• Changes from 1 April will cut the income for the Babylon GP at hand service and similar future digital services
  • Review of out-of-area rules announced, with a focus on digital GP services
  • The contract says changes aimed at ensuring funding for digital GP services is “fair”
  • GP at hand says “penalising” digital providers sends wrong signal.

NHS England has confirmed changes to the GP contract that will reduce funding for digital provider GP at hand from April this year.

The changes, first proposed in July, were contained in the 2018-19 GP contract, published on Thursday, and specifically aimed at “fair payment for digital first delivery”.

The contract states: “The emergence of digital-first providers, who directly register patients, raises the question of whether the consequential redistribution of the general practice funding pot is fair.”

There is currently only one NHS digital provider, Babylon’s GP at hand, based in London, that requires patients to deregister from their previous practice.

It has registered more 30,000 new patients in the past year by heavily advertising its smartphone video consultations. Most of its new patients live outside the practice’s catchment area in Fulham and some live outside London.

Under the contract, two rule changes will come into effect on 1 April. The first will amend the rurality index payment to apply only to patients living inside a practice’s catchment area, rather than to all the practice’s patients. The second will amend the London adjustment to apply only to patients living in London, rather than those registered to a London-based practice.

In addition, NHS England has agreed to review the new patient premium, currently 46 per cent, with a view to a possible reduction in 2020-21.

A review will also be carried out into the rules that allow patients to register with a GP outside their area, rules without which GP at hand’s business model would not be possible.

The contract states: “The out-of-area rules were originally set up to allow a relatively small number of patients to choose to register with a practice in a more convenient location than their home address (for example for commuters to register near where they work). But the rules were not designed with digital registration in mind, and they need to be revisited.”

The review would focus on linking new digital services to local services, supporting patients’ “right” to choose a digital provider, as outlined in the long-term plan, and retaining “the integrity of essential NHS systems including financial allocations to CCGs”.

Since it was established in 2017, GP at hand has faced accusations from medical bodies and other GPs that it has been “cherry-picking” healthy patients and undermining the integrity of NHS primary care.

Its popularity with patients and consequent rapid growth has created short-term financial difficulties for its commissioner, Hammersmith and Fulham CCG. NHS England has also intervened several times to prevent GP at hand’s expansion into Birmingham.

All four changes in the GP contract were originally proposed by NHS England in July.

At the time, NHS England said the practice most affected by the changes would face an immediate 9.5 per cent reduction in NHS income. However, a hypothetical future “digital first” GP practice that had expanded nationally would receive about 20 per cent less funding under the rule changes.

The changes would not lead to a total reduction in GP funding, with any payments cut from one practice distributed to other GPs.

Responding to the changes, British Medical Association GP committee chair, Richard Vautrey said: “Practices in and around London have been particularly concerned about the destabilising impact of digital providers that have used the out-of-area regulations to cherry-pick largely young, healthy patients which could impact on the previous home practices’ ability to maintain a comprehensive service to those patients that remain.

“These changes to the funding arrangements will impact some digital providers based in London but the plan for a review of the out-of-area arrangements is another important commitment and will enable us to look fully at whether further changes need to be made.”

Babylon GP at Hand spokesman said: “NHS England want to see greater uptake of digital-first primary care, which we completely support, and we also strongly welcome the £4.5bn investment in NHS primary care.”

“However, penalising providers like us who have invested in technology in order to serve patients over a wide geographic area sends the wrong signal. The NHS already gets excellent value for money from Babylon GP at hand, the only NHS practice that is open 24/7 (three times the hours required by the GMS contract) with appointments within two hours.”

He said GP at hand already gets less money per patient than the average GP practice.

”We currently receive two-thirds of the national average income per patient (around £93 vs. over £140), reflecting our younger-than-average population and putting to rest the myth that we are paid the same amount per patient as other practices.”