours urgent primary medical care enhanced service – ICBs (non delegated – NHSE) are responsible for commissioning urgent care provision for patients who have registered out of area, in the event that they become ill and need to be seen locally. Practices can choose to opt in or out of providing this service.
Out of Area Registrations:
1. Process for registering a patient as out of area:
- Completion of GMS1 or equivalent registration form
- Registration on GP system as normal with a note on the registration page of out of area, the following provides the agreed text
- OUT OF AREA REG
- OUT OF AREA SCHEME
- OOA REG
- Information on how to access urgent care arrangements in the event the patient becomes unwell at home to be given to the patient. However, in the first instance they should contact their registered practice.
2. Funding mechanism for out of area registrations
Practices receive the same funding (GMS/PMS) as they would normally receive for any other NHS registered patient.
3. Existing patients
- Patients that are currently registered with the practice and are living outside the practice boundary cannot be re-registered as out of area with no home visiting obligation. This would be unreasonable grounds for removing such patients from the practice list (NHS England interpretation of regulations)
- Where patients are currently registered within the practice area and then move out of the area (outer boundary) practices can:
- Choose to continue the registration of the patient, accepting their new address, where home visiting would still be required. The patient cannot be removed from the list at a later date should the practice change their minds.
- Choose to register them as an out of ‘area registration’. This must be agreed with the patient and the practice would be required to de-register them from the practice on the grounds that they are out of area and then re-register them (as this scheme is only available to new patient registrations). In this situation a patient can be de-registered in the future should their medical circumstances change meaning they need increased medical input (especially increased home visiting).
- Choose to not continue to offer them services and the patient must register with a new Practice that does cover the address they’ve moved to.
4. Registration Status
- If in an area there are a mixture of out of area registrations and normal NHS registered patients, the practice is not required to undertake home visits for patients that are out of area registrations
- Where a patient falls ill (who has an out of area registration with another practice), and needs to register with a practice near their home,a practice may register them in the normal way if they live within the practice boundary.
- The practice should ensure that when refusing an out of area registration that this is justified on clinical & practical grounds. Each registration will need to be completed on an individual basis and be accepted where clinically appropriate.
- If an out of area patient develops a condition that makes it inappropriate for them to continue being registered in this way, the practice needs to discuss this with the patient and recommend they register with a practice closer to their home
- Students will need to continue to be registered as an NHS registered patient
- If a student wishes to be registered with their ‘home’ practice this is possible. It is reliant on the choice of the patient and whether it is clinically appropriate and practical to be registered. They would need to be able to attend for routine appointments which are unlikely to be practical.
This would appear to contradict itself therefore the LMC believes that students should be registered with a practice near where they attend university and then be seen as a temporary resident when at home.
6. Assigning patients
- The area team cannot assign patients to practices as an out of area registration and the same applies to violent patients as this would not be appropriate
This scheme only applies to practices within England and will not be able to register patients who live in other countries of the UK.
7. Registering patients
When patients who live outside your practice’s area request to register, you will need to decide the following:
- To register as an out of area registered patient with no obligation on the practice to provide home visits etc., assuming the practice is satisfied it is clinically appropriate and practical to register the patient in this way; (GP practices should ensure that where registering new patients under these arrangements, the patient fully understands the terms of their registration – that is that the practice will not provide a home visit or any other form of urgent care unless the patient is able to attend to the practice, and the arrangements to access urgent care when they are not)
- To register as any other registered NHS patient. The practice provides access to the full range of services and therefore accepts the obligation on the practice to provide home visits etc.
- To not register the patient. The ability for GP practices to refuse registration on the grounds the patient lives outside the practice area remains unchanged and thus ensures the new arrangements for out of area registration apply on a voluntary basis.
Click here to see a flow diagram of what to consider if a patient has moved to outside of the practice boundary and requests to re-register.
Click here to see a flow diagram of a suggested process for a new registration of an out of area patient.
In Hours Urgent Primary Medical Care Enhanced Service:
The In Hours Urgent Primary Medical Care Enhanced Service is the second element of this and is technically separate from the out of area registration element. This will be needed when an out of area patient is unwell when at home and requires urgent care.
As this is an enhanced service practices can choose to opt in or out of providing this, there is no requirement to undertake this service.
To view the service specification please click here:
1. What will you have to do if you choose to sign up to this?
If you wish to sign up to this enhanced service you will need to provide the following:
- Information on how to access your service will be sent to NHS 111. This will enable the Directory of Services to be updated so that patients can be directed to the practice as and when required
- Ensure the practice has processes in place to provide services to patients who are resident in the practice area but who are registered with an out of area practice that enables:
- Access for people who are unwell at home during 8.00 – 6.30 pm Monday – Friday (excluding bank holidays) or who are recovering at home after a period of hospitalisation
- Offer of a consultation for the purposes of identifying any need for treatment or further investigations and making available any such treatment or further investigation as is necessary and appropriate
- Home visits where it is deemed necessary
- The transfer of information securely to the registered practice, no more than 24 hours after the consultation
2. How will this be monitored?
- Practices will submit on a quarterly basis the number of out of area registered patients accessing services
- This will need to be broken down into the number of consultations and home visits for each patient and a template will be provided for returns
- Clinical details are to be kept for each attendance and sent onto the registered practice within 24 hours of the consultation
3. What is the payment for this?
- £15.87 per GP consultation (can include telephone/skype consultations, excluding home visits)
- Where a patient is consulted 4 times in any 12 month period, they will need to be reviewed for their appropriateness on this scheme
- £60 per home visit
- Where a patient receives a home visit on 2 or more occasions they will need to be reviewed for their appropriateness on this scheme
4. When can a patient access the in hours urgent primary medical services?
Click here to see 3 different scenarios and whether a patient can access the in hours urgent primary medical service