‘GP at Hand is threatening general practice across the UK’

Dear Secretary of State for Health and Social Care,

The advent of GP at Hand, the online NHS GP service, powered by Babylon, the private digital health provider service, has brought the problems of the ill-conceived government GP Choice Scheme into sharp focus.

Since GP at Hand launched in November 2017 around 26000 patients have registered with GP at Hand, most of these being between the ages of 20 and 39.

When patients register with ‘GP at Hand’ they are ‘de-registered’ from their own surgery and funding is then removed from that surgery. Practices have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand. There is no doubt that ‘GP at Hand’ will destabilise other practices, robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients. Losing registration fees for younger, fitter patients who join ‘GP at Hand’ threatens the model of general practice relied on by so many patients. The scheme is hoovering up the younger, healthier patient and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems. Continuity of care is threatened because you may never see the same GP again when consulting GP at Hand.

In practice, 70% of all patients are reasonably well. Their funding helps surgeries care for the 30% who are sick. It’s a system that works, because it’s fair. We all eventually end up in the 30%.

The service targets the most profitable patients – those who are younger and healthier and don’t need extensive care from their GP. It is unclear if patients are fully advised of the implications of registering with ‘GP at Hand’ and how it can destabilise their previous practice by removing much needed funding.

Jeremy Hunt has said that general practice is the ‘jewel in the crown’ of the NHS. If he truly believes this, he will acknowledge that the ‘GP at Hand’ model threatens the very survival of NHS general practice as we know it and we call on him to abolish it. ‘GP at Hand’ have made it clear they wish to roll out their model of care across the country so this scheme will threaten general practice across England (Wales, Scotland and NI do not have this scheme in place).

Doctors in Unite demand that this aspect of the ‘GP Choice Scheme’ is abolished to ensure the survival of list-based NHS general practice within a defined geographical area. General practice is the cornerstone of the NHS which has provided excellent care with its other community partners for decades.

Signed by Dr Jackie Applebee and colleagues. Full list of signatories below

Doctors in Unite is part of Unite the Union, the largest union in the UK with 1.5 million members. We are committed to an NHS which is publicly funded, publicly provided and publicly accountable.If you are a doctor then join us in Doctors in Unite

Responding to the letter, a GP at Hand spokesperson told Pulse: GP at hand receives the same funding from the NHS as the vast majority of NHS practices do. The cross-subsidy allegation shows a failure to understand the basics of how NHS practices are funded. Capitation funding (the so called ‘global sum’) varies from below £35 per 15-44 man registered with a practice to over £190 for each person over the age of 85. And of course by providing care 24/7 despite only being paid for the core hours of 8am-6.30pm Monday-Friday, GP at hand is supporting the rest of the NHS as well as maintaining continuity of primary care within a single provider no matter what time of day or night.

The reality is that patients and GPs are flocking to GP at hand because they recognise the potential that high quality, digital-first 24/7 NHS GP services bring. The 200 GPs who have already joined Babylon do so because they are treated with respect and not put under the levels of pressure all too common in other practices. 95% of Babylon doctors surveyed say ‘Usually, I can manage the amount of my work well.’ In comparison, the BMA showed in 2016 that 84% of GPs across the NHS reported that workload pressures are either ‘unmanageable’ or ‘excessive’ and having a direct impact on the quality and safety of the care they deliver to patients.

People have the right to choose their NHS practice. GP at hand is an NHS service; paid for by the NHS; providing NHS services to all patients – just like the vast majority of GP practices throughout the UK. In seven months, over 40,000 people living or working in central London have applied to join NHS GP at hand, with more than four out of five people rating our digital appointments giving them the full five stars. The average waiting time for an NHS GP appointment with GP at hand is 38 minutes, compared to waits for routine appointments in traditional practices of a week or more.

Name	Location	Job role
Jackie Applebee	London Borough of Tower Hamlets	GP
Anu Mitra	London	Consultant in Emergency Medicine
Mark Butler	London	Consultant Paediatrician
Pam Wortley	Sunderland	Retired GP
Dr Tim Dowson	Newcastle	General Practitioner
Dr Gillian Breese	North Wales	Salaried GP
David Church	mid-Wales	GP – salaried
Prof Allyson Pollock	Newcastle	Prof of Public Health
Dr Kambiz Boomla	Queen Mary University of London	GP academic
John Puntis	Leeds	Consultant Paediatrician
Beatrice Rogers	Leeds LS16	Secretary Leeds Hospital Alert
Penelope Jarrett	London	GP
Dr Ben Hart	Chrisp Street Health Centre, Tower Hamlets, London E14	gp
Phillip Bennett-Richards	Tower Hamlets	GP
Ian Jackson	Tower Hamlets	Health Partnership Director
JOY FISHER	leeds	retired
Bronwen Holden	Leeds	Retired Social Worker
Wendy Savage	Islington London	Retired eniot Lecturer in Obstetrics and Gynaecology
Dr J Price	e3 2tj	GP
Sian Knight	Lewisham, London	General Practitioner
Jo Downes	Lincolnshire	GP Practice Manager
Emma Ovink	Tower Hamlets	GP
Jim Cole	Chrisp Street Health Centre	GP
Sifot Ali	Bow	GP
Dr Kirti shah	Grove rd surgery E3	Senior partner
Amjad khan	Bedford	General practitioner
Anna Livingstone	Limehouse	General Practitioner
Rodrigo Correa	London	Business Manager
Helen Berry	West Yorkshire	Hospital doctor
Emily Graves	Sunderland	Consultant
Timothy Yu	London	GP
Sally Harrison	Bristol	Salaried GP
Dr John Ward	Bath, UK	GP Registrar
Rozhia Salih	East Midlands	Doctor
Dr Peter Brooke	Norfolk	Paediatric Trainee
Sara Swan	Swansea	GP
Shakeeba Anwar	Ashton under lyne	Salaried GP
David Ritchie	South West	Medical Doctor
Vikram varma	Wrexham	Gp
Dr Vicki Holtby	Worcester	Salaried GP
Stella Johnson	East of England	Doctor
Dr Veronika Wagner	South East England	Registered Medical Practitioner and Unite Workplace Representative
Narin Shareef	London	Core medical trainee
Sebastian Hormaeche	London	Anaesthetist
Dr S Hafeez	London	GP
Rob Molloy	Birmingham	GP
Diana Lauder	Wakefield	Retired Nursing Sister
Anam Ahmed	Sheffield	Junior doctor
Dr Jennie Read	Tower Hamlets	GP
Gwen Adshead	Hampshire	Hospital consultant
Sarah Baines	Lancashire	Nurse, patient
Dr Helen Cranage	Liverpool	GP registrar
Amy jones	England	Emergency Medicine consultant
Tom Wrigley	Cambridge	Gp
Vikki Horton	Portsmouth	HSDU Technician
Sue Horton	Portsmouth	Patient Services Assistant
Christine Hunter	Newquay	GP locum
Sorcha Mackay	Scotland	Specialty Doctor
Sundus Ali	Birmingham	ST1
Monica Carter	Lonfon	Retired GP, volunteer doctor Freedom from Torture
Jeanne Lintonbon	London	Doctor
Hilary Kinsler	London	Old Age Psychiatrist
Matthew ryan	Cardiff	Doctor
Sian Ashby	Herne Hill	General Practice
Peter English	Surrey	Public Health Physician
Rebecca Mullen	Tunbridge wells	Doctor
Isobel Leckie	Norwich	Bssw
B Bhimarasetty	Birmingham	Gpst3
Lindsey Kent	Salford	Fy2 academic trainee
Dr. Tiago Ivo	Canterbury	Doctor
Krishnaveni Padala	Preston uk	Sho
Alan Courtney	England	Doctor
Dr Christopher Butler	Shipley, West Yorkshire	Retired GP
Simon Lawrance-Owen	Gloucester	GP Trainee
Anisha Antony	Sheffield	GP
Hannah Woodcock	West Suffolk	Junior Doctor
Dr Julian Bashforth	Hampshire	GP
Raina nazar	Sutton Coldfield	GP
Naomi Beer	Tower Hamlets	GP
Caroline Worsley	Sheffield	Doctor
Andy Atkins	Leeds	Retired
Caroline Cocking	Derbyshire	Registered nurse
David Topliss	Oxfordshire	Consultant
Jennifer Barclay	Salford	Foundation Year 2 Doctor
Jeanne Jackson	Greenwich, SE3	RETIRED
Martin Seager	Saffron Walden	Clinical Psychologist
Dr Robert Morley	Birmingham	Local Medical Committee Secro
Judith Kelly	Birmingham	Biomedical Scientist
Hannah Robinson	Cornwall	Occupational therapist
Kathryn McAdam Freud	Southwark	GP principal and trainer
Rebecca Leslie	Dundee	Paediatric Consultant
Mary Church	Bothwell	GP
Kathryn McAdam Freud	Southwark	GP partner and trainer
Sue Butters	Norwich, Norfolk	clinical research nurse
Maureen Huddleston	Lancaster England	Nurse
Dr Stefan Lipinski	SE London	Gp partner
Phillip Welldrake	Stockport	retired
Edoardo Cervoni	Southport	GP
Diana Lauder	Wakefield	Retired Nurse
Beverly Fernado	Tower Hamlets	Practice Manager
Hina Din	Newham	Practice Manager
Nitin Shori	Wales	GP Partner
Dr Prakash Kachhala	Nottingham	GP Partner
Siobhan Stapleton	Greenford	GP
Karen Haworth’s	Medway, Keny	GP
Dr Helen Lever	East Midlands	GP
Ruth Marchant	london	GP
James Morgan	Caerphilly	GP practice manager
Preethi Perera	Surrey	GP
Kerry Sneddon	Glasgow	Gp
Siobhan gillespie	Devon	Gp
Sarah Johns	Nottingham	GP Partner
Jaspal Taggar	Nottingham	Associate Professor and GP
Judith Bull	Abbots Bromley	Senior Partner
Sarwat shah	London	Locum consultant
Emma Willert	Sale, Cheshire	GP
Julie Boissonade	Cornwall	GP
Adele Parsons	Lincoln	Advanced Nurse Practitioner
Dr Tamsin	Cirencester	Gp
Michelle Teo	London	Doctor
Sarah Sanaghan	Glasgow	GP
Dr Ben Bromilow	London	GP Partner
Rob Gardiner	cambridgeshire	nurse practitioner
James Crane	London	Clinical Research Fellow, Obesity
Hugo Farne	London	Registrar in Respiratory Medicine
Amit Shukla	Lincoln	Consultant Surgeon
Andrea English	West yorkshire	Advanced nurse practitioner
Karam Sarsam	South London	Doctor
Dr Tejumola Olaoye	Birmingham	ST4 O&G
John Hewertson	East Midlands	Consultant Paediatricians
Heather Mycock	Winchester	Retired GP
Mary Valentine	Royal Wootton Bassett	GP