• London CCG blocks GP at Hand expansion into Birmingham
  • Digital practice calls on CCG to review “flawed process” behind decision
  • Second time the controversial service has been blocked from expanding beyond London

The controversial digital practice, GP at Hand, has been blocked from expanding beyond London, with commissioners citing patient safety concerns.

In a meeting on Tuesday afternoon, a committee of Hammersmith and Fulham Clinical Commissioning Group formally objected to GP at Hand’s proposal to set up a physical clinic in Birmingham, allowing it to register new patients in that city.

The changes would have allowed GP at Hand, a “digital first” practice which is based in south west London, to register thousands of patients in Birmingham who would be treated primarily online over video, with a single new Birmingham clinic for face to face appointments.

In blocking a variation to GP at Hand’s contract that would allow the expansion, the committee stated that there was “evidence of concern regarding the risk to patient safety of implementing the proposal without further assurance being undertaken or received”.

The proposed Birmingham expansion will be reconsidered at the next committee meeting in August, after GP at Hand has provided further assurances addressing the CCG’s concerns.

The committee also noted a letter received from Birmingham and Solihull CCG chief executive, Paul Jennings, which raised concerns about Birmingham patients being registered with a practice outside the city.

“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,” Mr Jennings said in the letter.

“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.”

Responding to the decision, a GP at Hand spokesman said it had responded to areas of concern raised by the CCGs but this was not properly considered in the final decision.

“We are shocked and disappointed by this approach, which denies people across Birmingham the opportunity to choose an NHS GP practice providing 24/7 GP appointments within two hours and misses a golden opportunity to reduce pressure on GPs and A&Es across Birmingham. We call on commissioners to immediately revisit this flawed process.”

It is the second time the digital first service has had attempts to expand beyond London blocked, with HSJ revealing earlier this year that NHS England intervened with similar concerns in November last year to prevent expansion into Manchester and Birmingham.

Earlier this month, NHS England also proposed changes to the GP payment model that would drastically reduce the NHS income of digital first GP practices.

In a statement, a Hammersmith and Fulham CCG spokeswoman said: 

“The committee were not fully assured of the proposal in relation to a number of patient safety issues highlighted and compliance with the GMS contractual obligations. They also wanted clarification on clinical and managerial governance, more detail on how GP at Hand would ensure patients would access local clinical pathways, screening and preventative services and more information about the adequacy of the proposed premises. It was noted that this was a material change to the contract, given the geographical distance of the new site from the main practice in Fulham.”

 The story was updated on 19 July to include additional comments from Hammersmith and Fulham CCG.

What is GP at Hand?

GP at Hand is a service offered by partnership between a Fulham based practice – formerly called Dr S Jefferies and Partners – and digital health provider Babylon Health.

As well as traditional physical GP appointments, GP at Hand offers free video appointments to NHS patients, and other digital services such as a symptom checker, through a mobile app.

The practice subcontracts Babylon to provide the digital element of this service but the company is also represented within GP at Hand, with Babylon medical director Mobasher Butt a partner.

It holds a general medical service contract and makes use of the national GP choice policy in combination with its video appointments to attract and register many patients from outside the immediate catchment of its physical surgeries.

While GP at Hand has been operating out of one site since late 2016, it attracted national media coverage in November when it expanded to five sites across London.

GP at Hand’s practice list grew more than six fold to more than 30,000 in less than six months.

The new patients are disproportionately younger than the national average and most live in other parts of London.

GP at Hand’s rapid growth has prompted concerns among GPs, regulators and commissioners that the service could destabilise the primary care system by undermining the financial viability of GP practices that are losing patients and CCGs struggling with the sudden shift in costs.

Hammersmith and Fulham CCG and NHS England have commissioned Ipsos MORI to conduct an independent evaluation of the GP at Hand model.