There may be cases where it would be clinically inappropriate for a patient to register with a practice far from their home, perhaps because the patient needs a package of home-based or community-based support (eg, for complex long-term conditions or for end-of-life care) and it would not be realistic to expect a remote practice to coordinate the package. Equally, a patient may be an ideal out-of-area registrant initially but then develop a condition which makes it inappropriate for so-called “remote registration” to continue.
In some cases, when a patient presents to a practice requesting out-of-area registration, it will not be possible to determine whether there are factors which might make this clinically appropriate. Participating practices will retain discretion to remove patients from the list where it becomes apparent that the patient’s health needs are such that they cannot be properly met through out-of-area registration. In the event that a patient is no longer deemed to be suitable for out of area registration however, the pilot PCT must ensure the patient has continuous access to primary medical services until they are successfully re-registered with a local GP practice.
Some patients will be patently unsuitable for remote registration, eg, it would not be appropriate for patients under a violent patients’ scheme to be either registered as out of area patients or treated as day patients, given that management of this group of patients requires a stable environment.
Protecting patients in vulnerable conditions, such as children, older people and those with learning disabilities or mental and physical disabilities is a crucial feature of a patient-centred service. Because GPs are an important link in the safeguarding chain, working and sharing information with other agencies in the health and social care system, it is essential that practices participating in the Patient Choice Scheme take action if they have concerns about patients either registering out of area or seeking day patient consultations. Since access to patient records and local knowledge may be critical in these cases, practices should urgently discuss with the patient’s home GP practice if they have concerns and inform the local authority where appropriate.