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The waiting game

NHS England enforces 1,001 patient list size limit on GP at Hand in Manchester

NHS England and local commissioners have placed a cap of 1,001 on the number of patients that can register with Babylon's GP at Hand service in Manchester.

Pulse reported earlier this week that the digital-first provider confirmed plans to expand to Manchester in early 2020.

This came at the same time as London's NHS Hammersmith and Fulham CCG lifted a previous cap on the number of patients signing up to its Birmingham service.

But in board papers released this week, the London CCG said it has set a limit on its patient list size in Manchester - of 1,001 registrations - 'in light of the outcome of the digital-first consultation'.

Following the consultation, earlier this year NHS England approved new rules, expected to come into force from April, that mean digital-first providers will be required to set up a new APMS contract once they register more than 1,000 out-of-area patients.

This week's board papers also said the CCG has agreed with NHS England to object to the latest expansion in Manchester 'on the grounds of risks to patient safety', due to concerns about screening, but will review this by January.

Babylon said the decision was 'expected' as commissioners are following the same route as happened with its Birmingham service of 'formally objecting in order to maintain control of the process while working closely with us'.

In its latest board papers, NHS Hammersmith and Fulham CCG said the objection will be reviewed in the new year and 'could be lifted' if there are no remaining concerns over patient safety.

The papers said: 'NHS England London region considered the application, assurance information from the contractor and comments from regional screening teams and Manchester commissioners. They agreed that an objection to the sub-contracting variation should be raised on the grounds of risk to patient safety.

'This would remain in place until the CCGs, the practice and other partners work together to complete implementation of robust measures to ensure patients can access all local care pathways, particularly those relating to cancer screening and follow up treatment and local protocols for safeguarding.

'They also agreed that a restriction on the list size in the Manchester area should be set at 1,001 patients in light of the outcome of the digital-first consultation.'

Last year, Babylon revealed plans to open a physical branch of its online services in Birmingham last year, which were initially rejected by NHS Hammersmith and Fulham CCG after evidence showed the services might put patient safety at risk.

NHS England decided to block the application before lifting it in February, after Babylon was found to be compliant with a series of imposed requirements. 

Last month, Babylon Partners Limited reported a £65m loss in its annual accounts, almost three times more than the previous year

Earlier this year, NHS England announced plans to make it easier for digital providers to set up practices in deprived areas from April 2020. 

In response, the BMA said out-of-area regulations should be scrapped as they are 'not in line' with wider NHS England policy. 

Elsewhere, Dominic Cummings, the Prime Minister's most senior aide, recently came under fire for his advisory role with Babylon.

Readers' comments (5)

  • Please can they come and impose a list size limit on me ? Fat chance.

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  • In 1975, our 3 GP practice in Sussex had a combined list size of 7,500 patients - 24 hrs coverage, including out-of-hours calls and visits, was the norm on a 1:3 schedule, as was the Saturday morning surgery - a round of home visits was the norm Monday to Friday. Sunday was on a call-out basis.

    The practice had 2 receptionists and 1 bookkeeper.

    None of us were burnt out or 'demoralised.

    What happened? You tell me.

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  • To answer you , Just Saying: the first generation of snowflake numpty GPs moaned so hard about sine qua non of GP ie 24hr cover for patients that they persuaded the even bigger Blair numpties in 2004 to remove it. Every wow in uk GP can be shorted home to these two groups

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  • 'In 1975, our 3 GP practice in Sussex had a combined list size of 7,500 patients - 24 hrs coverage, including out-of-hours calls and visits, was the norm on a 1:3 schedule, as was the Saturday morning surgery - a round of home visits was the norm Monday to Friday. Sunday was on a call-out basis.

    The practice had 2 receptionists and 1 bookkeeper.

    None of us were burnt out or 'demoralised.

    What happened? You tell me.'

    The demand went up. When I started in 1988, the number of consults per patient a year was about 3. It is now about 8. The advent of mobile phones has made Primary care instantly accessible so the work is far more. When I was a houseman, I did a 1:2 rota with 1:1 whenever my colleague was on holiday - so 2 weeks in a row. No-one would suggest that my job then was harder than juniors now doing their shift work as I was covering only my wards and was massively protected by the night staff nurses so did get to sleep. Comparing now and then is comparing chalk and cheese.

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  • When I joined our semi-rural two-handed practice in 1976, I would be called out of bed about once every 6 weeks. In 1995 when I gave up being on call, we had twice as many patients and twice as many doctors - and it wasn't uncommon to be called out of bed when on duty THREE times a NIGHT. THAT's what happened.

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