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A faulty production line

Growth of Babylon app threatens 'financial balance' of CCG

The CCG hosting the GP at Hand online appointment service has warned the service's rapid growth is threatening its financial balance.

Board papers from NHS Hammersmith and Fulham CCG reveal that Babylon is planning a physical expansion of its GP at Hand app – which pledges an online appointment within seconds and a same- or next-day face-to-face appointment if required – in London and a launch outside the capital in the summer.

Pulse revealed earlier this month that a new patient signs up with the service 'every two minutes' and the board papers said this amounted to 4,000 new patients a month.

Fulham-based GP practice Dr Jefferies and Partner, which hosts GP at Hand via the out-of-area registration scheme, now has 26,000 patients – up from 2,500 one year ago.

The CCG papers said that if patients continue to sign up at the same rate, it will cost the CCG an additional £10.6m in 2018/19 – or £5.4m even if no more patients signed up.

The papers reveal that 6% of the practice's patients – 1,400 – live outside of London, while 'almost all of the new patients are in the 20-64 age group, with three-quarters under 35'.

The paper adds: 'The baseline scenario, representing the growth so far absorbs almost all of the primary care headroom for 2018/19. Any further growth will push the primary medical services budget into deficit. The straight line growth scenario would see the primary care budget in deficit by approximately £1.3m.'

It says 'there are no automatic adjustments to primary care allocations in year to compensate for rapid changes in list size', and that GP at Hand's growth was 'creating significant cost pressures resulting in the CCG failing to meet its statutory requirement to deliver financial balance'.

'The CCG has raised the issue with NHSE (London) and is exploring options to enable in-year adjustments to its allocation,' the paper said, adding that its 'additional costs represent a windfall gain for the CCGs losing patients'.

It also said GP at Hand had lodged 'further subcontracting applications' for 'sites elsewhere in London' and 'the provider has indicated they will seek to expand to sites outside of London in July 2018'.

The CCG has already launched a bid worth £250k to hire an ‘independent evaluator’ to assess the 'outcomes and impact' of GP at Hand.

The LMCs Conference voted earlier this month to put a stop to online providers who 'cherry pick patients', citing GP at Hand as an example.

However GP at Hand rejected the claims, responding that its patients include people of all ages.

The GP at Hand website says the NHS advises that the app might be less suitable for some patients, including those who are pregnant or frail.

A GP at Hand spokesperson told Pulse: ‘What has happened is that a different CCG is now paying for patient care. Historically, when patients – who are now with GP at Hand – were registered at their previous practice, the CCG responsible for that practice would have borne the costs of the NHS care.

‘Now the costs fall to [NHS] Hammersmith and Fulham CCG.’




Readers' comments (24)

  • A new patient 'every 2 minutes'. That would be 720 a day, or 20,000 a month? Next, they say 4,000 new patients per month, yet list size only up 2,500 over the past year? Are lots of patients joining and then leaving again? The figures are clearly wrong. It would be interesting to know what the real figures are.

    The CCG will experience financial pressure if there is a rapid increase in list size as they are liable for primary and secondary care costs. Their financial allocation will take a while to catch up, but I'm sure this will be managed across their STP.

    There's too much at stake, politically, to allow this to fail.

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  • Who is NHSE anyway? My friend ( a psychologist) works for its regional cancer division. When I asked her what she did and what a typical day consisted of even she said it was a bit vague! Seems she goes into hospitals and makes tells them how to follow NICE guidelines. I love my friend but it made me feel so cross. The NHS is a bloody mess only prevented from utter chaos by a relatively few old schoolers battling on.

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  • A 2 partner practice with 20,000 patients?
    Could Pulse find out how 2 GPs - and corresponding staff and premises - manage to provide adequate services to this number of patients?
    And how - & by whom - is the underlying technology funded/supplied?

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  • Agree with almost everyone.
    Hammersmith & Fulham CCG deserves whats's coming. I am surprised that they did not see this coming. Everybody is running after short time goals & browny points but cannot see bigger picture.

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  • So if a practice can run a service based on a small catchment compared to out of area registrations, what is to stop 'traditional' practices reducing their boundary to a 20m radius of the practice, then accepting 'out of area' patients who have to agree to travel to the surgery or consult online?

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  • I'll like to see the easy young patients. The incompetence is laughable if the CCG and NHSE cannot see it coming.

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  • this is what is needed. in the absence of any radical change these kind of measures might just force a rethink of the contract.

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  • presumably this could work for a while if largely young mobile patients sign up but those pts will get older/pregnant/cancers/back pain.we would not be inclined to reregister pts who have left ,being at capacity anyway.

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  • Makers of Hand Knitted socks, Coopers and most Photographers have all been reduced to a vestigial cottage industry rump by the inevitable march of technology and consumer pressure. Primary Care is no different and our special pleading cuts no ice.
    Expect much much more of this.

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