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GPs go forth

CCGs contest being charged for Babylon GP at Hand patients

Some London CCGs are contesting being charged a fee for patients in their areas that have signed up to Babylon GP at Hand.

CCGs were told to ‘set aside’ money to cover the costs of patients who reside within the CCG but are registered with the digital-first service, which is based in NHS Hammersmith and Fulham CCG.

NHS Tower Hamlets CCG said it is ‘contesting this charge, together with other London CCGs’, and questions both the principle of the fee and the calculation method.

Babylon GP at Hand, which is based in a Fulham GP practice, allows NHS patients from across London to sign up to its practice for digital consultations on an app, via the out-of-area patient registration scheme.

But earlier this year, Pulse revealed that NHS Hammersmith and Fulham CCG needed an extra £18m in funding from NHS England to cope with the influx of patients caused by the service. This led to neighbouring CCGs bailing out Hammersmith and Fulham CCG, with over £1m in funding.

At the same time, NHS England's London regional team agreed to re-allocate funds from other London CCGs. However, some CCGs are now objecting to this.

NHS Tower Hamlets CCG board papers from a meeting last month said: ‘CCGs across London were being told to contribute to the cost of the service, and the associated costs of the additional patients in acute and mental health settings, as NHS Hammersmith and Fulham CCG were facing a significant deficit.

‘Steve Collins [the board’s finance adviser] advised that the CCG were questioning both the principle of this (as it is counter to responsibly commissioner rules) and the methodology for the calculation.’

The papers said: ‘The CCG has been instructed to “set aside” money to cover the costs of patients, who reside in Tower Hamlets, but are registered with Babylon GP at Hand. This has resulted in an increase in the cost pressure on this budget from £337k to £526k.’

Tower Hamlets, along with Lambeth and Southwark CCGs, are the three CCGs ‘most impacted by this cost pressure’, according to the report.

Tower Hamlets LMC chair Dr Jackie Applebee said: ‘CCGs have had to set tight budgets due to the unprecedented financial squeeze on the NHS. Any unexpected expenditure is destabilising.'

She continued: ‘This is yet another flaw with the GP at Hand model, it fragments care as the host CCG has no relationship with the community and secondary care services of GP at Hand patients.

‘Not only is it destabilising across the board, it fragments care. NHS England and the Government should end this pernicious social experiment before it does even more damage.’

A Babylon GP at hand spokesperson said: 'The needs of patients have to be put first. Regardless of which NHS practice they register with, they should never be denied local NHS care. People who choose Babylon GP at hand as their NHS GP must be able to access the full range of NHS services local to them, and this care should be fully funded.'

The rise of Babylon GP at Hand

Babylon started offering online GP services as a replacement to regular GP practices across London in November 2017.

GP leaders expressed concerns about the impact of Babylon's entry to London, after it rapidly signed up tens of thousands of patients to it's GP at Hand app via the out-of-area registration scheme.

The service has also been criticised for ‘cherry picking’ patients, as it advised certain patients - including pregnant women and patients with learning difficulties - to ‘discuss’ whether it may be ‘appropriate’ to register with ‘a practice closer to home’. Although these restrictions have now been lifted.

Despite concerns, health secretary Matt Hancock said he is a patient of Babylon, and that the company is ‘taking the pressure off the NHS’.

An independent evaulation of the service is currently being conducted by Ipsos Mori, while the CQC is assessing whether the app has destabilised other GP practices, and its impact on the overall quality of care.

Meanwhile, GPs called on the BMA to abolish the out-of-area registration clause in the GMS contract - which allows patients to register with practices outside of the traditional GP boundaries - at the England LMC conference last month.

Readers' comments (4)

  • Babylon are highlighting the broken funding model.

    In Sweden the patient’s ACG risk score for the past 18 months determines their primary care capitation.

    It has led to increased GP provision in the most deprived areas, the opposite of the situation seen in England.

    Babylon uses ‘tech’ as a proxy to cherry pick easy patients.

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  • Bob Hodges

    If Carr-Hill were to change to allocate funding to actual 'need', then Babylon's cherry-picked list would be worth ten bob and a pickled egg.

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  • CCGs are absolutely justified in contesting this. Babylon has a right to function as a Provider in it's own right but without encroaching on NHS Funding which could seriously undermine funds available for the GMS Practices. Pity CCGs don't hesitate throwing away money at APMS contractors too who are now being given lucrative contracts with utter disregard for procurement laws (Medway example)

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  • All patients have a “need” and are entitled to good basic care-
    Many deprived areas have huge social problems that are the drivers for many of the medical issues that result- as the Black report showed- increasing medical input
    Isnt the answer!
    What about the healthy individual with a first severe debilitating episode of depression - blights their lives- and takes a lot of GP, support, review- liaison with work, DDA etc
    Adolescent mental health.....postnatal depression,
    Multiple sclerosis, ovarian Cancer in a young patient with Lynch syndrome - pulmonary embolus, congenital cardiac problems in a sporty young man- (lost his uni scholarship).
    Epilepsy , endometriosis, acute psychosis, premature ovarian failure.....lymphoma, ankylosing spondylitis, Angelmans syndrome in a 3 y old, renal failure in a neonate, ectopic pregnancy, drug and alcohol ( occurs everywhere not just in areas of deprivation-)
    None of the above are related to deprivation- but none
    “ count” under QOF....saw all the above and so much more last week..... make my complex multimorbidity 80+ year olds look positively easy. Why should their care not be funded? East end GPs are v vocal about their deprivation workload - it’s a devicive approach- we’re all snowed under and overworked... 14-16 hours days are the new “norm “!
    Unrecognised work load is everywhere -
    stupid simplistic funding formulas like Carr Hill aren’t the answer!

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