• Babylon GP at Hand bosses welcome NHSE plans to overhaul rules around digital primary care services 
  • However, provider raises concerns over proposals to limit patient list sizes to CCG areas 
  • Plans to scrap rents relief scheme would signal NHS is financially favouring “traditional” services, adds Babylon 

Proposed rule changes to the provision of video GP appointments would have “unworkable practical and administrative implications” on digital primary care services, Babylon GP at Hand has said.

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.

What is GP at Hand?

GP at Hand is digital GP provider Babylon Health’s NHS service, which offers patients video consultations through an app on their smartphone.

The service is provided in partnership with a Fulham-based practice – formerly called Dr S Jefferies and Partners – and Babylon Health.

GP at Hand has used flexibility in the current rules to register tens of thousands of patients outside the immediate catchment area of its physical surgeries, all of which Hammersmith and Fulham CCG are financially responsible for.

The service has expanded quickly since its launch in 2016, growing its patient list to more than 60,000.

Earlier this summer, it expanded its services to patients in Birmingham – all of which will still be registered with the Fulham practice. Its patients are also disproportionately younger than the national average.

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.


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