• Matt Hancock says support for GP at Hand has helped competitors
  • Hints at further changes to GP payment system in response to digital first GP practices
  • Comment made during an HSJ roundtable with GP leaders and digital GP companies, including Babylon Health

Matt Hancock has told NHS IT suppliers his endorsement of GP at Hand has helped its competitors, even as he faces fresh criticism for supporting the digital GP practice.

He has also hinted at further changes to NHS and GP funding rules to accommodate digital providers like GP at Hand, suggesting it needed to be linked to a patient’s home address rather than their GP practice.

The health and social care secretary made the comments during a roundtable event on 21 November, convened by HSJ to discuss digital technology and the impact on general practice.

In addition to Mr Hancock, attendees included representatives from Babylon Health, which runs GP at Hand, seven other digital GP companies, Royal College of GPs chair Helen Stokes-Lampard and British Medical Association GP lead Richard Vautrey.

Mr Hancock told the group that he had caused a “bit of fuss” after he endorsed the GP at Hand service in a national newspaper and at an event held in the Babylon headquarters. The health secretary is regeisted as a patient with GP at Hand but reiterated he was “completely neutral” about the technology used by GPs.

“[GP at Hand] works for me, but it is by no means the only way of doing it. The first people I saw that provide a competitor to Babylon, I said, ’I’m really sorry that I went out and caused such a fuss with Babylon because I’m a member of their practice’ and he said, ’no it’s been brilliant because GPs around the country have been ringing up and saying we need this technology now so people don’t feel they need to leave our list’.”

He also faced fresh criticism after featuring in an Evening Standard article tagged as in “association with Babylon” and, again, endorsing the company. Labour shadow heath minister Justin Madders has written to the prime minister claiming that Mr Hancock’s endorsements may have breached the ministerial code.

The roundtable was sponsored by Care UK, another provider of primary care. 

During the discussion, Mr Hancock also hinted at further changes to rules for NHS budgets or GP payments to accommodate digital-first business models like GP at Hand, including how out-of-area patients are treated.

He said there was an “an implied presumption in the existing rules” that patients lived near their practice but, with the rise of digital GP services, “this was no longer true”.

This was a “classic case” of a rule that needed to change, he said.

He also said: “You have to innovate the rules sometime… that includes how we ensure that rules appropriately reward the treatment of different groups of patients… and in different types of models. So that is completely on the cards.”

CCGs are currently liable for all the general healthcare costs for people who are registered with their member GP practices - regardless of whether these patients live outside the CCG’s geographic catchment - and, in many cases, also for these people’s GP care.

GP at Hand has used video smartphone consultations and physical clinics near major London transport hubs to attract tens of thousands of patients that live outside its immediate catchment in Fulham, London - causing financial problems for its host CCG, Hammersmith and Fulham.

In July, NHS England proposed some changes to the GMS contract specifically designed to reduce payments to “digital first” GP practices.

It also hinted at further changes that echo Mr Hancock’s suggestion that payment should be linked to a patient’s address rather than their registered practice.

During the roundtable, Mr Hancock also said:

  • A new framework for GP IT being developed would be “radically different” and “bust open” the current arrangement with just four suppliers. This would include a greater emphasis on interoperability.
  • He was pushing to “accelerate as hard as possible” the roll-out of the HSCN network, which will replace the ageing N3. The comment came after Richard Vautrey, chair of the BMA GPs committee, said internet speeds and basic IT infrastructure was an inhibitor to GP take-up of new technologies, such as video consultations. In October, HSJ revealed the roll-out of HSCN was in doubt due to “vendor delays”.

The full write up of the roundtable discussion will be published in December.

 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.

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.