Out of Area Patients Policy

NHS Guidance is that patients have a choice of GP practice and so are free to request registration with a practice not in their usual area.  While this may be completely acceptable for several reasons, there are situations where the distance between the patient and the practice hampers care.

Examples where being OOA may impact on care:

–          A patient needing visits. The GMS contract is clear in this, GPs cannot perform visits for housebound patients outside their practice area.

–          A patient who is unable to attend appointments including for emergency on the day appointments due to their location.

–          A patient who needs support from services that cannot be accessed by the current GP, but who could be accessed by a GP closer (i.e. local services are better prepared and able to meet the needs of the patient). GP practices are increasingly working with services configured at a neighbourhood level. The Governments strategy is to develop increased integrated working at a neighbourhood level to support patients. Those patients needing to access ‘neighbourhood’ services will need to be living within a practice’s boundary.

–          A patient who has ongoing support from community services not adjoining or linked to the practice, this means there may not be established lines of communication between the GP and teams local to the patient.

–          A family live OOA and a safeguarding concern arises with a child, but the patients all belong to different practices. From a professional standpoint, having all members of the family under the same practice is far superior in terms of safety and investigations.

The following section will list specific policy information for the following areas.
6.1: Patients seeking registration from OOA.

6.2: Patients who have an active registration with the practice but who are OOA

For patients who are seeking registration from Out of Area, the practice will check against the following criteria.

All automated registrations submitted via Healthtec1 will be flagged for the attention of the reception team to check below.

–          Is the patient housebound? If the patient is housebound then registration will be automatically rejected.   A GP cannot visit a housebound patient who is out of area hence cannot provide care and the patient will be directed to register with a practice who has them in their catchment area.

–          Is the patient under the age of 18.  If the patient is under the age of 18 and out of area, registration will be automatically rejected. Increasingly services will be configured with integrated teams working at a neighbourhood level. This is likely to include Health visiting and community services. Under 18’s will need to be registered with a GP within their neighbourhood area so that local services are accessible to them. Underage patients may also require input from community teams that may not be adjoined or linked to the practice.

–          Do they have children under the age of 18 registered at the out of area address who are registered with a different GP practice? It is preferable that households should be registered with the same GP in case there are any issues relating to safeguarding that are more difficult to spot if members of the same household have different GPs.  If an adult patient is out of area but has children <18 years old registered at that address and they are registered with a different GP, then registration will be automatically rejected.

–          Is the patient receiving any assistance from community teams not linked to the practice? Examples of such services would include health visitors, community mental health teams or district nurses, such teams have several team areas covering the city and your address determines what community team you fall under, which does not always match up with the practice.   If the patient is under active input from community teams and out of area, registration will be automatically rejected.  Community teams that are in different areas may not be adjoined to the practice which can limit or hamper communication and therefore the ability to deliver safe care.

For patient who are currently registered with the practice but who are already out of area (OOA) or who change their address and move outside the practice area, the practice will not automatically deduct or off-list the patient. However, there are restrictions and limitations to the service we can provide for patients who are out of area.

The practice is happy to maintain the registration of patients who are out of area if they are:

–          Able to attend appointments including those in a timely manner i.e. on the day emergency appointments.

–          Able to consistently attend appointments if required for medical reasons or drug monitoring, and the distance between the patients address and practice is not a barrier to this.

–          Not needing home visits.

–          Above the age of 18 years old.

–          Do not have children <18 years living at the out of area address and registered with a different GP.

–          Not requiring services that are local to a patient’s area of address, but which cannot be accessed by the GP practice (i.e. a service in Chesterfield which is Derbyshire and who state they cannot accept a patient living in Sheffield which is South Yorkshire)

–          Not requiring ongoing community or neighbourhood services that are local to a patients address but not the same teams that normally work with that GP practice (i.e. under district nursing teams that are not local to the GP practice, as GP practices work closely with the neighbourhood teams in their area).

The practice may need to de-list patients (where we ask a patient to register with a different GP practice and remove them from our register after a 2-week period) for the following reasons: They are out of area AND;

–          Housebound patients.   A GP cannot visit a housebound patient who is out of area hence cannot provide care and the patient will be directed to register with a practice who has them in their catchment area.

–          Patients under the age of 18. Increasingly services will be configured with integrated teams working at a neighbourhood level. This is likely to include Health visiting and community services. Under 18’s will need to be registered with a GP within their neighbourhood area so that local services are accessible to them. Underage patients may also require input from community teams that may not be adjoined or linked to the practice.

–          Patients who demonstrate difficulties accessing (i.e. not attending an appointment) the practice on at least 2 occasions. This includes appointments which are offered for same day medical assessment. The distance between the patients address and the surgery can act as a barrier to accessing services normally provided by the surgery including medication monitoring and appointment access. If patients do not or cannot attend appointments for subjects like medication monitoring, the GP service cannot provide its usual level of service, and we would direct the patient to register with a GP closer to them so they can access help easier.

–          Patients who are under the care of community or neighbourhood services not local or linked to the practice, or who require input from teams that are local to the patient, but which cannot be accessed by the practice. The practice is linked to its local district nurse and neighbourhood teams to provide an increased level of care, and if the patient lives outside of those areas they may not be able to access those teams which may result in a reduced ability by the practice to offer the same care as an in-area patient, and by registering with a GP closer to them they would have better access to services that can help them. This will also apply if an out of area patient is denied or limited access to local services because registered with a Sheffield GP (Example: a patient in Chesterfield (i.e. Derbyshire) cannot be seen by local teams because the registered GP is in Sheffield, South Yorkshire).

–          Adults of patients who are under 18 who are removed from the practice register for being out of area (OOA) per the above statements, may also be required to register elsewhere if there are additional complexities such as safeguarding or circumstances affecting the whole household. Such decisions to off list adult patients in this manner will be made on a case-by-case basis by the GPs at the practice (Example: a safeguarding concern arises in an OOA household concerning a child, the children have already been deregistered as above but the adult requests to stay. Having members of the household registered with different GPs can make abuse harder to spot, it complicates investigations and the ability of the GP to monitor the whole situation. Therefore, the adult would also be deregistered).

–           How to register with a GP surgery – NHS

–          Registering with a GP surgery outside your local area – NHS

–          NHS England » Standard general medical services (GMS) contract

This policy will be updated with any changes to practice position of legislation.   Any change of policy will be reflected in this document.

If you have specific questions about this, please contact the practice via email: syicb-sheffield.carterknowle@nhs.net