Intended for healthcare professionals


GP at Hand: NHS England upholds CCG’s objection to planned Birmingham expansion

BMJ 2018; 362 doi: (Published 13 September 2018) Cite this as: BMJ 2018;362:k3899
  1. Gareth Iacobucci
  1. The BMJ

NHS England has upheld an objection by clinical commissioners to a request from GP at Hand to subcontract its digital service from London to Birmingham, citing concerns about how patients will access screening services.

GP at Hand, run by an NHS general practice in Hammersmith in partnership with the technology company Babylon, offers patients GP consultations 24/7 on their smartphone or in person at five clinics in London. But it is keen to expand beyond the capital and submitted a request on 22 June to vary its subcontracting arrangements with Hammersmith and Fulham Clinical Commissioning Group (CCG) by adding a physical site in Birmingham.1

But Hammersmith and Fulham CCG and Birmingham and Solihull CCG both raised objections to the proposal because of concerns over clinical safety.2 Hammersmith and Fulham subsequently escalated the matter to NHS England because the proposal was considered “novel, contentious or repercussive” and extended beyond London.

In an update to Hammersmith and Fulham CCG’s board published this week its managing director, Janet Cree, said, “Having considered the committee’s recommendation on 3 September, NHS England agreed with the CCG and did not lift the objection.”3

When approached by The BMJ for further comment a London spokesperson for NHS England cited a paper presented to Hammersmith and Fulham CCG last month by Julie Sands, NHS England’s head of primary care for northwest London.4 The paper said that NHS England would not agree to the move until a “safe and sustainable solution” was in place.

It said, “Access to local clinical pathways could be addressed as part of the mobilisation and prior to registering any patients in Birmingham. However, the concerns regarding patients accessing screening services and related follow-up services is more complex to resolve at a local level, and currently there is not a satisfactory or sustainable solution to ensure that patients will be able to participate in screening easily.

“It is therefore the view of the NHS England (London) medical directorate, incorporating feedback from the [NHS England] screening team, that it would not be reasonable to lift the objection until a safe and sustainable solution is in place.”

A GP at Hand spokesperson commented, “Commissioners have known for more than nine months of the proposed national expansion of GP at Hand. The NHS has not been able to put in place the screening arrangements that enable this.

“As a result, the choice of GP practice promised by the NHS to people across the country is being held back, and the opportunity to reduce pressure on primary care and A&Es is being missed. We hope this issue will be resolved without further delay so that safe, effective and extremely convenient primary care can become a reality for anyone who chooses it.

“The CCG made it clear at its August meeting that GP at Hand has done everything required of it in planning the expansion to Birmingham. We will continue to work with commissioners and screening leads to bring GP at Hand to people across the country.”


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