Patients should be able to choose their own GP, says health secretary Andy Burnham. He's going to tell the King's Fund thinktank today that GP practice boundaries should be abolished and that patients can scour the country to find the GP of their choice. A person may prefer to register at a practice near their office, or in a more upmarket area than their own. The inference is that GPs in posher areas may be better. Tellingly, he is due to say, "There are a lot of what-ifs, but it is important to get on with this." The BMA says it will discuss it, but points out major logistical barriers. These are my initial thoughts:
1) You're usually at home, not at work, when you get ill so it makes more sense to have a GP near your home.
2) It has taken me 20 years to accrete layers of knowledge about my practice area – local resources and community services. If a patient comes to me from another area, I have no idea which playgroups to suggest, where the library is or which bus she needs to get to reach me.
3) We get a lot of feedback about local hospitals and consultants. We see the results of their operations and aftercare. So if you ask me which surgeon to recommend for varicose veins, I can confidently suggest someone. If you come from the other end of the country, I haven't a clue about your local hospitals or consultants. You may want to come to see me as a GP near to your office, but presumably you wouldn't want to be hospitalised far form home.
4) What about the government's commitment to building communities? Our small general practice is a busy hub of local activity. People in the waiting room meet neighbours, the local priest, rabbis, teachers. Young mums, older people, stressed parents and even the busy city lawyers seem to like that homely feel. They can always pop in to a walk-in centre near work if they want a quick, anonymous fix.
5) It's good to walk. We're supposed to be using cars less, walking more. Save the planet, avoid obesity – that sort of thing. In some young communities, people may choose to register near work and find their residential area no longer served by a local practice. As the years go by and they work less and get ill more, they may regret not being able to walk down the road to a surgery.
6) Patients may choose "good" practices over their own local ones. The vast majority of practices are deemed better than satisfactory by a majority in national surveys. Local primary care trusts act to root out poorly performing practices. The General Medical Council (GMC) can stop doctors who are not fit to practise and the public is encouraged to complain if not satisfied with the care they get. So there are lots of mechanisms in place to ensure minimum standards. The GMC is now introducing relicensing, which means doctors have to show evidence of ongoing self-education and drives to improve. Standards may not yet be "excellent" across the board but they are mostly good enough and improving.
7) How do you know what a good practice is? Most people can judge what constitutes a good practice. They want accessibility, fast response time, accurate diagnosis, safe treatment and pleasant interaction. Fair enough. That should be available to all, not just those who can get in a car and drive to a "good" practice, not just those who have the education, language and assertiveness to determine which practice will provide these. It shouldn't be up to the individual – the state should ensure that all practices meet these requirements.
8) Some people don't know what's good for them. If you're addicted to valium, a good GP is one who will provide it for you. If you're beating up your child, a good GP is one who will ignore your kid's bruises, or won't look carefully and won't alert social services. If you're getting sick notes while moonlighting or living abroad, a good GP is one who will turn a blind eye and keep signing the notes.
Think again, Burnham. It's an awful idea.
