• New rules to limit the number of out of area patients registered to a single practice approved 
  • Digital GP providers will need to separate lists and open more clinics
  • Only able to open in quarter of GPs with biggest GP access problem
  • Trusts working with firms encouraged to enter market 

Digital-first GP providers will have to set up a clinic in most localities where they have patients, and will be denied entry to areas which already have enough doctors, under new rules adopted by NHS England. 

The framework adopted at a joint NHSE and NHS Improvement board meeting today will have a signficant impact on Babylon GP at Hand, the only such provider to currently operate on a GP contract, and creates a regulated route for others to enter the market.

The rules will limit the number of “out of area” patients which can be registered by a single practice in a given clinical commissioning group area, and follow a consultation over the summer.

GP at Hand has used flexibility in the current rules to register around 60,000 patients to its practice which is based in Hammersmith and Fulham, and which have all effectively become the responsibility of Hammersmith and Fulham CCG. Its model has sparked controversy with some, particularly other GPs.

Under the new rules, once a practice registers 1,000 people in a given CCG area, then they would need to be issued with a new and separate “alternative provider medical services” contract for that patch, dividing up the list. It is in part meant to make sure the practice takes part in local decision making and networks.

Babylon had responded to the consultation asking for the rule to be set at one contract per sustainability and transformation partnership/integrated care system area – rather than CCG – which would have required fewer.

However, this was rejected, and the new rules mean the 60,000-odd GP at Hand population will be divided into 17 different lists for the different areas it has more than 1,000 patients, the board meeting was told.

NHSE said it would “usually expect” a new face-to-face clinic to be set up in each CCG area when another APMS contract is triggered, unless commissioners “agree otherwise”, for example ”in particularly urban areas where premises are easily accessible in a neighbouring CCG”.

Following consultation, NHSE has “ruled out” suggestions that “out of area” registrations should be scrapped completely, as it would limit patients’ choice of GP. They did, however, drop a proposal to restrict the premium all practices receive for registering new people, as this could involve “destabalising practices with high churn”.

Health bosses stuck with their proposal that new digital primary care providers should be required to set up in under doctored areas, saying they will initially have to open in the 20 to 25 per cent of CCGs where “patient access to primary care is the worst”.

The report stated: “There was support in principle for requiring providers taking these new opportunities to set up physical premises in deprived areas, to require new contract holders to bring in additional GP capacity through the service and make all efforts to ensure their lists reflected the make-up of the local population.

“During 2020-21 we will aim to create a list of approved providers who could set up new digital-first practices in under-doctored areas only.”

It is unclear how these tests will be applied, including to GP at Hand, which already has a large list on a different contract model.

There are also set to be changes to the allocation of CCG funding – which will now be reviewed quarterly “to reflect patient movement” which has been ”stimulated by registration of digital first practices in London”.

The consultation also found that there was support for a “partnership approach” to forming digital-first GP models, and stated: ”We expect the approved providers list could include a range of partnership models.

“This may, in the first instance, include partnerships between NHS trusts or foundation trusts, whether acute or community, and digital providers. It could also include groups of salaried or sessional GPs who want to set up their own new independent partnerships on a digital-first model. Indeed, we expect this route will provide a useful opportunity for people wishing to innovate in primary care.”