- NHS England remains responsible for the patient's urgent medical care when the patient is at or near home.
- Practices registering patients from outside the area need to decide whether it's in the patient's best interests.
- Patients need to understand the implications, such as not having access to home visits during normal hours.
Since January 2015, GP practices have been able to register patients who live outside the immediate practice area without being obliged to provide home visits.
Participation by GP practices is voluntary. NHS England remains responsible for providing in-hours urgent medical care for out of area patients if needed near their home.
Practices who consider registering out of area (OOA) patients need to think about their ethical duties to patients, and the possible medico-legal risks involved. Some practices may wish to advertise that they accept patients from outside the area, although it's important that the information published is factual, verifiable and doesn't exploit patients' vulnerability or lack of medical knowledge.
Consider the patient's best interests
- When an OOA patient applies to register, the practice needs to decide whether it's in the patient's best interests, based on their likely clinical requirements and how much time they spend in the practice area.
- Consider each case individually, based on the individual circumstances of the patient and including any chronic conditions that may require urgent care.
- Ask patients about their medical history and the time they spend in the area. Get their consent if you need to obtain further information from their current practice.
Keep patients informed
- Before accepting an OOA patient, explain to them the clinical implications of registering. For example, if the practice can't provide home visits, how will the patient access urgent medical care in-hours if they can't attend the practice?
- Check the necessary arrangements are in place where the patient lives before allowing them to register.
Good communication with other services
- You may need to find out what services are available in the patient's home area and how to access them. This could include referring patients to secondary care for tests, for community health services and following up any screening programs.
- Services like physiotherapy, midwifery or district nursing may be provided by organisations local to the patient's home rather than local to the practice. Good communication between these organisations and the practice is vital in order to avoid any harm to the patient.
- If the patient's immediate family members are registered elsewhere, consider the implications for child and adult safeguarding.
Keep registration under review
- If an OOA patient's circumstances change or turn out to be different to those initially understood, it may be clinically appropriate to discuss this with the patient and ask them to re-register nearer their home.
- NHS England guidance suggests a patient who has consulted four times in 12 months in their home area, or needed two home visits, should be reviewed. The practice will be notified of the contacts by the urgent care provider.
- If patients registered in the practice boundary move out of the area, they should still be removed from the register. However, the practice may wish to invite them to re-register as an OOA patient. If they stay registered, home visits will still need to be provided.
Declining an application
- If you decide to decline a patient's application, you will need to explain why. The patient has no right of appeal, but they can complain via the NHS complaints procedure.
- As long as you can justify refusal on clinical or practical grounds, or because the practice has no capacity, this will not be viewed as discriminatory.
Advertising practice services
- If you are considering advertising to attract OOA patients, the GMC makes it clear that any information you publish must be factual, verifiable and does not exploit patients' vulnerability or lack of medical knowledge.
- Registration of OOA patients is ultimately a voluntary decision by the practice, and the implications of registering patients needs to be carefully considered before offering the service.
- You should only proceed if it is in the patient's best interests, and the patient should understand the potential implications.
This guidance was correct at publication 31/03/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.