• Committee papers say London CCGs “contesting” instructions to help cover GP at Hand costs
  • Responsible CCG forecasting a £11.3m cost associated with hosting GP at hand this year
  • Comes as secretary of state hints at further rule changes to accommodate digital GP services
  • NHS England contests claims that it instructed CCGs

London commissioners have contested demands that they help pay for the escalating cost associated with GP at Hand, according to committee papers.

Papers that went to Tower Hamlets Clinical Commissioning Group’s primary care committee last month stated some London CCGs were objecting to NHS England “instructions” that they help meet the cost of the digital GP practice based in Fulham.

According to the papers, the CCGs have been told they should help Hammersmith and Fulham CCG meet the cost associated with hosting the service. The CCG has been left stranded with millions of pounds of additional funding obligations to pay for the care of the tens of thousands of patients registering with GP at hand in the past 12 months.

The papers said: “The CCG has been instructed to set aside money to cover the costs of patients, who reside in Tower Hamlets, but are registered with ’GP at hand’. This has resulted in an increase in the cost pressure on this budget from £337k to £526k. At this time, however, this has not been confirmed, and a London CCG CFO’s steering group has been established to work through the issues arising.”

The committee was told that Tower Hamlets CCG, as well as other London CCGs, were “questioning both the principle of this (as it is counter to responsible commissioner rules) and the methodology for the calculation.

“Tower Hamlets CCG is contesting this charge, together with other London CCGs.”

Tower Hamlets, Southwark and Lambeth were the three London CCGs likely to face the biggest cost associated with the proposal, as they had lost the most patients to the digital practice, the papers said.

GP at Hand, a partnership between a Fulham GP practice and Babylon Health, has, with a combination of the GP choices policy, free video smart phone consultation, and substantial advertising, attracted tens of thousands of out of area patients.

The speed of the influx has strained an NHS funding model based around geographical boundaries, with critics of GP at Hand arguing the service is cherry-picking young health patients at the expense of other practices and fragmenting continuity of care.

Hammersmith and Fulham CCG is forecasting £11.3m in additional cost associated with funding healthcare for GP at Hand patients. Governing body papers last month suggest that some CCGs within north west London have already helped meet this cost.

The paper said: “NWL allocation transfers have been made to offset intra-NWL transfers and discussions are ongoing at NWL CFO level to ensure the appropriate mitigations materialise.

“Intra-NWL allocations valued at £360k have been received [in the year to September] and further estimates and ‘true-ups’ will be actioned through the year.”

In July, HSJ reported that NHS England was considering changes to the GMS contract which were likely to reduce funding for “digital-first” GP practices like GP at Hand.

Speaking at aHSJ roundtable in November, health and social care secretary Matt Hancock hinted at further changes to NHS and GP funding rules to accommodate digital providers, suggesting it needed to be linked to a patient’s home address rather than their GP practice.

Approached for comment, a Babylon GP at Hand spokesman said: “The needs of patients have to be put first. Regardless of which NHS practice they register with, they should never be denied local NHS care. People who choose Babylon GP at hand as their NHS GP must be able to access the full range of NHS services local to them, and this care should be fully funded.”

In a comment provided subsequent to publication, NHS England said it had not instructed and London CCGs to help meet the cost of GP at hand, despite claims made in the papers.

“At no point has an instruction been issued by us to London CCGs to pay Hammersmith and Fulham CCG. The law makes clear that CCGs are responsible for commissioning services for - amongst others - those patients on the registered lists of their local GP practices, so individual CCGs’ funding is updated periodically to reflect this. In that sense, the money follows the patient, based on their choice of GP practice.”

Tower Hamlet, Southwark and Lambeth CCGs all refused to comment for this story.

Hammersmith and Fulham CCG did not provide comment before publication.

The story was updated on 7 December 2018, to reflect additional comments provided by NHS England after publication.

What is GP at hand?

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

It offers physical GP appointments to NHS patients, but most patients are seen via free video appointment on their smartphone.

The practice 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 patients from outside the immediate catchment of its physical surgeries.

While GP at hand has been operating since late 2016 it has expanded substantially since late 2017, growing its patient list to more than 30,000.

It is pushing to expand into Birmingham, Leeds and Southampton but has thus far been blocked by regulators.

GP at hand patients are disproportionately younger than the national average and most live in other parts of London.

Its 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.