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New laws will make it easier for digital-first providers to set up new practices



NHS England has announced plans to make it easier for digital-first providers – such as Babylon GP at Hand – to set up practices in deprived areas from April 2020.

Under the plans, which form part of a consultation on out-of-area patient registration – providers could be able to set up new practices in deprived and under-doctored areas through an APMS contract if they can demonstrate a ‘credible plan’ for bringing new GPs to the area, and offer face-to-face appointments in underserved areas.

NHS England stressed the current GP shortage, saying that digital-first providers have the potential to address issues in access to services and mitigate the effects of the inverse care law.

As part of the same consultation, which runs for two months, NHS England has proposed that Babylon, which has a huge number of patients based in different CCGs, should be forced to open a new practice under an APMS contract in CCGs where they have a large presence. These practices will then have the right to join an existing primary care network.

Under the long-term plan, released earlier this year, NHS England committed to offer every patient in England access to digital-first primary care over the next five years.

Documents published today said that this will be achieved ‘by supporting existing general practice to expand and develop its digital-first offer, as some practices are already doing by partnering with suppliers of digital technology to deliver a digital offer to their patients’.

The documents state: ‘A new programme will be introduced in 2019/20 to support ICSs, STPs, CCGs, PCNs and practices to develop an integrated digital-first offer that supports both patients and staff. The programme will ensure a new framework is available for digital suppliers to offer their platforms on standard NHS terms.

‘But we recognise that change takes time and this approach alone is unlikely to maximise take-up and innovation in digital-first services at pace, ensuring delivery of the NHS long-term plan commitment. We also need to continue to improve access to general practice services in some geographies, and digital-first providers could help achieve this.

The documents added: ‘In this chapter, we consider whether we could go further to facilitate new digital and physical services to be set up via an APMS contract in a way that would help to address issues in access to services.

‘The development of digital general practice now offers the possibility that has never before existed – to expand GP capacity for patients in an area even when the GP sessions are provided at some distance. By targeting under-doctored areas, it could help to bring additional capacity into these areas and deliver improvements in access. This would support our wider goals to reduce health inequalities. We would therefore require any such providers to have a credible plan for bringing additional GPs into the area from outside, and to deliver this additionality as an ongoing contractual requirement.’

In a briefing with Pulse, NHS England national director for strategy and innovation Ian Dodge said: ‘We start a debate as to whether or not there should be any circumstances in which it is easier for people to set up new practices. For example, in our most under-doctored communities, if that is a way of bringing in extra GPs and tackling inequality rather than making it worse.

‘We pose a series of questions and we will be engaging with a lot of people, including the BMA and GPC.’

The consultation closes on 23 August. 

Earlier this month, NHS England chief executive Simon Stevens said digital services will help ease GP shortages.

This comes after Hammersmith and Fulham CCG approved GP at Hand’s expansion to Birmingham, with a limited list size of 2,600.