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GP at Hand improves health access for migrants and homeless, finds review

Babylon’s GP at Hand smartphone app ‘advances equality of access to GP services’, an assessment of its impact on patients has found.

The equality impact assessment, carried out on behalf of NHS Hammersmith and Fulham CCG, found that the NHS app was ‘more likely to address most barriers than traditional GP services’ in 10 out of 11 protected groups.

It especially found the app made it easier for ‘vulnerable migrants and homeless people’ to register for NHS general practice.

Since November last year, GP at Hand has used the GP out-of-area registration scheme to sign up over 30,000 patients from across London and beyond to a GP practice in Fulham in south west London. It promises a same-day online consultation or a next-day face-to-face assessment if required.

The report, carried out by by Verve Communications and published in CCG board papers, said that ‘the GP at Hand service advances equality of access to GP services for some groups, especially in the areas of obtaining an appointment and getting to appointment’.

It added: ‘Confusion about entitlements and the need for ID are an ongoing issue in UK primary care. Although an NHS guideline states that the lack of ID should not be a barrier to registering, vulnerable migrants and homeless people are still being refused registration in primary care. 

‘GP at Hand registration allows this cohort to register online.’

The report also suggested ‘carers may benefit from [the] use of GP at Hand as this will allow them to consult a primary care practitioner whilst continuing with their care responsibilities’.

The results of the assessment comes as accusations of ‘cherry picking’ patients has riddled GP at Hand since the London launch, including from the BMALondonwide LMCs and the RCGP – an accusation which GP at Hand has repeatedly denied.

GP at Hand does not block anybody from using the service, but says people who are frail or elderly, pregnant or have severe mental health issues may be advised they are better serviced by a local practice. Despite this, GP at Hand has registered patients with these conditions, including 86 patients with serious mental illness.

The equality assessment found that patients with mental health conditions that mean that leaving their home is a challenge are benefitted by GP at Hand as it ‘offers a route to GP care without the need for a person to travel for an initial conversation’. 

The review did not look at the impact on pregnant patients as NHS England currently deem out-of-area GP Choice registrations to be inappropriate for those who are pregnant or seeking to become pregnant.

Dr Robert Morley, BMA GP Committee contracts and regulation policy lead, told Pulse: ‘It’s certainly laudable if the vulnerable are better able to access GP services, but questions remain as to whether the GP at Hand model is the most appropriate one for many of these patients.

‘There is no doubt that the model is certainly not the best one for providing the holistic, non-fragmented care that is in all patients’ best interests, depending as it does on cherry picking the young and healthy through exploitation of the out-of-area registration regulation.’

A GP at Hand spokesperson said the report ‘shows that we go further than traditional general practice in addressing barriers to access for people with protected characteristics’.

They added: ‘GP at Hand and Babylon are making high accessible, high quality NHS primary care a reality for everyone, and we are very grateful to NHS Hammersmith and Fulham CCG and NHS England for their support as we conducted a full and through Equality Impact Assessment.’

The news comes as LMC leaders recently advised their practices not to register homeless patients using their surgery’s address, contrary to NHS England advice.

It also comes as NHS England is consulting GPs on changes to the GP contract which would boost the expansion of ‘online first’ providers of GP services.

A wider review of GP at Hand’s ‘outcomes and impacts’, which is being led by Ipsos Mori under a £250,000 contract, is still ongoing.

Babylon is currently trying to expand its GP at Hand offering to Birmingham, however it is being blocked by commissioners which have concerns about patient access to screening services.

Which are the ‘protected’ patient groups?

The report said GP at Hand is ‘more likely to address most barriers [to access] than traditional GP services’ in every category out of 11 protected patent groups except pregnant patients. These groups are protected based on:

  • Age
  • Religion or belief
  • Disability
  • Sex
  • Sexual orientation
  • Gender reassignment
  • Pregnancy and maternity
  • Marriage and civil partnership
  • Race
  • Carers
  • Socio-economic disadvantage

Source: NHS Hammersmith and Fulham CCG