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‘GP at Hand is threatening general practice across the UK’

GPs in Doctors in Unite write to the health secretary, warning that the GP at Hand service is a threat to UK general practice and calling for changes to the out-of-area registration policy 

Dear Secretary of State for Health and Social Care, 

The advent of GP at Hand, the online NHS GP service, powered by Babylon, the private digital health provider service, has brought the problems of the ill-conceived government GP Choice Scheme into sharp focus.

Since GP at Hand launched in November 2017 around 26000 patients have registered with GP at Hand, most of these being between the ages of 20 and 39.

When patients register with ‘GP at Hand’ they are ‘de-registered’ from their own surgery and funding is then removed from that surgery. Practices have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand. There is no doubt that ‘GP at Hand’ will destabilise other practices, robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients. Losing registration fees for younger, fitter patients who join ‘GP at Hand’ threatens the model of general practice relied on by so many patients. The scheme is hoovering up the younger, healthier patient and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems. Continuity of care is threatened because you may never see the same GP again when consulting GP at Hand.

In practice, 70% of all patients are reasonably well. Their funding helps surgeries care for the 30% who are sick. It’s a system that works, because it’s fair. We all eventually end up in the 30%.

The service targets the most profitable patients – those who are younger and healthier and don’t need extensive care from their GP. It is unclear if patients are fully advised of the implications of registering with ‘GP at Hand’ and how it can destabilise their previous practice by removing much needed funding.

Jeremy Hunt has said that general practice is the ‘jewel in the crown’ of the NHS. If he truly believes this, he will acknowledge that the ‘GP at Hand’ model threatens the very survival of NHS general practice as we know it and we call on him to abolish it. ‘GP at Hand’ have made it clear they wish to roll out their model of care across the country so this scheme will threaten general practice across England (Wales, Scotland and NI do not have this scheme in place).

Doctors in Unite demand that this aspect of the ‘GP Choice Scheme’ is abolished to ensure the survival of list-based NHS general practice within a defined geographical area. General practice is the cornerstone of the NHS which has provided excellent care with its other community partners for decades.

Signed by Dr Jackie Applebee and colleagues. Full list of signatories below

Doctors in Unite is part of Unite the Union, the largest union in the UK with 1.5 million members. We are committed to an NHS which is publicly funded, publicly provided and publicly accountable.If you are a doctor then join us in Doctors in Unite   

Responding to the letter, a GP at Hand spokesperson told Pulse: GP at hand receives the same funding from the NHS as the vast majority of NHS practices do. The cross-subsidy allegation shows a failure to understand the basics of how NHS practices are funded. Capitation funding (the so called ‘global sum’) varies from below £35 per 15-44 man registered with a practice to over £190 for each person over the age of 85. And of course by providing care 24/7 despite only being paid for the core hours of 8am-6.30pm Monday-Friday, GP at hand is supporting the rest of the NHS as well as maintaining continuity of primary care within a single provider no matter what time of day or night.

The reality is that patients and GPs are flocking to GP at hand because they recognise the potential that high quality, digital-first 24/7 NHS GP services bring. The 200 GPs who have already joined Babylon do so because they are treated with respect and not put under the levels of pressure all too common in other practices. 95% of Babylon doctors surveyed say ‘Usually, I can manage the amount of my work well.’ In comparison, the BMA showed in 2016 that 84% of GPs across the NHS reported that workload pressures are either ‘unmanageable’ or ‘excessive’ and having a direct impact on the quality and safety of the care they deliver to patients.

People have the right to choose their NHS practice. GP at hand is an NHS service; paid for by the NHS; providing NHS services to all patients – just like the vast majority of GP practices throughout the UK. In seven months, over 40,000 people living or working in central London have applied to join NHS GP at hand, with more than four out of five people rating our digital appointments giving them the full five stars. The average waiting time for an NHS GP appointment with GP at hand is 38 minutes, compared to waits for routine appointments in traditional practices of a week or more.

 

NameLocationJob role

Jackie Applebee

London Borough of Tower Hamlets

GP

Anu Mitra

London

Consultant in Emergency Medicine

Mark Butler

London 

Consultant Paediatrician 

Pam Wortley 

Sunderland 

Retired GP

Dr Tim Dowson

Newcastle

General Practitioner

Dr Gillian Breese

North Wales

Salaried GP

David Church

mid-Wales

GP - salaried

Prof Allyson Pollock

Newcastle 

Prof of Public Health 

Dr Kambiz Boomla

Queen Mary University of London

GP academic

John Puntis

Leeds

Consultant Paediatrician

Beatrice Rogers

Leeds LS16

Secretary Leeds Hospital Alert

Penelope Jarrett

London

GP

Dr Ben Hart

Chrisp Street Health Centre, Tower Hamlets, London E14

gp

Phillip Bennett-Richards

Tower Hamlets

GP

Ian Jackson

Tower Hamlets

Health Partnership Director

JOY FISHER

leeds

retired

Bronwen Holden

Leeds

Retired Social Worker

Wendy Savage

Islington London

Retired eniot Lecturer in Obstetrics and Gynaecology

Dr J Price

e3 2tj

GP

Sian Knight

Lewisham, London

General Practitioner

Jo Downes

Lincolnshire 

GP Practice Manager 

Emma Ovink

Tower Hamlets

GP

Jim Cole

Chrisp Street Health Centre

GP

Sifot Ali

Bow

GP 

Dr Kirti shah

Grove rd surgery E3

Senior partner

Amjad khan

Bedford 

General practitioner 

Anna Livingstone

Limehouse

General Practitioner

Rodrigo Correa

London

Business Manager

Helen Berry

West Yorkshire

Hospital doctor 

Emily Graves 

Sunderland

Consultant

Timothy Yu

London

GP

Sally Harrison

Bristol

Salaried GP

Dr John Ward

Bath, UK

GP Registrar

Rozhia Salih

East Midlands 

Doctor 

Dr Peter Brooke

Norfolk

Paediatric Trainee

Sara Swan

Swansea

GP

Shakeeba Anwar

Ashton under lyne

Salaried GP

David Ritchie 

South West

Medical Doctor 

Vikram varma

Wrexham

Gp

Dr Vicki Holtby 

Worcester 

Salaried GP

Stella Johnson

East of England 

Doctor

Dr Veronika Wagner

South East England

Registered Medical Practitioner and Unite Workplace Representative

Narin Shareef

London

Core medical trainee 

Sebastian Hormaeche 

London 

Anaesthetist 

Dr S Hafeez

London

GP

Rob Molloy

Birmingham 

GP

Diana Lauder

Wakefield

Retired Nursing Sister

Anam Ahmed

Sheffield 

Junior doctor 

Dr Jennie Read

Tower Hamlets

GP

Gwen Adshead

Hampshire

Hospital consultant

Sarah Baines

Lancashire 

Nurse, patient 

Dr Helen Cranage

Liverpool

GP registrar

Amy jones

England 

Emergency Medicine consultant

Tom Wrigley 

Cambridge 

Gp

Vikki Horton

Portsmouth

HSDU Technician 

Sue Horton

Portsmouth

Patient Services Assistant

Christine Hunter 

Newquay 

GP locum

Sorcha Mackay 

Scotland 

Specialty Doctor 

Sundus Ali

Birmingham

ST1

Monica Carter 

Lonfon

Retired GP, volunteer doctor Freedom from Torture 

Jeanne Lintonbon

London

Doctor

Hilary Kinsler

London

Old Age Psychiatrist

Matthew ryan

Cardiff

Doctor

Sian Ashby

Herne Hill

General Practice

Peter English 

Surrey 

Public Health Physician 

Rebecca Mullen

Tunbridge wells 

Doctor

Isobel Leckie

Norwich

Bssw

B Bhimarasetty

Birmingham 

Gpst3 

Lindsey Kent

Salford

Fy2 academic trainee

Dr. Tiago Ivo

Canterbury

Doctor

Krishnaveni Padala

Preston uk

Sho

Alan Courtney

England

Doctor

Dr Christopher Butler

Shipley, West Yorkshire

Retired GP

Simon Lawrance-Owen

Gloucester

GP Trainee

Anisha Antony

Sheffield

GP

Hannah Woodcock

West Suffolk

Junior Doctor

Dr Julian Bashforth

Hampshire 

GP

Raina nazar

Sutton Coldfield 

GP

Naomi Beer

Tower Hamlets

GP

Caroline Worsley

Sheffield 

Doctor

Andy Atkins

Leeds

Retired

Caroline Cocking

Derbyshire

Registered nurse

David Topliss 

Oxfordshire 

Consultant 

Jennifer Barclay

Salford 

Foundation Year 2 Doctor

Jeanne Jackson

Greenwich, SE3

RETIRED

Martin Seager

Saffron Walden

Clinical Psychologist

Dr Robert Morley

Birmingham 

Local Medical Committee Secro

Judith Kelly 

Birmingham 

Biomedical Scientist 

Hannah Robinson

Cornwall

Occupational therapist 

Kathryn McAdam Freud 

Southwark 

GP principal and trainer

Rebecca Leslie

Dundee

Paediatric Consultant

Mary Church

Bothwell 

GP

Kathryn McAdam Freud

Southwark 

GP partner and trainer

Sue Butters

Norwich, Norfolk

clinical research nurse

Maureen Huddleston

Lancaster England

Nurse

Dr Stefan Lipinski

SE London

Gp partner

Phillip Welldrake

Stockport

retired

Edoardo Cervoni

Southport 

GP

Diana Lauder

Wakefield

Retired Nurse

Beverly Fernado

Tower Hamlets

Practice Manager

Hina Din

Newham 

Practice Manager

Nitin Shori

Wales

GP Partner

Dr Prakash Kachhala

Nottingham

GP Partner

Siobhan Stapleton 

Greenford 

GP

Karen Haworth’s 

Medway, Keny

GP

Dr Helen Lever

East Midlands 

GP 

Ruth Marchant

london

GP

James Morgan

Caerphilly

GP practice manager

Preethi Perera 

Surrey 

GP

Kerry Sneddon

Glasgow

Gp

Siobhan gillespie

Devon 

Gp

Sarah Johns

Nottingham

GP Partner

Jaspal Taggar

Nottingham

Associate Professor and GP

Judith Bull

Abbots Bromley

Senior Partner

Sarwat shah

London 

Locum consultant 

Emma Willert

Sale, Cheshire

GP

Julie Boissonade

Cornwall

GP

Adele Parsons

Lincoln

Advanced Nurse Practitioner

Dr Tamsin 

Cirencester 

Gp

Michelle Teo 

London 

Doctor

Sarah Sanaghan 

Glasgow

GP 

Dr Ben Bromilow

London

GP Partner

Rob Gardiner

cambridgeshire

nurse practitioner

James Crane

London

Clinical Research Fellow, Obesity

Hugo Farne

London

Registrar in Respiratory Medicine

Amit Shukla

Lincoln

Consultant Surgeon

Andrea English

West yorkshire 

Advanced nurse practitioner 

Karam Sarsam

South London

Doctor

Dr Tejumola Olaoye

Birmingham

ST4 O&G

John Hewertson 

East Midlands

Consultant Paediatricians

Heather Mycock

Winchester

Retired GP

Mary Valentine 

Royal Wootton Bassett 

GP 

 

 

 

 

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Readers' comments (3)

  • So are the Tories.

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  • and the RCGP.

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  • David Banner

    The main reason GPs are furious is because Babyon openly discourage certain groups of patients from registering (namely the older sicker ones), and NHSE and the DOH not only allow this but blatantly encourage it. Yet we mere mortal GPs would never be allowed to discriminate so flagrantly.
    Ah well, it’ll all unravel after the inevitable medicolegal meltdown and Panorama expose in a few years time.

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