Heaving with more than 19.5 million attendances in England a year, stretched to breaking point and forever chasing targets, how are we supposed to sort the prolific mess of A&E? If you’ve ever been a patient seeking care or a professional at A&E, you’ll know just how incredibly chaotic the department is – and don’t even get me started on Friday nights!
Our report: ‘Responsibility In Healthcare: changing the culture’ has already highlighted the increasing burden of repeat alcoholic and drug offenders in need of regular medical assistance, on A&E. Doctors and Nurses work like dogs as it is, in a system we take for granted; and as if ignorance from the public isn’t bad enough, the constant change of health practice regulations from the DOH never fail to induce knock on effects onto our A&E departments.
Today the Department of Health initiated a consultation on a widespread abolition of GP practice boundaries in the country, allowing us to register wherever we please. The DOH has got the hole-in-one for patients wanting flexibility and choice with their GP visits on this one; aiming to help all patients seeking medical advice. Under the recommendations, patients can remain registered with their GPs when they move home and those who register away from home could have their local PCT arrange home visits from their own GPs. At first instant this seems wonderful – I could register closer to work, children nearer to their schools or relatives, saving us all a great deal of stress and time. Hold on……what happened to all those proposals desperately aiming to reduce A&E attendee numbers?!
This consultation is massively contradicting those government policies striving to cut A&E numbers, have care closer to home and away from expensive health sites. In fact, the consultation admits that the scheme would cause A&E numbers to increase. It would introduce the new problem of finding urgent care were a GP were registered miles away from home and patients had nowhere but A&E to go to for help. A&E departments already suffer from tremendous pressure and with targets meaning that all patients must be treated and discharged or admitted to a ward within four hours of arrival, this added responsibility will not be welcomed with open arms. Having two GPs (close to home and far) would be great, but it’s never going to happen with the costs and replications of services. Andy Burnham, Health Secretary, stated: “Giving people more choice of GP services will help drive up standards and improve quality’’. This may be so, but removing boundaries could prove expensive and no doubt patients will flock to the best practices, whilst those such as the elderly or housebound will be unable to express choice.
And at a time where a government-commissioned report revealed today, that attempts to discourage patients with minor issues from attending A&E will turn away those in need, this consultation potentially leaves vast numbers without appropriate access to healthcare. The government wants to have its cake and eat it too. We must find a way of installing choice and greater flexibility in GP services, without placing extra burden on the already heavily strained budgets, staff and workload of our abused A&E system.
Pawandeep K Kahlon
2020health researcher
2020health's Blog 
At a time when the NHS is being asked to make huge savings it seems ridiculous that we are spending time and money on fixing a problem that never existed. Practice boundaries are a rationally and natural way in managing practice lists, doing away with them will open up a can of worms in terms of home visits, community services and alot more. Read more on my blog at http://therantingsofapracticemanager.blogspot.com/2010/05/will-scrapping-practice-boundaries.html