• Some NHS services refuse to accept GP at Hand referrals, claiming “insufficient capacity”
  • CCG escalates concerns to NHS England
  • Disagreement raises wider issues with GP choice policy
  • Babylon claims “vested interests” are “punishing patients”

Some patients referred to secondary care by the controversial GP at Hand practice have been refused treatment on the basis of “insufficient capacity”.

The difficulty was revealed in a Hammersmith and Fulham Clinical Commissioning Group committee paper this month, with commissioners escalating concerns about the impact on patients to NHS England.

It said: “GPAH have reported ongoing challenges in terms of access to referral pathways. For example, there have been a number of challenges with IAPT [psychological therapies] services, where other London CCGs and providers have indicated they are unable to accept referrals.”

The paper said that after the CCG intervened, and agreed to pay for the patients’ treatment, most neighbouring CCGs and services had agreed to accept referrals. However, some have continued to refuse, it said.

Neither the extent nor the exact services affected are known, but HSJ understands they are referrals for community and mental health rather than acute care.

In the past six months, tens of thousands of NHS patients have switched to GP at Hand, a partnership between tech company Babylon and a Fulham GP practice that offers video GP consultations via a smart phone app.

The CCG paper added: “There remain some unresolved difficulties where the local CCG has indicated the local provider has insufficient capacity to deliver the additional activity required. This has been escalated via the NHSE (London) team.

“The CCG is in ongoing dialogue with the practice, including currently working with the practice and NHS England team to assure that patients registered with GPAH have full access to accessible screening services.”

In a statement, Babylon Healthcare, which runs GP at Hand, said “some senior individuals in a few London CCGs and providers” were to blame, for placing “their narrow business interests or ideology ahead of patient care and NHS policy”.

Neither Babylon nor Hammersmith and Fulham CCG would name the providers and CCGs refusing to take referrals, or confirm how many patients had been affected.

The partnership takes advantage of the GP choice policy, introduced in 2015, that allows a practice to register patients outside its area. The majority of GP at Hand’s patients live outside the Hammersmith and Fulham area.

The model has created a number of difficulties for both local and national policymakers, including how access to secondary care is coordinated and paid for. The H&F CCG paper shows this specific concern has been “raised nationally for consideration in relation to the GP choice policy”.

In a statement, a CCG spokeswoman said paying for community and mental health services for out of area patients had proved more difficult than acute services, partly because they were contracted on a population rather than volume basis.

“In these instances, H&F CCG has confirmed their willingness to pay for any non-contracted activity to ensure that patients registered with GP at Hand are able to access community and mental health services at an appropriately accessible location as possible. The CCG is continuing to work with the practice, other CCGs and NHSE to resolve such situations as and when they arise,” the statement said.

A Babylon spokesman said: “People are fully entitled to their local NHS services, regardless of which NHS GP practice they choose to register with. We work closely with NHS colleagues across London, ensuring timely local referral and investigation pathways that put patients’ needs first. Hammersmith & Fulham CCG and NHS England have supported and facilitated this collaborative working, with H&F CCG covering the costs of care for all GP at hand members regardless of where they live.

“However, some senior individuals in a few London CCGs and providers continue to put their narrow business interests or ideology ahead of patient care and NHS policy. As a result, patients have been denied care by their local mental and physical health providers, despite the funding being in place and the patients continuing to live in the area covered by the provider.

“These vested interests, including senior GPs, should consider the shortcomings of their own practices that lead so many people to switch to GP at Hand, and must stop punishing patients who exercise their rights to choose the NHS GP that best supports their needs.”

NHS England did not respond to requests for comment before publication.

What is GP at Hand?

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

As well as traditional physical GP appointments, GP at Hand offers free video appointments to NHS patients, and other digital services such as a symptom checker, through a mobile app.

The practice subcontracts Babylon to provide the digital element of this service but the company is also represented within GP at Hand, with Babylon medical director Mobasher Butt a partner.

It 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 many patients from outside the immediate catchment of its physical surgeries.

While GP at Hand has been operating out of one site since late 2016, it attracted national media coverage in November when it expanded to five sites across London.

In the eight months to 25 May 2018, GP at Hand’s practice list grew from about 5,000 patients to more than 30,000.

The new 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.