• CCG committee maintains objection to GP at Hand expansion
  • NHS England will now have the final say on any decisions about the digital service
  • National commissioning body has already objected amid concerns over screening access for patients

NHS England has intervened in a potential expansion of GP at Hand – saying it should be blocked until concerns about patient access to screening can be resolved.

On Tuesday, a committee of Hammersmith and Fulham Clinical Commissioning Group agreed with NHS England and decided not to lift an objection blocking the controversial digital provider’s expansion into Birmingham.

The change, if approved, would have allowed GP at Hand, a “digital first” practice which is based in west London, to register thousands of patients in Birmingham who would be treated primarily online over video, with a single new Birmingham clinic for face to face appointments.

A paper that went to the CCG committee said that, due to the “novel, contentious or repercussive” nature of GP at Hand, NHS England would now have final sign-off on any CCG decision regarding the service.

According to the paper, the national body has also recommended that the CCG maintain its objection, because of outstanding concerns about GP at Hand patients’ access to screening and related services.

It says: “The view of the NHS England (London) medical directorate… (is) that it would not be reasonable to lift the objection until a safe and sustainable solution is in place.”

A spokesman for GP at Hand said Hammersmith and Fulham CCG “had made it clear” that the practice had now addressed all concerns previously raised about the expansion, and that the new concerns needed to be resolved by the NHS.

NHS England also intervened in November last year to prevent expansion into Manchester and Birmingham.

Birmingham and Solihull CCG, which has little formal power over whether the expansion proceeds, has previously objected to GP at Hand moving into the city.

Specifically, the CCG raised concern that the service would disrupt existing GP practices and would not “integrate and work with the locally agreed pathways for services in an effective and safe manner”.

In response to these earlier concerns, GP at Hand has submitted additional information outlining its ability to provide continuity of care, good governance, and the ability to integrate with the local clinical pathway in Birmingham.

Responding to the CCG’s decision on Tuesday, a GP at Hand spokesman said Hammersmith and Fulham CCG “had made it clear” that the practice had now addressed all concerns previously raised about the expansion into Birmingham.

New concerns about screening need to resolved by the NHS, not GP at Hand, he said.

“Commissioners have known for more than nine months of the proposed national expansion of GP at Hand. The NHS has not been able to put in place the screening arrangements that enable this.

“As a result, the choice of GP practice promised by the NHS to people across the country is being held back and the opportunity to reduce pressure on primary care and A&Es is being missed. We hope this issue will be resolved without further delay so that safe, effective and extremely convenient primary care can become a reality for anyone who chooses it.”

This story was updated on 14 August to reflect Hammersmith and Fulham CCG’s decision and additional comments from GP at Hand.

What is GP at Hand?

GP at Hand is a service offered by a 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.

GP at Hand’s practice list grew more than six-fold to more than 26,000 in less than six months.

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.