Exclusive: NHSE plans ‘unworkable’, says Babylon

Bosses at the digital care provider said they “fully agree” with NHS England plans to tackle challenges raised by video GP consultations, adding some of the proposals “increase stability” for clinical commissioning groups and providers.

However, they raised concerns over a number of the plans, including limiting patient list sizes to CCG areas, and said plans to scrap a rent and business rates relief scheme for digital practices “send a clear signal” that “traditional” primary care services are “financially favoured” by NHSE.

GP at Hand – Babylon’s NHS service – has used flexibility in the current rules to register tens of thousands of people from across London, and more recently Birmingham, to one practice based in Fulham. This has placed major pressure on Hammersmith and Fulham CCG, which is financially responsible for all GP at Hand patients.

NHSE launched a consultation on digital GP services in June. This proposed that, when a single practice exceeds a certain number of patients in another CCG area, then a new contract, known as an alternative provider medical services contract, would be triggered.

This would separate the patient list and avoid a disproportionate number of patients being registered to one practice, ultimately relieving financial pressures on H&F CCG.

The provider would also be required to have physical premises in the area where a new contract has been triggered and join a local primary care network so patients are able to access the full range of services, NHSE said.

In its response to the consultation, which closed on 23 August, Babylon GP at Hand said, while it agrees that list sizes for digital first providers need to be restricted, the boundary should be the wider sustainability and transformation partnership/integrated care system areas, with a patient limit of 1,000.

This would tackle the current issues posed by Babylon GP at Hand, while still “making the best use of digital first care”.

The provider went on to say that creating new clinics in each CCG would be “operationally and financially unmanageable” as launching new sites “requires a large investment in time”.

The document stated: “The current CCG-level proposal also has unworkable practical and administrative implications for providers and commissioners.

“Experience with setting up the first seven Babylon GP at hand clinics has shown that every new clinic requires a large investment of time, by the provider and local commissioner, alongside high costs to source an appropriate site, obtain the necessary planning permissions, fit out the clinic to high clinical standards, and make the ongoing rent and rates payments…

“For the principle to be manageable for digital-first providers operationally and financially, the geographical unit of classification would need to change from a CCG to an STP / ICS.”

Speaking to HSJ, director of NHS services for Babylon Health Paul Bate said the proposed restrictions could potentially threaten the sustainability of the digital primary care model. 

He said: “I think it makes the sustainability much harder. If you are asking any digital provider to ensure in any borough in London if they have more than 1,000 patients they will automatically have a clinic, then whatever else you do is you increase the cost of commissioners, because of all the work that then has to go on between the commissioner and the provider.

“You increase the total cost in the system because of the need for more and more physical space.”

However, he added that Babylon “absolutely agrees” with the principles of the consultation.

He said: “The reasons we agree with it is because we have known for some time there are challenges in the current way in which digital first care is being provided, particularly with the Babylon GP at Hand model for how the funding flows between commissioners.

“It’s not a problem for the NHS as a whole, but it is an issue for how Hammersmith and Fulham is covered by NHS England. [The proposals] look to us like a good sustainable way of bringing digital first care across the country, and it does it in a way that embeds the provision within the local community.”

An NHSE spokesman said all consultation comments are being reviewed and a general response will be published in due course.