Out of Area Registrations

The aim of this guidance is to help practices manage out of area registrations fairly and in line with the Standard General Medical Services Contract, NHSEI guidance and BMA guidance.

NHS England published its ‘Choice of GP practice: Guidance on the new out of area patient registration arrangements’ on 5th January 2015.  This allows GP practices to register patients who live outside their practice area, with home visit services provided separately.

All primary medical services contracts (GMS, PMS and APMS) have consistent contractual terms that provide practices the option to register out of area without obligations to provide:

(i)  Home visits;

(ii)  Immediately necessary treatment following accident or emergency when the patient is at home;

(iii)  Access to out of hours services (if not opted out) when the patient is athome (and it is not reasonable to expect the patient to attend); or,

(iv) Other such services provided by the contractor, which for clinical or practical reasons it is not reasonable to expect the patient to attend their registered practice, e.g. this could include follow up care following hospital discharge.

Registering patients

If a patient who lives out of area requests to register, Practices can: 

1. Choose not to register the patient. GP practices can refuse registration on the grounds the patient lives outside the practice area.

2. Choose to register the patient as a fully registered patient. GP Practices would provide access to the full range of services including home visits and urgent treatment. 

3. Choose to register the patient as an out of area registered patient. GP Practices would have no contractual obligation to provide home visits or urgent treatment.  If following this option, GPs must:

  • Be satisfied it is clinically appropriate and practical to register the patient in this way.
  •  Ensure the patient fully understands the implications of being registered in this way and that they know the process to follow if they are too ill to attend the surgery in person, including warning them that if their health circumstances change in the future, they could be asked to consider registering with a practice closer to home.

Home visits

If a Practice deems it necessary for an out of area patient to require a face-to-face consultation but the patient is unable to visit the practice, they should advise the patient to ring NHS111 as per their registration arrangement. 

Practices should also provide patients with information on how they can access urgent care services if they need it.

If community services are required, Practices remain responsible for discussing these options with out of area patients. 

Students

Students should be registered in the normal way at a practice close to their university residence and if they need to be seen by a GP whilst at home, they can be registered as a Temporary Resident. 

Existing patients who then move out of area

If existing patients, currently registered subsequently move out of area, there is no mechanism to change their registration status and practices would remain responsible for providing all services including home visits and urgent treatment.

When reviewing patients who have subsequently moved out of the area, Practices can:

1. Choose to continue to register the patient in the normal way where home visiting would still be required.

2. Choose to register the patient as an out of area registered patient. GP Practices would have no contractual obligation to provide home visits or urgent treatment.  If following this option, GPs should:

  • Fully and clearly explain the requirement of de-registration on the grounds that the patient has moved out of area and then re-registration as an out of area patient.
  • Ensure the patient fully understands the implications of being registered in this way and that they know the process to follow if they are too ill to attend the surgery in person, including warning them that if their health circumstances change in the future, they could be asked to consider registering with a practice closer to home.
  • Be satisfied it is clinically appropriate and practical to register the patient in this way.
  •  Ensure the patient is in full agreement before amending changing the registration status on the GP system.

3. Choose to invite the patient to look to register with another GP Practice local to their home address where they would have full access to all services including home visits and urgent treatment.

Cambs LMC Ltd View: It is our view that Practices, at any time can look at their options to ensure they can continue to provide a safe and adequate service to all of their patients.  So as not to discriminate and to ensure a fair process is followed, Practices must review all of their out of area patients and provide them with the same options for their care going forwards. If Practices choose to write to their patients to respectfully request that they either consider their type of registration or to look to register elsewhere, Cambs LMC Ltd would be happy to review any draft letters or discuss further to ensure a safe and fair process has been followed in line with GMS Regulations and NHS/BMA Guidance. 

GMS Regulations: https://www.legislation.gov.uk/uksi/2015/1862/regulation/30/made

NHSE Guidance:  https://www.england.nhs.uk/wp-content/uploads/2017/10/Guide-out-area-reg-1214.pdf

BMA Guidance: https://www.bma.org.uk/advice-and-support/gp-practices/managing-your-practice-list/out-of-area-gp-registrations-and-patient-choice

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