The south-west London GP practice that hosts the controversial GP at Hand service - run by private provider Babylon - was inspected in November 2017 and rated 'good' in a report published in March 2018.
Practices rated 'good' or 'outstanding' by the CQC can be allowed up to five years before facing a repeat inspection - but the CQC has confirmed that changes in list size are among factors that can bring a repeat inspection forward. Signs that services may have significantly deteriorated or improved, as well as feedback from patients or health officials can also trigger a fresh visit from inspectors.
The March inspection report, meanwhile, makes clear that 'the digital element of service provision was not inspected'. The inspection took place when GP at Hand had only recently opened up to out-of-area patient registrations - a move that has seen its list size grow from around 5,000 patients at the start of November 2017 to more than 30,000 now.
The March CQC report acknowledges that the service had only recently ‘substantially changed its model of care’ to allow out-of-area patients to register for a service ‘whereby their first contact is online’, resulting in an ‘additional list’ of 7,500 patients on top of the 2,500 it served locally.
In addition to the rapid change in list size, the profile of the practice has changed significantly, with the vast majority of new patients registered aged between 20 and 39 years old. The registration of predominantly young patients has led to accusations of 'cherry picking'.
The GPC has warned that the CQC must pay close attention to emerging models of primary care provision to ensure patient safety. Meanwhile, RCGP chair Professor Helen Stokes-Lampard hit out at tech providers 'siphoning off' young patients at the college's annual conference last month.
GPC chair Dr Richard Vautrey said: ‘Rapid changes in a practice are likely to lead to CQC reviewing that practice, and it is particularly important for the regulator to pay more close attention when the model of care delivery is still developing and under evaluation. It's vital that all patients have confidence that the care they receive is safe and effective.’
A CQC spokeswoman said: ‘We do not discuss the potential timings of inspection but it is linked to a range of indicators, one of which is changes in the size of the provider’s list both up and down.’
She said there was no specific level of increase or decrease in list size that would trigger a reinspection, and that list sizes are also considered alongside ‘other factors’ such as clinical indicators, feedback from patients or the public and information from NHS England.
The CQC was also aware that GP at Hand was planning to increase its list size as part of its business plan, the spokeswoman said.
Last week, CQC chief inspector for general practice Professor Steve Field said the watchdog would be ‘looking at the surgeries that might be impacted’ by online providers including GP at Hand.
New care models
His comments came after House of Commons health and social care select committee chair and former GP Dr Sarah Wollaston highlighted concerns that ‘rapidly emerging’ online consulting systems ‘like Babylon and GP at Hand’ may ‘have a destabilising effect on the wider system’.
Professor Field told the committee: ‘I support the introduction of these alternative methods of consulting because it could save time for clinicians and certainly will save time for patients who want to use those services,’ he said. ‘But they do have to be safe and effective just like traditional face-to-face consulting.’
Health and social care secretary Matt Hancock has been criticised for endorsing a national rollout of GP at Hand, which he said should made ‘available to all, not based on postcode’.
Mr Hancock said last month that the GP funding model would have to change to accomodate emerging services such as GP at Hand.