• Digital primary care service can be a primary care network pending an NHS England review
  • Local commissioners agreed to allow GP at Hand to be a network after NHS England assurance it would be within the rules
  • Questions remain over how the PCN’s diffuse footprint will align with local services as networks integrate with local systems

A primary care network composed only of Babylon’s GP at Hand is only a temporary measure while NHS England conducts a review of digital first providers and out of area registration.

Local commissioners this week approved the digital first practice’s application to form its own network. This came before the provider officially launched a clinic in Birmingham, after NHS England lifted its restrictions on its move to the Midlands.

An NHS England spokesman told HSJ: “Each GP practice can be a member of only one primary care network. Arrangements for this practice are temporary pending the outcome of the review of out of area rules, announced in the new GP contract, which will be launched shortly.”

NHS England’s comments came after Richard Vautrey, chair of the British Medical Association’s general practice committee, told HSJ the Babylon GP at Hand PCN “could only be a temporary arrangement”.

Hammersmith and Fulham Clinical Commissioning Group said in committee papers from 18 June that NHS England assured it the GP at Hand PCN is permitted, and also said its geography had been revised “to focus on the practice registration areas, whilst acknowledging out of area registrations”. However, it said, “work will be required to ensure an effective operating model is developed to deliver the network requirements”.

The CCG’s decision is contingent on agreement from the north-west London sustainability and transformation partnership. The NHSE and BMA framework agreement for the five-year network contract, published in January, said PCN footprints were meant to align with their neighbours and normally would not overlap.

There is some leeway for this in urban areas, however the spread of Babylon GP at Hand’s patient list means its network footprint will include people registered across London and in Birmingham.

“Clearly a large number of patients, probably the vast majority of patients, registered with Babylon GP at Hand are registered under the out of area arrangements,” Richard Vautrey, chair of the BMA’s GP Committee, told HSJ.

“And that’s the issue that causes the problem in terms of the PCN link to physical geography,” he said. “The PCN is clearly physically based within one CCG but has the vast majority of patients outside of that area.”

“But it’s still important for patients outside of the CCG area to gain access to services that are physically provided within the area that they live. I think that’s the challenge, for NHS England and CCGs to be able to deliver that, and I would imagine that’s one of the issues that they would be wanting to consider as part of the out of area review.”

One of the review’s goals will be “to ensure that digital-first models can have appropriate links with other local services”. Integrating with local NHS providers as well as social care and voluntary and community services will also be a key facet to PCNs as they develop.

This integrated working will become more significant to PCNs from April 2020, when additional service specifications kick in, Dr Vautrey explained.

A Babylon GP at Hand spokesman said: “Primary care networks should be about having joined up care for patients so that it’s easier for them to see a healthcare professional and get access to the right services, whilst reducing the burden on NHS resources – we do that by offering all the traditional GP services plus 24/7 access to a GP through digital consultations.”

There are more than 60,000 patients in England registered with a practice away from where they live, excluding GP at Hand, he added. He said this is likely to grow, “making geography less of a defining factor – so it makes sense for NHS England to ensure all the systems support digital-first and out-of-area providers.”

However, GP representatives in London were disappointed by the CCG’s decision. The Londonwide Local Medical Committees chief executive Michelle Drage said Hammersmith and Fulham had “taken the path of least resistance by rubber-stamping” GP at Hand’s application.

“This decision is not good for patients or practices. It encourages fragmentation of services and rides roughshod over the ethos and detail of the NHS long-term plan, which highlights the value of place-based care,” Dr Drage added.

Hammersmith and Fulham CCG said the five networks it approved this week “will provide the focus for delivering better coordinated primary care and offer consistent services to all patients registered within a network.”

Update: this article was updated at 14.26 on 20 June to incorporate a statement from NHS England confirming the Babylon GP at Hand arrangements are temporary pending the outcome of a review.