Memorandum submitted by Gloucestershire Primary Care Trust

(CBPS 20)

Patients who live on the border between England and Wales can experience differing levels and entitlements relating to health care depending on a number of factors including:

· The GP they are registered with (whether they belong to an English or Welsh practice).

· Their postcode.

Waiting Times

Welsh Trusts are currently working towards a combined waiting time of 16 months (outpatients and inpatients).

English Trusts are currently working towards a combined waiting time of 18 weeks (from referral to treatment).

Choice of Welsh Trust

Gloucestershire patients can not choose to be treated at a Welsh Hospital through the Choose and Book system (which applies to English Trusts only). However, a Gloucestershire GP could choose to make a paper referral to a Welsh Trust.

Welsh patients can choose to be treated at an English Hospital, however the Welsh wait time target applies not the English. Hospitals Trusts close to the Welsh border (for example, Gloucestershire Hospitals NHSF Trust) hold contracts with Welsh Local Health Boards where there are patient flows from Wales to England for treatment.

Interventions Not Normally Funded (INNF)

Gloucestershire has an INNF policy which applies to patients registered with Gloucestershire GPs. Wales also has a similar policy, but this is managed directly by the Welsh Assembly and applies to the whole of Wales, rather than being the responsibility of individual Welsh Local Health Boards. Therefore, there is the potential for differential treatment when looking at available treatment in practices / villages close to the border in Gloucestershire, as this will depend on GP registration.

Patient Transport

For a Gloucestershire resident receiving treatment at Gloucestershire Hospitals NHS Foundation Trust, the practice would apply to Great Western Ambulance Service (GWAS) for the transport. If the patient has a Welsh address and needed transport, Gwent Ambulance Service would be approached.

Social Care

In Gloucestershire, Social Services are responsible for the population in the 'GL' postcode rather than GP registration.

Prescribing

Whether a patient pays a prescription charge or not is based on whether they are registered with a Welsh GP, and is not dependant on where the patient lives.

Therefore, if patient lives in Gloucestershire but has a Welsh GP address/postcode on the prescription then they will NOT be charged if this is presented to a Welsh pharmacy for dispensing (but will be charged if this is presented to a pharmacy in England).

If a prescription is presented to a Welsh pharmacy with an English GP address on, then whether the patient lives in Wales or England, they will be charged for the prescription.

Screening programmes

Gloucestershire responsible patients access screening services run by Gloucestershire Hospitals NHSF Trust. Until recently this service was not available in Wales and practices with both Welsh and English patients would need to identify those eligible for screening.  Now Gwent are running a similar service to Gloucestershire. The main difference between the service is the screening round lengths. The only exception is retinopathy screening - this is not postcode driven but for all registered at Practice and is now being organised by Gwent for Welsh responsible practices.

Breast screening: Gloucestershire PCT offers breast screening to all women in the county between fifty and seventy years of age.

In Wales, breast screening is also offered to women between fifty and seventy years of age (the upper age limit increased from sixty-four in 2006).

Cervical screening: Women in Gloucestershire between twenty and thirty-four years of age are invited for cervical screening every three years. Women aged between thirty-five and sixty-four are invited for cervical screening every five years.

In Wales, cervical screening is offered to women aged twenty to sixty-four years of age every three years.

Health Visiting

The Gloucestershire PCT Provider Arm (Care Services) receives funding from Wales to pay for Health Visiting services across the border. Gloucestershire PCT provide services to the PCT's responsible population (registered with a Gloucestershire GP), regardless of location, however Welsh services only work within their own geographical area.

District Nursing

In-hours: The GPCT District Nursing service may receive contact from patients that live in Gloucestershire but are registered in Wales. If this occurs the patients will be treated as necessary but the DNs will transfer care to Wales when appropriate.

Out of hours: For the twilight service, there is a historical arrangement that exists for up to three named patients that live in Gwent and are registered in Wales. If these patients need to access the service this is commonly for assistance with Insulin.

15 March 2008