GP at Hand set for expansion to Manchester in early 2020

Babylon GP at Hand plans to expand to Manchester from early next year in a move that would give the digital-first provider a foothold in NHS primary care in England's three largest cities.

Digital-first service (Photo: Towfiqu-Photography/Getty Images)

The provider told GPonline that it expects to give formal notification this month to commissioners of plans to open a Manchester clinic - and that it aims to open the facility before the end of the current financial year.

Managing director of NHS services at Babylon Paul Bate confirmed that 'a number of other conversations are going on' over potential future expansion to other areas - and suggested the service would not only target major cities.

GP leaders said the provider's latest expansion plan would leave practices in Manchester concerned over its 'potentially destabilising impact' - and called for urgent investment to improve technology within existing practices rather than a focus on digital-first providers.

Digital-first GP service

Plans to expand the service to Manchester come just months after it began recruiting patients in Birmingham. GP at Hand - an NHS service run by private provider Babylon that offers GP appointments primarily via video consultation - now has more than 60,000 registered NHS patients, the vast majority of them living or working in London.

Managing director of NHS services at Babylon Paul Bate said informal discussions had taken place already with commissioners in Manchester. A potential site for the new clinic has been located, he confirmed, and the formal process of notifying commissioners of the expansion plan will begin later this month.

He said the provider would shortly notify Hammersmith and Fulham CCG - which hosts the service because GP at Hand's patient list was built up under a subcontracting arrangement through a small practice in west London - formally of the proposal.

Patients registering in Manchester would - along with those in Birmingham - be added initially to a single patient list for GP at Hand held in Hammersmith and Fulham CCG.

APMS contracts

However, under revamped rules for digital-first services set to take effect from April 2020, the list will be split up into multiple separate contracts. The new rules will see providers awarded a new APMS contract and potentially forced to open physical premises in any CCG area from which they recruit more than 1,000 patients.

Mr Bate said the service hoped to complete the expansion during the current financial year, but added that 'mobilising safely' was the first priority.

Plans to develop digital first services set out last month by NHS England said expansion of digital-first services would be focused on areas of greatest need, with low numbers of doctors per patient.

Mr Bate said Manchester had significant areas of deprivation, and argued that an accessible digital-first service would be welcomed.


Although patients attracted to date by GP at Hand have been predominantly young, relatively well-off patients, he said the service would aim to serve deprived populations in Manchester.

Asked how, he said: 'First make sure your clinic is in an accessible location for everyone - that’s why it will be in central Manchester. Make sure services are always available - 24/7, which is rare for the NHS - and let people know about the service.'

He said that people who had registered with GP at Hand to date were not universally young or healthy - and that some had complex care needs that the service was able to manage.

He added: 'I think [the GP at Hand model] does work across all the different geographies in the NHS and around the country. Wherever people are looking for a service that is digital first we will be looking to provide it.'

NHS impact

BMA GP committee chair Dr Richard Vautrey said: 'Practices in Manchester will be concerned about this proposed extension and the potential destabilising impact it could have.

'Cherry-picking largely healthier and wealthier patients at the expense of the poor and vulnerable is not what the NHS is about nor should be supporting.

'Practices want to be able to offer a full range of services to their patients, including where clinically appropriate digital services and video consultations, but they are dependent on CCGs and NHS England enabling this. There is therefore an urgent need to upgrade practice IT and this should be the priority, not focusing on alternative providers.'

A spokesperson from Manchester Health and Care Commissioning said: ‘This week, we were informed by Babylon Health that they intend to begin operating in Manchester from early 2020. Whenever any new provider of health and care services plans to come into the city, our priority is to ensure that their services are high quality, meet the needs of local people, and contribute to the financial and clinical sustainability of the health and care system in the city.

'We will consider Babylon Health’s proposal within this context and expect to have further discussions with them, and health and care colleagues across the city, over forthcoming weeks.'

A spokesperson for Hammersmith and Fulham CCG said GP at Hand 'has not made a formal application for a subcontract variation' and that any application would be considered in due course.

GP at Hand is currently subject to a 2,600-patient cap on registration in the Birmingham and Solihull area. The cap - imposed in June for an initial three-month period - was extended in September because an IT solution required to improve access to local clinical pathways and screening had not been finalised.

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