GPonline reported last month that GP at Hand's list of more than 60,000 patients - all currently registered with a single west London host practice - would be broken up into more than a dozen separate contracts, potentially from April 2020.
The shift will be pushed through under NHS England plans to award digital-first providers a separate APMS contract and force them to set up physical premises in any CCG area from which they have recruited more than 1,000 patients.
But the move could have wider implications for the controversial provider, as well as for PCNs in its host Hammersmith and Fulham CCG and those in each area where it wins a contract.
Board papers published by Hammersmith and Fulham CCG reveal that as patients are disaggregated from the current unified GP at Hand patient list, its remaining patient population may fall below the 30,000-patient minimum size for a typical PCN.
The board papers highlight the 'disaggregation of patient lists and creation of new APMS contracts when a provider registers over 1,000 out-of-area patients in another CCG area' as the factor likely to have the most significant impact for Hammersmith and Fulham CCG.
They add: 'Currently there are 18 other CCGs each with over 1,000 residents registered to Babylon GP at Hand. In total this equates to around 46,000 patients. If this level of registered patients is disaggregated away from Hammersmith and Fulham, the Babylon GP at Hand PCN will have a registered list of fewer than 30,000, which is below the NHS England stipulated list size for a PCN.
'This could lead to a reconfiguration of the current H&F PCNs, which inevitably would have a significant impact on the new and evolving Hammersmith and Fulham PCNs.'
BMA leaders and Londonwide LMCs opposed the decision - announced in May this year - to allow GP at Hand to set up a standalone PCN. They warned that the move did not fit with plans for PCNs to drive integration of care around local populations because GP at Hand's population was drawn from a wide geographical area.
The BMA has also opposed plans to award GP at Hand multiple APMS deals and warned that practices that were just beginning to work together through local networks would 'not welcome' having to work with these new practices.
The BMA has called for NHS England to 'commit to, fund and deliver the necessary IT equipment and infrastructure' to allow all existing practices to develop their digital offering.
Responding to NHS England's digital first proposals last month, Babylon GP at Hand called the plans 'a vote of confidence in the unparalleled access to high quality primary care that Babylon GP at Hand brings'.
A spokesperson for the provider added: 'We will continue to expand our digital and in-person services, having already added three new clinics this year in addition to our usual 24/7/365 digital access to GPs within minutes. We are already looking at a number of new sites and will soon open even more.'
GPonline revealed last month that Babylon GP at Hand is aiming to expand to Manchester from early next year, adding to its existing London- and Birmingham-based services.