Between April 2012 and March 2013, in four Primary Care Trust (PCT) areas in England – Westminster, Manchester, Salford and Nottingham – patients were able to access a General Practitioner (GP) practice away from the area in which they lived, either in place of, or in addition to, their ‘home’ practice.
The evaluation examined:
The evaluation comprised:
There were 1108 out of area (OoA) registered patients and 250 day patients at the 43 volunteer practices that participated in the pilot.
There were four types of OoA registered patients:
Most OoA registered patients were positive about the scheme. Convenience and continuity of care after moving house appeared to be the main benefits perceived.
The scheme also suited patients with long commutes.
There were three types of day patients:
Most day patients expressed positive views of the scheme for its convenience to their work or lifestyle and ease of making an appointment. The scheme suited patients wishing to remain registered with a practice near their homes.
PCT managers had some concerns related to the risk that, with out-of-area registration, practice populations could become more socio-economically segregated. Another concern for the future, if more patients found themselves living outside the area where their general practice was located, relates to making and managing referrals and their costs. Practice staff were broadly (though not uniformly) positive about extending the out of area registration aspect of the scheme.
The discrete choice experiment showed that a minority of the population would be willing to register with a practice outside their neighbourhood provided that there was such a practice available that was more convenient for them. However, there was considerable heterogeneity in preferences. Some sub-groups, either because they are less mobile (e.g. older people and those with caring responsibilities), or because they are satisfied with their local services, were far less interested in registering at a practice outside their neighbourhood. In choosing a practice, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Most people did not regard weekend opening (Saturday and Sunday) as important in determining their choice of practice. Some people, in particular those who worked and older people, felt strongly about having responsive services that had extended opening hours, whether it meant that they had to register with a practice locally or not. These findings are consistent with the results from the surveys of patients using the pilot.