Board papers for Hammersmith and Fulham CCG highlight a risk that 'the list size growth associated with the GP at Hand practice is not accommodated within the CCG's core and primary care allocations for 2018/19, creating significant cost pressures resulting in the CCG failing to meet its statutory requirement to deliver financial balance'.
The Lillie Road Medical Centre, where patients register to use the GP at Hand service, has seen its list size grow from 2,500 in April 2017 to 24,652 on 1 March 2018.
The board papers warn that to date 75% of these new patients have been from patients who live outside north-west London. The CCG says the huge influx of patients to the service has driven up its total registered population by around 10% in just 5 months.
The CCG warns that the growth of the GP at Hand service could 'destabilise other GP practices', with the greatest risk in the local area, but also 'regional and national risks' if the model rolls out beyond its current scope.
Board papers confirm that a bid from GP at Hand to widen the existing 'sub-contracting arrangement' that allows it to provide services from multiple sites has been rejected by Hammersmith and Fulham CCG on the grounds that it did 'not have control' of four further sites it planned to expand into across north and east London.
CCG documents suggest it could yet reverse this decision if GP at Hand 'subsequently confirmed they held a lease, license, agreement to lease or other agreement for the premises'.
However, GPonline reported last month that senior figures behind GP at Hand believe 'vested interests' are blocking expansion of the service, after north London CCGs did not approve its bid to occupy vacant space in health centres.
GP at Hand growth
A spokeswoman for the North London CCGs group said last month: 'Firstly, as with any provider of primary care services, we would need to work with GP at Hand on issues such as equity of access, quality, clinical governance, and potential impact on local general practice stability. Secondly, we need to understand how their service fits with our own digital plans to expand access to local primary care.
'Also, potential hub venues would need consideration alongside our existing plans to house services transferring from secondary care in unused primary care space. Importantly, we are confident our patients have good access to flexible local GP services, with appointments from 8am to 8pm, seven days a week that can be booked same day, telephone appointments and online booking.'
Since November 2017, when GP at Hand was opened up to NHS patients living in a broad area of London or working in any of the three central London travel zones, the practice's list size has grown by almost 20,000 from 4,970 - with 85% of new registrations for patients aged between 20 and 39 years old.
If the patient population using GP at Hand stabilises at its current level, the CCG estimates that its total primary care and acute costs will rise by £5.4m in 2018/19. If the service grows at the average rate of 4,000 patients a month seen since November 2017, the CCG believes it could face extra costs of £10.6m in 2018/19.
Latest data from NHS Digital suggest the picture could be even worse. GPonline reported earlier this month that more than 5,500 patients joined the service in the month to 1 March - the fastest one-month increase since the month to 1 December 2017.
Hammersmith and Fulham CCG is currently advertising a £250,000 contract for a 12-month 'independent evaluation' of the GP at Hand service.
The CCG is 'exploring options to enable in-year adjustments to its allocation' in talks with NHS England's London office.
A spokesman for Babylon, the company that provides the technology behind the GP at Hand service, said: 'What has happened is that a different CCG is now paying for patient care. Historically, when patients - who are now with GP at Hand - were registered at their previous practice, the CCG responsible for that practice would have borne the costs of the NHS care. Now the costs fall to Hammersmith and Fulham CCG.'