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Out-of-area regulations should be scrapped, says BMA

NHS England should withdraw its out-of-area regulations as they are ‘not in line’ with wider NHS England policy, the BMA has said in response to NHS England’s consultation on digital-first primary care. 

Responding to the consultation, the union criticised NHS England’s proposal to automatically move out-of-area patients to a separate local practice list once they reach a certain number, and called for GP at Hand to be used as an NHS 111 service instead of registering patients. 

The BMA said the out-of-area regulations were outdated given the future of digital consultations and that patients can discuss medical issues with GPs on the phone. It said this meant digital providers could prioritise largely healthy patients over those with longer term needs. 

The response said: ‘We believe that the out-of-area regulations should be withdrawn as they are not in line with wider NHS England policy relating to population-based health management and are no longer required due to the greater use of telephone, and in the future digital, consultations via existing practices.

‘The regulations, furthered by the proposals in the consultation, give the potential for largely healthy patients and short-term care to be prioritised over predominately multi-morbid patients and continuity of care for a local population in order to profit from this arrangement.’

It added that the proposals would enable the Government to avoid investing in GP practices to help them manage large patient lists.

The response added: ‘The proposals seek to avoid NHS England and commissioner responsibility for investing appropriately in all practices to achieve a fair and consistent digital first offer to patients.

‘Providing the funding, resources and ability for all practices in England to provide safe and appropriate care via a digital first platform would negate the need to introduce the proposals within this consultation and would cause the out-of-area regulations to become redundant.’

The BMA response also recommended that GP at Hand provide an NHS 111 service, rather than registering patients. 

It said: ‘This consultation doesn’t disguise the fact that one practice, Babylon/GP at Hand has caused considerable difficulties by its exploitation of the patient choice scheme and out-of-area regulations, both to neighbouring contract holders and Hammersmith and Fulham CCG.

‘We suggest that the way to resolve the problem created by Babylon/GP at Hand’s operation is not only to properly fund and enable every practice to have digital access, but to separate GP at Hand from the registered patient and instead link it to NHS 111.’

It said that patients were ‘clearly’ using GP at Hand like NHS 111 already.  

The response said: ‘Patients are clearly using GP at Hand in the same way they would NHS 111. It therefore would be more appropriate, rather than making the current system more complicated, to instead use Babylon/GP at Hand as an adjunct to NHS 111 to triage and where appropriate treat patients and decide whether they need to see their registered GP or not, without the requirement for patients to be registered with them. ‘

However, a Babylon spokesperson said: ‘The BMA are once again showing how out of touch they are by comparing completely different services, when they could be backing the public to have a choice of convenient and high quality primary care. Babylon GP at Hand is a full NHS general practice with over 60,000 patients, making it one of the five biggest practices in the country and evidently meeting a demand for accessible, round the clock care.

‘From co-ordinating the ongoing care of people with complex physical and mental health conditions to supporting the timely diagnosis of cancer and other life-threatening illnesses, Babylon GP at Hand clinicians are showing what a 21st century NHS can do.’

‘It comes after it was revealed that patients were ‘getting around’ rationing rules by registering with out-of-area practices.

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