Cherry-picking patients for smartphone GP service threatens NHS, doctors warn

Pressure on existing GP practices will increase if an NHS service offering video consultations 'within minutes' to Londoners is allowed to exclude patients with complex needs, GP leaders have warned.

Professor Helen Stokes-Lampard: concerns over video consultation scheme (Photo: Pete Hill)

Patients in London - and the service will soon extend across the country - are being invited to switch from their existing GP practices to register with the new GP at Hand service. GP at Hand is offering patients video consultations via smartphones or computers 'typically in under two hours of booking' and face-to-face appointments at 'convenient city-centre locations' within 48 hours.

But although NHS rules bar traditional GP practices from refusing to register patients based on factors including their age, disabilities or medical conditions, the GP at Hand service will be able to reject patients who fall into any of the following groups:

  • Women who are or may be pregnant
  • Adults with a safeguarding need
  • People living with complex mental health conditions
  • People with complex physical, psychological and social needs
  • People living with dementia
  • Older people with conditions related to frailty
  • People requiring end of life care
  • Parents of children who are on the ‘Child at risk’ protection register
  • People with learning difficulties
  • People with drug dependence.

Read more: How does GP at Hand work?

NHS England says the service - developed by a west London GP practice in conjunction with private health technology provider Babylon Health - operates under the practice's existing GMS contract, and offers services to patients outside its boundary just like any other service for out-of-area patients.

It says the NHS has carried out 'a clinical review of the new service model and will continue to closely monitor and evaluate this initiative over the coming weeks and months'.

But GP leaders have reacted angrily to the new service, warning that it risks creating a two-tier NHS and that existing practices could be undermined if patients transfer to the new service.

GPC chair Dr Richard Vautrey said: 'While these proposals appear to be focused on making access to a GP easier, in reality it will divert patients away from their GP and practice and leaves them receiving care from doctors who don't know them as well as their own GP would do.

'This approach risks undermining the quality and continuity of care and further fragmenting the service provided to the public. It is also delivered by a private company that is primarily cherry picking younger, generally healthier people and excluding many others. It will do nothing to help the growing number of older, vulnerable patients who need well funded services that can provide the specialist care they need in the community.'

Two-tier NHS

Londonwide LMCs chief executive Dr Michelle Drage told GPonline: 'We have a number of serious concerns and questions that need to be answered. Who is ultimately responsible for NHS England commissioning the service?

'What evidence from pilots has been published in recognised journals to suggest it was of greater benefit than similarly resourced general practice to patients and to GP practices serving their current registered populations?

'How is this not promoting cherry picking of comparatively healthy patients ahead of those with complex needs, when both are assigned the same level of funding while local general practices are forbidden from doing so?'

Dr Drage also questioned the potential impact on continuity of care from patients being invited to register with a new provider, on the understanding that they would be 'told to de-register if their medical needs increase to the point where they can only be effectively served by a local general practice'.

RCGP chair Professor Helen Stokes-Lampard said: 'Some patients will see this as a "golden ticket" to get quick and easy access to a GP - and for younger, healthier commuters it could prove a solution to long waiting times for an appointment.

Pressure on GPs

'Technology can achieve wonderful things when used properly, but we are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being cherry-picked, which could actually increase the pressures on traditional GPs based in the community.

'We understand that with increasingly long waiting times to see a GP, an online service is convenient and appealing, but older patients and those living with more complex needs want continuity of care and the security of their local practice where their GPs know them.'

The RCGP chair pointed to the 'extensive list of patient conditions' that are 'the essence of general practice and which GPs deal with every day, but which are not eligible for this service'.

She added that although the service was operating within the NHS, it would divert part of the already-threadbare GP workforce away from frontline services 'at a time when we are facing a severe workforce crisis'.

However, GPs involved in the scheme are convinced it offers a solution to patients' current frustrations with general practice. Dr. Mobasher Butt, a partner in the GP at Hand service, said: 'We do everything from grocery shopping to our banking online yet when it comes to our health, it can still take weeks to see a doctor and often means taking time off work for an appointment.

'With the NHS making use of this technology, we can put patients in front of a GP within minutes on their phone, so the days of ringing frantically at 8am for an appointment should be long gone. This new NHS service makes it easier for patients to see a doctor quickly at anytime and from anywhere and doesn’t cost the NHS a penny more. It’s a win win.'

An NHS England spokeswoman said: 'This particular GP practice has developed this patient offer which is included as part of their existing standard GMS service for their registered patients. The practice is subject to all the data protection and information security rules applicable to any NHS practice.'

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