Board papers discussed on Tuesday by the primary care commissioning committee of Hammersmith and Fulham CCG - which covers the practice that hosts GP at Hand - show that NHS England had highlighted concerns around screening and referrals in advice to the CCG.
GP at Hand has hit out at the refusal to allow its expansion to Birmingham, arguing that NHS commissioners had been informed months ago of its wish to extend the service but had failed in that time to come up with a solution to allow access to local screening and other services.
A spokesperson for Hammersmith and Fulham CCG said after the board meeting: 'The clinical advice received from NHS England (London) medical directorate is that whilst further assurance has been received on the areas outlined in the July committee meeting, there continue to be outstanding concerns regarding access to clinical pathways and arrangements for GP at Hand patients accessing screening services.
'It is therefore not reasonable to lift the objection until a safe and sustainable solution is in place.'
Because national screening services such as mammography 'can only currently be accessed via the patient’s GP referring them to local services', it was unclear whether GP at Hand patients in Birmingham would be able to access screening services in their local area, the CCG warned.
The CCG spokesperson added: 'Similarly, the committee wanted clarity on how referrals to local services in Birmingham, such as community mental health services, would work in practice. For these reasons, the committee’s objection remains in place at this stage.'
A spokesman for GP at Hand told GPonline: 'Commissioners have known for more than nine months of the proposed national expansion of GP at Hand. The NHS has not been able to put in place the screening arrangements that enable this.
Pressure on GPs
'As a result, the choice of GP practice promised by the NHS to people across the country is being held back and the opportunity to reduce pressure on primary care and A&Es is being missed. We hope this issue will be resolved without further delay so that safe, effective and extremely convenient primary care can become a reality for anyone who chooses it.'
The number of patients registered with the Fulham practice that offers the GP at Hand service has now risen to more than 31,000, with thousands of younger patients leaving existing practices to switch to the service. In November 2017 the Lillie Road Medical Centre had just under 5,000 registered patients.