• Decision clears way for digital practice to expand outside of London for the first time
  • NHS England twice previously stopped expansion due to safety concerns
  • Long-term plan explicitly gives patients right to online or video consultation
  • BMA ”incredibly disappointed” and calls for acceleration of NHS England review

Controversial digital practice GP at Hand has been cleared to expand into its second city after NHS England lifted its objection.

Hammersmith and Fulham Clinical Commissioning Group, which hosts GP at Hand, received an update from NHS England London team during a primary care committee meeting on Tuesday.

NHS England confirmed one of its officials had told the committee that a solution had been found to previous concerns about GP at Hand integrating with local screening and immunisation services.

The decision clears the way for the digital practice to expand outside of London for the first time and potentially makes it easier to set up in other cities in the future. GP at Hand has also made attempts in the past to expand into Leeds and Southampton.

GP at Hand is a single practice based in Fulham, but is effectively run by digital primary care company Babylon Health.

It is an NHS GP practice which uses video consultation via the patient’s smartphone and heavy advertising to attract new patients from outside its immediate practice catchment.

Since November 2017, the patient list has grown from about 4,000 to more than 44,000, most of them from outside Hammersmith and Fulham. But its rise has faced strong opposition from GPs, who have accused it of cherry-picking healthy patients and destabilising the NHS primary care model.

Its expansion has caused severe financial problems for the CCG and been subject to regulatory intervention. NHS England has twice stopped its expansion due to safety concerns and changed the entire GP payment system to reduce the income of this type of practice

Babylon has controversially attracted repeated praise from health secretary Matt Hancock, and the NHS long-term plan explicitly gives patients the right to online or video consultation, including the ability to switch to digital first practices, like GP at Hand.

The expansion into Birmingham will mean, for the first time, a London-based practice will be registering patients remotely in another city. GP at Hand will have a physical clinic in Birmingham but most of the care will be delivered digitally.

An NHS England spokesman said: “As set out in the long-term plan, the NHS will see increasing use of digital technology and from 2021 every patient in England will have access to online and video consultation – if they choose it – and this practice is just one of the ways of providing that.”

While a date has not been picked, the expansion into Birmingham is expected soon.

Birmingham and Solihull CCG has previously objected to the expansion of GP at Hand into the city, raising concerns about fragmentation of care and patient safety.

Speaking to HSJ on Wednesday, Birmingham and Solihull CCG chief executive Paul Jennings said the expansion had probably been “inevitable” and he broadly welcomed more digital options for people in the city.

However, the CCG would continue to work with local GP practices to develop alternative digital services that did not require patients to register with a practice based in London, he said. “We do welcome the digital component of healthcare but we think it should be delivered locally not remotely.”

A GP at Hand spokesman said: “We welcome the decision to allow the expansion of Babylon GP at Hand to people living and working in Birmingham. The NHS long-term plan and GP contract framework set the vision for digital-first primary care and we look forward to making this a reality, in Birmingham and across the country.

“We will continue to work closely with NHS commissioners, regulators and local providers on the safe and effective delivery of all our services.”

BMA GP committee chair Richard Vautrey said: “We are incredibly disappointed with this decision, which is not only premature, but flies in the face of place-based care delivered by practices embedded in local communities, which the recent changes in the GP contract are committed to deliver.

“The independent evaluation into GP at Hand is yet to publish its findings, so it is wholly inappropriate to allow this service’s expansion with no assurances over its safety and effectiveness…

“Following this decision, NHS England must make it their priority – as promised in the GP contract agreement – to complete its review into the out of area arrangements that GP at Hand has exploited for too long.”

Describing the decision as “a worrying development”, Royal College of GPs chair Helen Stokes-Lampard said: “It is difficult to see how a practice based in south London will be able to deliver meaningful population-based care to patients who live in Birmingham. The expansion clearly undermines the importance of place-based care to the NHS long-term plan.

“Technology has the potential to transform the NHS, but it must be implemented in an equitable way that benefits all patients and that is not to the detriment of the general practice service as a whole.”

Health secretary Matt Hancock told HSJ: ”The new change in the GP contract takes into account a lot of the concerns about the unintended consequences [of GP at Hand].

“It’s a decision by NHS England but ultimately this will allow more people to have more choice about how they access NHS services.”

Updated at midday on 13 February to include into comments from the BMA and Matt Hancock, and at 13:15 on 13 February to include comments from the Royal College of GPs