Intended for healthcare professionals


CCG blocks GP at Hand’s request to expand to Birmingham over safety concerns

BMJ 2018; 362 doi: (Published 13 July 2018) Cite this as: BMJ 2018;362:k3123
  1. Gareth Iacobucci
  1. The BMJ

Clinical commissioners have rejected a request from the service GP at Hand to subcontract its digital service from its London base to a site in Birmingham because of concerns over patient safety.

Board papers published by Hammersmith and Fulham Clinical Commissioning Group show that GP at Hand submitted a request on 22 June 2018 to “vary their subcontracting arrangements” with the CCG by adding a site in Birmingham.1 The digital service, run by an NHS general practice in Hammersmith in partnership with the technology company Babylon and which operates from five physical clinics in London,23 is keen to expand. The proposed Birmingham clinic would operate in the same way as the London satellite clinics, with patients able to see a GP at the location if they chose to.

But Hammersmith and Fulham CCG rejected the proposal after Birmingham and Solihull CCG issued a formal objection. Paul Jennings, chief executive officer of Birmingham and Solihull CCG, wrote to Janet Cree, managing director of Hammersmith and Fulham CCG, formally objecting to the plan on the grounds of clinical safety. The letter can be seen alongside the board papers.4

Jennings wrote, “The overall assurance framework is not yet robust or tested for a national service to be delivered from a single practice outside of Birmingham. Our concerns also relate to the ability of the contractor to integrate and work with the locally agreed pathways for services in an effective and safe manner.

“In addition, we would also require assurance around how the service remains safe and effective around safeguarding issues, medicines management, and delivery of local policies as well as dealing with complex patients.”

He requested that the application be refused until Hammersmith and Fulham CCG had obtained additional assurances from GP at Hand concerning the delivery of the service and NHS England had reviewed the overall assurance framework.

Jennings added, “This new digital offer in effect could potentially significantly destabilise a number of local practices if a large number of patients (particularly young adults) register with GP at Hand. This would have consequences on the wider population and the chronically sick, who would need alternative care if a practice becomes unviable.”

After considering the application and noting Birmingham and Solihull’s concerns, Hammersmith and Fulham CCG said that it would put the plans on hold to allow “the assurance framework to be completed.”

Hammersmith and Fulham said that it needed assurance of sufficient clinical capacity and skill mix and of clinical leadership, governance, and managerial structure to support a safe rollout. It said that it also needed assurance of knowledge and access to local patient pathways, of access to local and national screening services, and of completion of a standard premises checklist.

A GP at Hand spokesperson said, “We are surprised and disappointed by the [CCG] paper, having provided detailed assurances about the clinical safety of our service, including its expansion to Birmingham. GP at Hand has already been subjected to more scrutiny than any other practice. For example, there is an ongoing NHS clinical review led by senior NHS England doctors, which continues to provide assurance about the service. With immediate 24/7 access to GPs, fully recorded consultations, and high levels of staff motivation and engagement, safety levels far higher than in traditional general practice are able to be delivered.”

“It is high time that the financial and ideological interests of the few are challenged and the rights of the public to choose their NHS GP are respected”—GP at Hand

The spokesperson told The BMJ that the board paper contained several inaccuracies. “Most concerning, the lack of a commissioning ‘assurance framework’ is cited as a major reason for not approving the expansion. Your readers, and the public at large, will want to know why commissioners have been so slow to put such a framework in place, given that GP at Hand’s intention to expand has been widely known and reported for more than six months. People may speculate as to whether this is down to a lack of preparation or the vested interests of a few seeking to block the expansion of GP at Hand,” the spokesperson said.

“It is high time that the financial and ideological interests of the few are challenged and the rights of the public to choose their NHS GP are respected.”


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