Service cut warning over NHSE's GP at Hand bailout fears

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CCG cluster has moved the £10m cost of hosting GP at Hand to its bottom line and warned of cuts to other services
Comes after NHS England assurance of financial support for 2018-19 fails to materialise
Concerns financial problem could worsen amid GP at Hand’s expansion into Birmingham

Local commissioners are expecting a £10m hit for hosting digital practice Babylon GP at Hand and could be forced to cut other services after a promised NHS England bailout failed to materialise.

Papers to a joint meeting of a north west London clinical commissioning group collaborative on Tuesday moved the rapidly rising cost of hosting GP at Hand patients from being just a risk to a £10m hit on their joint bottom line for 2018-19.

The decision was based on diminishing confidence in NHS England’s assurances that the spiralling costs associated with GP at Hand would be “fully mitigated” this year.

One paper noted that if “the mitigation [does] not materialise there will be a material worsening of the financial position of the CCG, potentially jeopardising other health and care services in Hammersmith & Fulham”.

Hammersmith and Fulham CCG, part of the north west London CCG collaborative, has been struggling to cope with the impact of hosting GP at Hand, a single Fulham practice that uses digital provider Babylon Health’s video consultation service to attract out of area patients.

Since GP at Hand fully launched in 2017, the practice’s patient list has grown from about 4,000 to more than 40,000 patients, with the vast majority drawn from other parts of London.

As the host CCG, Hammersmith and Fulham has to pay for these new patients’ NHS healthcare, despite most of them living and receiving much of their care outside the CCG’s catchment.

The north west London CCGs have all agreed to help Hammersmith and Fulham meet the cost for patients living in their area. But, so far, other London CCGs have refused, leaving a £10.2m unfunded financial hole for 2018-19.

A paper to the north west London CCG meeting on Tuesday stated NHS England had told Hammersmith and Fulham CCG that GP at Hand will be “cost neutral” but it has also told other London CCGs they will not be expected to pay for GP at Hand patients living in their area.

Responding to HSJ, a Hammersmith and Fulham CCG spokesman said: “We have previously presented the costs arising from patients outside north west London registering for GP at Hand as a risk, as our expectation was that the impact would be cost-neutral to Hammersmith and Fulham CCG.

“As this has not yet been resolved, we are now presenting the £10m cost as part of our financial deficit.”

Without a financial bailout or additional changes in payment rules, the CCG’s financial difficulties are likely to continue. NHS England cleared GP at Hand to expand into Birmingham last month, which potentially means Hammersmith and Fulham will have to pay for health services delivered to patients living in Birmingham.

Minutes for Hammersmith and Fulham CCG’s primary care committee meeting last month stated that “the committee also highlighted that extending the service to Birmingham would put additional financial pressure on the CCG and were concerned that there was still no resolution to the current, in-year funding issues”.

NHS England has been approached for comment on this story.

What is GP at Hand?

Babylon 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.

It offers physical GP appointments to NHS patients from several clinics in London, but most patients are seen via free video appointment on their smartphone.

The practice holds a general medical service contract and makes use of the national GP choice policy in combination with its video appointments and extensive advertising to attract and register patients from outside the immediate catchment of its physical surgeries.

While GP at Hand has been operating since late 2016, it has expanded substantially since late 2017, growing its patient list from about 4,000 to more than 40,000.

In February 2019, it was cleared to expand into Birmingham. It has plans to expand into Manchester, Leeds and Southampton.

GP at Hand patients are disproportionately younger than the national average and most live in other parts of London, although that will change as it expands.

Its rapid growth has prompted concerns among GPs, regulators and commissioners that the service could fragment patient care and destabilise the primary care system by undermining the financial viability of GP practices that are losing patients, as well as 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, which is due by the end of March 2019.