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Field: CQC to review impact of GP at Hand on other practices

The CQC is going to be looking at whether Babylon’s ‘GP at Hand’ app has destabilised other GP practices, and its impact on the overall quality of care, the outgoing chief inspector of primary care told MPs today. 

Professor Steve Field told the House of Commons Health Committee this afternoon that GP at Hand was ‘potentially having an effect on patients in their locality’, after it partnered with a GP practice in Fulham to offer its video consultations to NHS patients. 

The BMA, Londonwide LMCs and the RCGP have expressed concerns about the impact of GP at Hand’s entry to London, after it rapidly signed up over 30,000 patients via the out-of-area registration scheme since launching last November.

They have criticised GP at Hand for ‘cherry picking’ patients as it advises certain patients – including pregnant women and patients with learning difficulties – to ‘discuss’ whether it may be ‘appropriate’ to register with ‘a practice closer to home’. Babylon says it was advised to do so by NHS England.

Dr Sarah Wollaston, who is the committee chair and a former GP, asked Professor Field whether he was concerned that online providers of general practice were ‘having a destabilising effect on the wider system’.

She had started the questioning by referring both to unregulated health apps and ‘services like Babylon and GP at Hand’.

Professor Field responded: ‘The problem we have as CQC, is we are an independent and strong regulator, but we do not do the commissioning, have no responsiblity for the commissioning and the contracting. 

‘So we are observers of services that perhaps had started recently in London – if you are alluding to the impact on other patients there – so we can observe that, and we will actually be looking at the surgeries that might be impacted on the quality of care they provide.’

But he added that although there was one ‘high-profile case at the moment which might be having an effect on patients in their locality’, there were many other GP practices elsewhere in England that are also providing online consultations.

‘There are other things happening at the same time, and that really is a question I think you should ask, with respect, NHS England, as the overarching body,’ he said.

Professor Field said that on the whole he was ‘optimistic’ regarding online providers of general practice, which he suggested ‘could save time for clinicians, and certainly will save time for patients’.

His comments come as the CQC’s first round of inspections of 35 online GP providers in 2016 and 2017 found problems at 30, including cases of high opiate prescribing.

Although a report from March this year found 43% of online prescribers were still unsafe, Professor Field said the sector was now ‘improving’, suggesting that the worst culprits had already shut up shop, as a result of the CQC’s intervention.

He said: ‘We had a big impact, especially in this area. We will not tolerate providers who provide very unsafe services.’

And he added: ‘We know that those providers can provide safe, effective care because many do. And even more do now that we have intervened. So I am an optimist about this.

‘I think it can improve access and add to the variety of care that patients can get but it’s about access to the medical record, it is about communication, it is making sure things are safe.’

During the hearing, Dr Wollaston said she was especially interested in hearing about the CQC’s thoughts on online providers of general practice due to the ‘focus’ on these by health secretary Matt Hancock.

Mr Hancock recently responded to GP criticism of his endorsement of Babylon’s GP at Hand app, saying it does not differ to other GP practices who are also ‘private’. 

The RCGP wrote to Mr Hancock to complain after he spoke out to back a national rollout of the app last month.