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GP at Hand is given go ahead to expand to Birmingham

BMJ 2019; 364 doi: (Published 15 February 2019) Cite this as: BMJ 2019;364:l748
  1. Gareth Iacobucci
  1. The BMJ

The digital GP service is setting up a hub outside its original London home. Gareth Iacobucci looks at what the move means for primary care

Babylon’s GP at Hand service has been given the green light to expand outside its west London base to Birmingham after a U turn by NHS England.

GP at Hand had previously been blocked from subcontracting its digital service from Hammersmith to the Midlands on clinical safety grounds, amid concerns about how patients would access screening services.1

However, Hammersmith and Fulham Clinical Commissioning Group, which holds GP at Hand’s NHS contract, was told by NHS England at a meeting on Tuesday 12 February that a solution had now been identified. NHS England would not give any further details as to how the concerns had been resolved. But it will now work with Hammersmith and Fulham CCG, Birmingham and Solihull CCG, national screening services, and GP at Hand to firm up the arrangements and a start date.

The decision is significant, as it paves the way for Babylon to expand its offering beyond Birmingham to other areas in which it is known to be interested, such as Manchester, Leeds, and Southampton. The fact that GP at Hand also has the backing of the digitally enthusiastic health secretary for England, Matt Hancock,23 is also likely to aid its cause.

“Premature” decision

Babylon’s proposed Birmingham service would operate in the same way as its London satellite clinics that are subcontracted by the main GP at Hand practice in Hammersmith. Patients would be able to see a GP at a physical clinic in Birmingham or receive digital consultations through GP at Hand’s smartphone app—but they would all be registered with the Hammersmith practice, and the money attached to them flows there.

Richard Vautrey, chair of the BMA’s General Practitioners Committee, said it was “premature” to allow GP at Hand to expand before publication of Ipsos MORI’s independent evaluation of the service. Due next month, this will provide a full assessment of GP at Hand’s effects on the wider NHS and examine whether it has contributed to inequality in service provision and outcomes among patients.

“It is wholly inappropriate to allow this service’s expansion with no assurances over its safety and effectiveness,” said Vautrey. “We are incredibly disappointed with this decision, which is not only premature but flies in the face of place based care delivered by practices embedded in local communities, which the recent changes in the GP contract are committed to deliver.”

“It is wholly inappropriate to allow this service’s expansion with no assurances over its safety and effectiveness”—Richard Vautrey, BMA

The GP contract deal announced at the end of January made a commitment that every patient in England would have access to online and video consultations from 2021.4 But for practices to achieve this, Vautrey said that they must be properly supported, with more investment in their IT and infrastructure to be able to operate on a “level playing field” with private companies such as Babylon, “including improved broadband capability in surgeries.”

GP at Hand has provoked much debate since it launched in November 2017, with critics accusing it of cherrypicking young, healthy patients and destabilising existing NHS GP services.5 Earlier this month The BMJ revealed that Hammersmith and Fulham CCG was planning to cut the number of outside hours GP appointments available to patients in other local practices because of funding pressures, with GP at Hand identified as “the key driver” of the cost pressures.6

But Babylon has pointed to its popularity with patients. The service signed up tens of thousands of new patients since it launched, after a high profile advertising campaign across London.

Changes to payments

A Babylon GP at Hand spokesperson said, “The NHS Long Term Plan and GP contract framework set the vision for digital first primary care, and we look forward to making this a reality, in Birmingham and across the country. We will continue to work closely with NHS commissioners, regulators, and local providers on the safe and effective delivery of all our services.”

After a consultation and a commitment in the GP contract deal,47 NHS England is due to change how practices are paid for patients they register from outside their catchment area, after those practices and CCGs that lost patients complained about falls in income.

Vautrey urged NHS England to make these changes as a matter of urgency, to alter rules that he says “GP at Hand has exploited for too long.”

Paul Jennings, chief executive of Birmingham and Solihull CCG, said that his group was supporting the development of “a local digital offer” that would be available to all practices in the CCG area by the end of March 2019.

An NHS England spokesperson said, “As set out in the long term plan, the NHS will see an increasing use of digital technology, and from 2021 every patient in England will have access to online and video consultation—if they choose it—and this practice [GP at Hand] is just one of the ways of providing that.”

But Bob Morley, a GP in Birmingham and executive secretary of the Birmingham Local Medical Committee, said that Babylon’s expansion to Birmingham was “extremely worrying” given the concerns over the impact of GP at Hand’s London operation.

“The decision to allow expansion out of London seems even more incomprehensible and raises even greater concerns over the provision of safe, holistic care, together with it flying in the face of current NHS England strategy on primary care networks and geographical population based care.”

Vautrey also argued that patients in Birmingham “would benefit far more from being seen by a doctor close by and with a full understanding of their medical history, rather than someone miles away from their home.”