From 5 January 2015, all GP practices became able to register new patients who live outside the practice area without any obligation to provide home visits or services out of hours when the patient is unable to attend their registered practice.

Where a patient is accepted under the new arrangements (having satisfied itself there are no clinical or practical reasons not to register without home visits etc.), the practice still provides the full range of contracted services (essential, additional, enhanced) but is under no obligation and cannot be compelled to provide home visits or other urgent care to the patient when outside the practice area and if they cannot reasonably be expected to attend the practice.

NHS England is responsible for ensuring patients who choose to register out of area without home visits can continue to access primary medical services if they have an urgent need when at home and if they cannot reasonably be expected to attend their registered practice.

Registration of an out of area patient is not an obligation, but a choice exercised by the practice made subject to the individual needs of the patient.

Where the condition of the patient changes such that it is no longer appropriate to remain an out of area patient, the practice may serve notice to the patient with subsequent removal from the list of registered patients.

Practices must include a manual note on the registration system to include one of the following “OUT OF AREA REG”; “OUT OF AREA SCHEME”; “OOA REG”; “PC-OOA”; “PCS-OOA”; “OOAR” prior to sending registration via the LINKS software.

28.1.3A Where, under clause 28.1.1, a Contractor accepts onto its list of patients a person who resides outside of the Contractor’s practice area and the Contractor subsequently considers that it is not clinically appropriate or practical to continue to provide that patient with services in accordance with the terms specified in clause 28.1.3, or to comply with those terms, clause 13.10 (which relates to the removal of a patient from the list at the Contractor’s request)is deemed modified in relation to that patient so that:

(a)in clause 13.10.1, the reference to the patient’s disability or medical condition is removed; and

(b)clause 13.10.4 applies as if, after clause 13.10.4(a), there were inserted the following paragraph:“

(aa) the reason for the removal is that the Contractor considers that it is not clinically appropriate or practical to continue to provide services under the Contract to the patient which do not include the provision of such services at the patient’s home address”.

28.1.4. The Contractor and the Board are (for such period of time as a person registered under clause 28.1.1remains so registered) released, in relation to that person, from all obligations, rights, and liabilities relating to the terms contained in clause 28.1.3 (including any right to enforce those terms) where, in the opinion of the Contractor, it is not clinically appropriate or practical:

(a)to provide the services or access to such services in accordance with those terms:or

(b) to comply with those terms.

28.1.5. The Contractor must give notice in writing to a person where the contractor is minded to accept that person onto its list of patients in accordance with clause 28.1.1 that the Contractor is under no obligation to provide:

(a)essential services if, at the time treatment is required, it is not clinically appropriate or practical to provide primary medical services given the particular circumstances of the patient;

(b)out of hours services if, at the time treatment is required, it is not clinically appropriate or practical to provide such services given the particular circumstances of the patient; or

(c)additional services to the patient if it is not clinically appropriate or practical to provide such services given the particular circumstances of the patient