Since 5 January 2015, GP practices in England have had the option to register new patients who live outside their designated practice area without the obligation to provide home visits or urgent care services when the patient is unable to attend their registered practice. This policy was introduced to increase flexibility and patient choice, allowing individuals to register with a practice that best suits their needs, such as one near their workplace rather than their home.
Practice Discretion: GP practices are not obliged to register out-of-area patients. Each registration is subject to the practice’s clinical and practical assessment of whether it is appropriate to accept the patient without the provision of home visits.
Full Range of Services: Once accepted, the patient is entitled to receive the full range of contracted primary care services, including essential, additional, and enhanced services.
No Home Visit Obligation: Practices are under no obligation to provide home visits or urgent care to the patient when they are outside the practice area and cannot reasonably be expected to attend the practice.
Responsibility for Urgent Care: NHS England is responsible for ensuring that patients who register under this scheme can still access urgent primary medical care in their home area when necessary.
If a patient’s condition changes such that it is no longer clinically appropriate or practical for them to remain an out-of-area patient, the practice has the right to serve notice and subsequently remove them from the practice list.
This decision should be made based on clinical judgment and practicality, ensuring patient safety and continuity of care.
Practices must manually note the registration type in their system using one of the following codes before submitting the registration via the LINKS software:
“OUT OF AREA REG”
“OUT OF AREA SCHEME”
“OOA REG”
“PC-OOA”
“PCS-OOA”
“OOAR”
Under the NHS Standard Contract:
If a practice determines that it is no longer clinically appropriate or practical to continue providing services to an out-of-area patient, the practice can request removal of the patient from the list without reference to disability or medical condition restrictions.
The practice must inform the patient in writing if it decides to accept them under the out-of-area scheme, clarifying that it is not obliged to provide:
Essential services if it is not clinically appropriate or practical at the time treatment is required.
Out-of-hours services if it is not clinically appropriate or practical to provide them.
Additional services if it is not clinically appropriate or practical to do so.
Registration is voluntary: Practices can decline to register an out-of-area patient if they deem it clinically inappropriate or impractical.
Responsibility for urgent care lies with NHS England: Practices should inform patients that NHS England will facilitate urgent primary care services when they cannot attend their registered practice.
Clear documentation is essential: Properly recording an out-of-area registration ensures clarity and compliance with NHS contractual obligations.
Practices can remove patients when necessary: If an out-of-area arrangement becomes unsuitable due to a patient’s changing needs, practices can initiate de-registration.
For further guidance or support, practices should contact their Local Medical Committee (LMC) or NHS England regional office.