In its response to NHS England's consultation on digital-first primary care, the union said that the best way to resolve the problems created by Babylon GP at Hand was to 'separate the service from the registered patient and instead link it to NHS 111'.
‘Patients are clearly using GP at Hand in the same way they would NHS 111,’ the BMA said. ‘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.’
The BMA said GP at Hand had 'exploited' the patient choice scheme and out-of-area regulations and caused ‘considerable difficulties’ for neighbouring practices and Hammersmith and Fulham CCG, which hosts the service.
It acknowledged that NHS England was attempting to resolve these problems with its consultation, but said the only solution was to 'properly fund and enable' every GP practice to provide digital access and prevent GP at Hand from registering patients.
However, Babylon GP at Hand said that the BMA was 'out of touch' and comparing 'completely different services'.
A Bablyon GP at Hand spokesperson said the service was '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.'
The spokesperson added: 'Despite being paid to provide care in core hours of the working week, the Babylon GP at Hand service is available 24 hours a day, every day of the year. The NHS Long-Term Plan has called for new ways to tackle the problems being faced by patients trying to access a doctor, and Babylon is focused on doing just that. We want to work with the NHS for the benefit of all patients.'
As part of its consultation NHS England has suggested that the out-of-area rules should change so that when a provider exceeds a threshold of between 1,000 and 2,000 patients in any CCG they would automatically be awarded an APMS contract and have to set up a physical presence in the area.
The new practice - whose local patient list would be split from the main provider - would then have to join a local primary care network under existing rules set out in the five-year GP contract agreement.
Babylon GP at Hand has used the rules that allow practices to register out-of-area patients to attract large numbers of predominantly young patients who live across a wide geographical area. Latest official figures show that it is now the fifth largest practice in England and 85% of its patient list is aged between 20 and 39.
In its consultation response, the BMA said that NHS England's proposals would create a more complex system that would be difficult for CCGs to manage and have significant workload and cost implications.
It argued that the out-of-area regulations should be withdrawn and said that by reforming them NHS England was avoiding responsibility 'for investing in all practices to achieve a fair and consistent digital-first offer to patients.'
NHS England has already ruled out scrapping the rules because this would restrict patient choice. The BMA said that if the arrangements remained in place, providers should no longer be allowed to refuse to register out-of-area patients on the grounds of medical conditions. Providers should also be obliged to carry out a home visit whenever necessary, the BMA said – at present they are not required to do this for out-of-area patients.
Tackling health inequalities
NHS England is also considering whether to restrict the expansion of digital-first providers to areas of high need. It has suggested that this could be a way of tackling workforce shortages in underdoctored areas.
However, the BMA said the proposal was 'unlikely' to address the inverse care law and would make health inequalities worse. It argued that existing GP practices should be supported to provide services in these areas instead.
GPC chair Dr Richard Vautrey told GPonline earlier this year that the idea would short change patients and create a two-tier service, where those in deprived areas lose out on face-to-face consultations when they were more likely to experience complex problems.
NHS England has also proposed to change the new patient premium – which sees practices paid an additional amount for new patients registered with them during the first year after they sign up – so that it is only paid if a patient remains registered with a practice for a defined period.
The BMA said that this change should only be applied to out-of-area patients, otherwise it would disadvantage practices in areas with a high patient turnover, such as those with care homes on their list.
NHS England's consultation closes on 23 August. Full details are here.