GP at Hand cherry-picking is undermining practices, warns London's top GP

Online service GP at Hand's ability to 'cherry-pick' the patients on its list risks undermining general practice in the capital, London's top GP has warned.

Dr Michelle Drage, chief executive of Londonwide LMCs, said there was ‘massive anxiety’ among GPs in London about how the new service would affect practices, adding that the way it had been rolled out ‘demeaned’ those already working in general practice.

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‘My real angst about GP at Hand is what they’re offering. I think there’s a risk that it’s perceived as general practice which I don’t think it is – it’s symptom sorting,’ Dr Drage said.

‘The business model is built on taking money out of a fixed resource for everyone and shunting it towards a resource which is aimed at a certain group of people, whose needs are probably less, which is not what the NHS was set up to do.

‘It is a threat to other practices because when it hits a certain scale each practice has less money to spare on those with the greater need. And that to my mind isn’t right.’

Dr Drage said that there was an idea that because GP at Hand ‘was disruptive it must be good.’

‘But the way it’s been landed, this disruptive, innovation approach, it demeans the people providing the existing service,’ she said. ‘It makes you think that you’re not good enough. It makes you think that you’re luddites and resistant to change.

‘I don’t think GPs are resistant to change, I think they are very careful about change because they’re so involved with the nitty-gritty of patient care and holistic care that it’s too precious to meddle with until there’s evidence to show that it’s good.’

GP at Hand

GP at Hand was set up by private online consultation service Babylon in partnership with west London GP practice the Lillie Road Health Centre. NHS patients living in west London or working in zones 1-3 in the capital can switch from their existing practice and register with the service. Once registered, patients can book appointments through an app, and have a video consultation on their phone or computer 'typically in under two hours of booking'.

Figures released today show that since GP at Hand was opened to the whole of London in November 2017, 21,545 patients have joined the service, with 2,518 additional patients joining in the month to 1 May 2018. GP at Hand has plans to expand the service around the UK.

GP at Hand has sparked fears of ‘cherry-picking’ because certain patients, such as older people with frailty, people with dementia, those with learning difficulties or complex mental health issues and pregnant women, are unable to register.

The service was set up under the out-of-area registration scheme, which enables practices to decide which patients from outside their immediate area they are prepared to register. The scheme also means that practices are not required to provide home visits to these patients.

GP recruitment

Dr Drage said there was a place for new technologies in general practice but new ways of working needed to be ‘properly measured and piloted’ before being introduced, which had not happened in the case of GP at Hand.

She also raised concerns that the rapid expansion of GP at Hand could make it even more difficult for practices in the capital to recruit GPs.

‘Babylon are offering GPs jobs to work in both its private and NHS arms at substantial salaries for the work they’re doing. So there’s another issue around recruitment and retention that you’d think the NHS would be concerned about. Meanwhile our practices are running with at least one doctor vacancy for 18 months,’ she said.

Last month GP campaigners urged health secretary Jeremy Hunt to pull the plug on GP at Hand by scrapping the out-of-area registration scheme. Meanwhile Hammersmith and Fulham CCG in west London, which is where the Lillie Road Health Centre is based, has revealed that the influx of patients to the service means it needs an £18m bailout from NHS England to cover its increased costs.


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