London School of Hygiene & Tropical Medicine

The report, published on the Policy Innovation Research Unit website, found that the Department of Health's Choice of GP pilot scheme saw modest demand overall, but that participants were generally positive about the scheme and there was little sign of major increased cost to primary care trusts (PCTs) for providing the service. Patients will be able to register with volunteer practices outside the area where they live throughout England from October 2014.

The pilot began in April 2012 for 12 months in four PCT areas of the country with volunteer practices (Westminster, Salford, Manchester and Nottingham City), and allowed patients to register with a pilot practice as an 'out of area' patient.

A total of 43 practices participated in the pilot, with approximately half of the practices in Westminster.  However, 11 of the 43 pilot practices recruited no patients over the 12 months, and the authors suggest that this could be because the scheme was not widely advertised.

A total of 1,108 patients registered with pilot practices as 'out of area', with the scheme being most popular in Westminster, which accounted for 71% of all 'out of area' patients. Overall, patients were much younger, more likely to have better self-reported health, more likely to be in work, and twice as likely to have more than a 30-minute commute than other patients in the pilot areas.

There were four types of 'out of area' registered patients; patients who had chosen their new practice for convenience, for example, because it was close to their work (32.6%), patients who had moved house but did not want to change their practice (26.2%), patients who were new to the area and had registered with a pilot practice but lived outside the practice's catchment area (23.6%) and patients who were dissatisfied with their previous practice or chose their new practice for specific services or to see a particular GP (13.9%).

Lead author Professor Nicholas Mays from the Policy Innovation Research Unit at the London School of Hygiene & Tropical Medicine, said: "While demand for the pilot was modest, our evaluation found that patients had positive views of the scheme because, for example, they didn't need to take time off work to visit a GP or they were able to continue care with a doctor they had a longstanding relationship with after they moved house. Our findings suggest that the extension of the scheme across England later this year will appeal to a minority of the population who have these needs and in particular parts of the country."

"However, we need to bear in mind that the pilot was only for 12 months and only in four areas of the country, so it is difficult to know precisely how the scheme will work on a larger scale and over the long term."

Health Minister Lord Howe said: "Our recent changes to the GP contract will help patients choose a GP practice to suit them. This will support hardworking people who commute to work and cannot access their local surgery during opening times, and enable people who move house to stay with their GP if they want to."

While patients and the majority of pilot practices were very positive about extending the scheme, health system managers were more cautious.  The authors also note that patients were not in the pilot long enough for many potential drawbacks to become apparent, including issues related to receiving out of hours care while registered at a practice far from their home.

Although there were a number of practical problems to be resolved in implementing the pilot, none were seen as insurmountable if the scheme were rolled out. Managers had some concerns related to the risk that 'out of area' registration could lead to practice lists becoming more socio-economically segregated. Another concern was related to managing referrals and their costs if more patients found themselves living outside the area where their general practice was located.

Older patients, or patients who were satisfied with their local services, were far less interested in registering at a practice outside their neighbourhood. In choosing a practice, the report found that people felt most strongly about getting an appointment with a GP as quickly as possible and most people did not regard weekend opening as important.

The independent evaluation was commissioned by the Department of Health on behalf of NHS England through its Policy Research Programme, as part of the core research programme of the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine.

Podcast

Nick Mays talks about his study into GP choice

Publication

• Nicholas Mays, Elizabeth Eastmure, Bob Erens, Mylene Lagarde, Martin Roland, Stefanie Tan and Michael Wright. Evaluation of the choice of GP practice pilot, 2012-13 Final report. Policy Innovation Research Unit.