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Independents' Day

Commissioners provide £1m bailout to CCG after influx of Babylon patients

Exclusive Neighbouring CCGs are bailing out Babylon's NHS host CCG as it struggles to cope financially with the rapid influx of patients.

The Dr Jefferies and Partner GMS practice - which is based within NHS Hammersmith and Fulham CCG - has offered Babylon's 'GP at Hand' service to NHS patients across London since November, which allows them to get an appointment in person on the same or next day and have an online consultation with GPs within minutes.

But the CCG has had to receive funds from elsewhere to cope with the influx of patients, including £800,000 from its neighbour NHS West London CCG, while the North West London Collaboration of CCGs is expecting to provide another £300,000 top-up by the end of this month.

Meanwhile, NHS England's London regional team has agreed to re-allocate funds from other CCGs across London which are outside of the collaboration.

Under the GP at Hand scheme, patients must deregister with their existing GP practice and Pulse has learned that GP at Hand had signed up over 30,000 patients by the end of last month, with a further 20,000 having applied to join.

But this has come at a cost for NHS Hammersmith and Fulham CCG, which warned in March that it would be £18m short in this financial year unless NHS England agreed to an in-year top-up to its primary care funding allocation.

The North West London Collaboration of CCGs has a ‘risk-sharing’ arrangement in place to transfer contingency funds between members to cover unexpected costs, and its board papers reveal:

  • NHS Hammersmith and Fulham CCG has seen a 10% increase in its registered population as a result of GP at Hand;
  • 'Financial support' worth £5m was transfered from the group of CCGs to NHS Hammersmith and Fulham in 2017/18, £800,000 of which was directly related to GP at Hand;
  • The collaboration expects to transfer another £300,000 to the CCG at the end of this month, with further transfers expected during 2018/19;
  • Unlike other transfers via the risk-sharing agreement, GP at Hand-related funds are not re-payable because it 'relates to a permanent shift of commissioning responsibility';
  • NHS Hammersmith and Fulham CCG 'has received confirmation' that 'additional costs will be met by NHS England', and there is 'an ongoing dialogue' between the parties 'to agree the value of the costs attributable to GP at Hand'.

A spokesperson for the North West London Collaboration of CCGs told Pulse: 'The financial strategy relating to GP at Hand is to reallocate funds as the population transfers registration from other north west London CCGs to Hammersmith and Fulham.

‘The normal NHS allocation process is fixed for 2018/19 and therefore this north west London local arrangement moves the appropriate funding to the CCG as a patient registers with the GP at Hand practice. This should be a cost-neutral process as allocation is shifting in-line with costs.'

Since November, GP at Hand has been signing up patients from across London by making use of the out-of-area registration scheme.

But last month, CCG board papers revealed that one fifth of patients who had signed up from south west London have since re-registered with their original GP practice, prompting complaints from GP leaders regarding the related additional practice workload.

Londonwide LMCs chief executive Dr Michelle Drage said: 'We hope that this transfer of now over £1m in funding is not to the detriment of practices and patients in the CCG areas losing money.

'Our interest is in ensuring that patients continue to have access to properly resourced, authentic general practice close to their homes.'

Dr Drage further questioned why the service is being allowed to continue to expand whilst a full evaluation is still outstanding.

She said: 'This again raises questions about why a service which undermines the financial model of NHS general practice has been permitted to launch without any assessment of its impact on an already cash-strapped system.

'We hope that the forthcoming independent evaluation will look into the full impact of this model on patients and general practice funding.'

Pulse can also reveal that Ipsos Mori has won the the £250k bid to carry out an independent evaluation of GP at Hand on behalf of NHS Hammersmith and Fulham CCG, which will look at its ‘outcomes and impacts’.

A GP at Hand spokesperson said: 'The reality is that people across London are exercising their rights to choose their NHS general practice... This, of course, means that Hammersmith and Fulham CCG’s budget will need to increase as they commission services on behalf of more people.

'Balancing this, CCGs with fewer registered patients going forward will also see changes in their budgets.'

GP leaders have expressed significant concern about the NHS app arguing the service 'cherry-picks' fit, young and healthy patients - claims that GP at Hand has refuted.

NHS England London declined to comment.

Readers' comments (6)

  • Dear All,
    Well Mr Hunt wanted his disruption, here it is. How to respond?
    Paul C

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  • Vinci Ho

    Ha ha ha
    My question is : how many smartphone-using patients who were previously not registered any GP(thought they didn’t need one ) have now registered with GP at hand?
    Then , the fundamental question is whether the total annual GP funding budget was supposedly to serve every patient in country registered with a GP?
    Anybody has figures on the number of people in UK who are not registered with a GP???

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  • deserve everything they get.

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  • AlanAlmond

    This service is only avalibale in London because

    A) The people of London are special
    B) People outside London don’t pay tax
    C) No one has a smart phone outside of the M25
    D) All the MPs are in London and whoever set this up has ‘contacts’

    Choose one option only. One gold star will be awarded for the correct answer. £1M will be deducted from other peoples health budgets for each wrong answer received.

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  • Cannot be undone. But NHS needs to move to Australin type of pay systemm with fee for service, so those practices that offer telephone or skype like consults only get a different fee from face to face or those able to visit.

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  • Just Your Average Joe

    Fit and mobile online fee for capitation needs to reduce by a significant amount, which needs to move to help offset the huge number of appointments and vists the frail and elderly and very young require, as this workload is left behind when you cherry pick the easy to deal with patients from other colleagues lists.

    There will not be sufficient funding to support staffing to allow care for those left behind in this stupidly rolled out model.

    A pilot with separately funded money should have been set up to evaluate the impact before letting this medico-legal monstrosity of a care model to be allowed to nuke the current primary care landscape, with risk of leaving a scorched earth model of care behind.

    Yes some improved access would be nice, but not at expense of caring for the elderly and vulnerable, and no extra funding to prevent the imbalances that are slowly being introduced.

    If not resolved soon, it will become too hard to stop the flood of fallout from this disastrously poor;y considered plan from the DOH/JH.

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