Intended for healthcare professionals

Rapid response to:


Why we should be concerned about accountable care organisations in England’s NHS

BMJ 2018; 360 doi: (Published 30 January 2018) Cite this as: BMJ 2018;360:k343
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Infographic available

The key uncertainties and complexities of Accountable Care Organisations (ACOs)

Rapid Response:

Re: Why we should be concerned about accountable care organisations in England’s NHS

Allyson Pollock and Peter Roderick's excellent article should be a clarion call to us all. There is no doubt that the development of ACOs takes us further down the path of the break up of the NHS. This is brought into sharp focus by the advent of GP at Hand,“Powered by Babylon” the private digital health provider and run by Dr Jeffries and partners in Hammersmith.

GP at Hand it works by exploiting the out of area registration rule which allows them to take on patients who do not live within their practice boundary. The service is mainly on line, catering for younger, fitter patients with short term health issues.

General Practice, like the NHS as a whole, relies on risk pooling. A cheaper service can be provided to us all because those who use the service less, generally younger people, cross subsidise those who use it more, which we all do eventually as we get older. GP at Hand threatens to destabilise other GP surgeries as this risk pooling is undermined by their model..

This obviously has grave implications for the survival of General Practice but it is also important to understand that GP at Hand will syphon NHS funding from other STP/ACOs towards it's own. The funding of CCGs is based, as Pollock and Roderick point out, not on geographical populations, but on the number of people registered with a GP in the CCG area. So for example, if thousands of patients living in North East London choose to register with GP at Hand, the NEL STP/ACO will lose money to North West London. The forty four STP/ACOs are already charged with saving £22 billion between them, an impossible task without huge cuts. The advent of GP at Hand, stripping even more cash away, makes their task even more daunting.

A halt has to be called to this madness. The public have to be told what all of this complex manoeuvring means for their NHS. The dangers are obvious. Those in power must stop pretending that the dangers are imaginary and that those of us who insist that the NHS is being wantonly destroyed are scare mongering.

There is an alternative, we are a rich country and the NHS is the most cost effective health care system in the developed world. We can and should afford it and we should not allow this whole scale, back door re-organisation to be the final nail in the coffin of the NHS.

Competing interests: No competing interests

11 February 2018
Jackie Applebee
Tower Hamlets