Health

‘GP at Hand’ threatens destabilisation of NHS, health expert warns

Expanding the ‘GP at Hand’ service across the country could risk “destabilising” public health care for the most vulnerable patients with complex conditions, a health professor and veteran GP has warned.

The round-the-clock service allows patients to book NHS GP appointments via its app and have a video consultation soon afterwards. It was first made available in London, where it has been adopted by tens of thousands of NHS patients. The service is run by Babylon Heath, which was founded Ali Parsa, a prominent advocate of greater private-sector involvement in NHS.

According to Martin Rowland, Emeritus Professor of health services research at the University of Cambridge, GP at Hand risks attracting the healthiest patients at the expense of more vulnerable patients.

A GP practice receives the same amount of money for each patient registered at the practice. The funding that comes from younger, healthier patients requiring fewer appointments supports older patients with complex health needs, such as multiple chronic conditions. GP at Hand has been criticised for forbidding patients with complex health needs to register, excluding groups such as pregnant women, people with dementia, complex mental health conditions, and learning difficulties; conventional GP practices are not permitted to refuse to register patients based on these factors.

In November 2018, the service began to accept patients with more complex conditions, although an independent Ipsos MORI study found that the service remains disproportionately used by young people. Approximately three-quarters of patients are under the age of 35.

Rowland expressed concern that GP at Hand threatened to leave conventional GP practices underfunded and with disproportionately high numbers of chronically ill and elderly patients in need of more intensive care.

“It’s essentially taking money away from practices,” he told the Press Association. “This hasn’t happened to a great degree because clearly GP at Hand has only taken a small number of patients from any one practice, but if you are making the situation where, in a hypothetical example, GP at Hand took away all the patients from the practice and left the practice just with the chronically ill and elderly and the funding didn’t reflect that, then essentially those GPs would have even less money to look after those older people.”

Writing in the BMJ, Rowland acknowledged that an independent evaluation had found that some part-time GPs felt that the app was a good way of increasing their work with NHS patients. The review also found, however, that older people with more complex needs were not enrolling with the service, raising questions about the impact of the digital service on the NHS.

“The current NHS funding formula does not adjust adequately for the costs of providing a comprehensive primary care service, and the NHS needs urgently to review its arrangements that have allowed a private company to cream off fit young patients from existing NHS practices,” Rowland wrote. “If the GP at Hand model became widespread, it would risk destabilising care for patients with the greatest needs and those who need regular proactive care.”

Richard Vautrey, chair of the British Medical Association’s (BMA’s) GP committee, said at the time that the review raised the question of “whether a wider rollout in an already overstretched NHS would be able to cope with additional demand”.

A NHS spokesperson said: “The NHS has already changed GP funding arrangements to account for new digital services and are currently consulting on further changes to funding and commissioning rules. As set out in the new GP contract, the NHS is committed to supporting GPs to increase the use of digital technology, with every patient in England having access to online and video consultation by 2021 if they choose it, and this practice is just one of the ways of providing that.”

In October 2018, an advertising campaign for GP at Hand was ruled misleading by the Advertising Standards Authority for failing to communicate that users signing up for the service are deregistered from their previous GP surgery. The British Medical Association criticised the service for promoting “inequitable access to NHS-branded GP services”, and in June, MPs called for the expansion of the service to Birmingham to be halted until there is a better understanding of its impact on healthcare.

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