• Simon Stevens said changes will be proposed to control GP at Hand expansion
  • Will include changes to address GP payments, patient churn, and a requirement that new GP practices be set up when GP at Hand expands into new areas
  • Sarah Wollaston says GP at Hand’s “uber-GP model” is a grave concern for the service

NHS England is proposing changes in GP funding and regulation to control the expansion of Babylon’s controversial digital-first GP at Hand service, Simon Stevens has said.

NHS England’s chief executive revealed the changes while giving evidence to the Commons health and social care committee on Tuesday afternoon. He said a consultation document on the changes would be published on Thursday.

Mr Stevens’ comments followed criticism by committee chair Sarah Wollaston, who called GP at Hand an “Uber GP model” that was disrupting an already fragile GP system. 

She said: ”It’s driving increased health equalities, it’s not answering the problems that the NHS has in terms of long term conditions and deprivation. It is providing a very expensive service for people that are using it more than they need to.

”I think it extraordinary that you don’t have any control if this is a disruptive model, a sort of uber-GP model that we are developing.”

Mr Stevens said NHS England would consult on changes that would alter the formula for paying GPs to “fairly reflect the workload you would expect in different types of practices”, ensuring non-GP patient costs “followed the patients”, and addressing the high patient churn of digital services.

He also said the proposed changes would include insisting digital GP services operate through separate GP practices in each area they are active in.

Digital company Babylon Health’s GP service for the NHS, GP at Hand, has been running out of a single GP practice in Fulham since 2017. It has used a combination of free video GP consultations and an NHS policy that allows patients to register with GPs outside their area of residence to grow its patient list tenfold to more than 50,000.

However, the service has faced criticism for undermining the financial viability of other GP practices by “cherry picking” younger, healthier patients. It has also generated a £23m unmet liability for its commissioner, Hammersmith and Fulham CCG, which, under current rules, is required to meet all health costs of patients registered with the practice, even those that live outside north west London.

This liability had been set to grow exponentially with GP at Hand expanding into Birmingham last week. albeit with some restrictions. But Mr Stevens’ comments on Tuesday suggest the service will need to find a separate Birmingham GP practice to work with, and the cost will likely sit with Birmingham and Solihull CCG.

He said: ”What we are going to publish for consultation later this week is that where practices do that [what GP at Hand has done] then they should be required to create new local practices so you can connect the new practice with other practices in the area. Rather than having a national practice operating out of Hammersmith and Fulham.”

The consultation would also make “two very specific” proposals that would address the financial burden that is being disproportionately borne by Hammersmith and Fulham CCG as a result of GP at Hand’s rapid expansion, he said.

“The money will follow the patient and there will be regular adjustments to make sure that the funding fairly represents the patients that are attributed to a particular geography.” 

NHS England and Hammersmith and Fulham CCG have made several attempts to slow down the expansion of GP at Hand, blocking its expansion twice amid care continuity and safety concerns. 

However, on Tuesday Mr Stevens told the committee that NHS England had only “very, very circumscribed” routes of preventing the services growing and further rule changes were needed.

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