GPs raise alarm over CQC failure to report on fast-growing GP at Hand

GP at Hand's controversial video consultation service has never been reported on by the CQC despite signing up more than 45,000 NHS patients and preparing to expand to a second major city - sparking calls from GPs for urgent checks.

The RCGP, along with GP leaders in London and Birmingham, have called for a fresh CQC report on Babylon GP at Hand 'as a matter of urgency', warning that all providers must operate on a level playing field to ensure patient safety.

The west London GP practice that hosts GP at Hand was inspected in November 2017 and subsequently rated ‘good’. However, the CQC made clear in a report published last year that ‘the digital element of service provision was not inspected’ because the visit took place soon after it was implemented and just after registration was opened up to out-of-area patients.

However, more than a year later - with more than 45,000 NHS patients who live and work in London signed up and plans for expansion to Birmingham approved - the CQC has yet to publish a report or rating of the digital-first video consultation service.

GP at Hand

The CQC has confirmed after repeated requests from GPonline that the Babylon GP at Hand service was reinspected in January 2019 - but no date has been set for publication of a report or new rating of the service.

RCGP chair Professor Helen Stokes-Lampard told GPonline: ‘Any service offering GP services to patients should be held up to the same high standards as any other, and if following scheduled inspection, the circumstances that a service is working under change dramatically, then it makes sense they are proportionately re-inspected so that the public has confidence in the validity of the rating.’

The CQC says rapid changes to a service - such as those seen by GP at Hand - can trigger a re-inspection.

Birmingham LMC executive secretary Dr Robert Morley said he was 'astonished' that the CQC had yet to update its report on the service despite a near ten-fold increase in its patient list over 15 months, and described GP at Hand’s planned expansion to England’s second-largest city as 'very concerning'.

CQC inspection

'With the unbelievably rapid list expansion and the novel arrangement in terms of subcontracting and the digital service, I am astonished,’ Dr Morley told GPonline.

He added that it was 'unfathomable' that plans for the service to expand beyond London had been rubber-stamped before the publication of a report on the impact of the service on patients and the wider health service.

The report, commissioned from Ipsos Mori by London NHS leaders, is expected to be completed this month - but the market research firm confirmed in December that its final evaluation would ‘not include a comprehensive assessment of the safety and effectiveness of the Babylon symptom checker (‘Artificial Intelligence’ triage tool)’.

Dr Morley said: ‘You have to ask if the health and social care secretary's support of Babylon might’ve influenced local commissioning decisions.'

Birmingham expansion

Meanwhile, Londonwide LMCs confirmed that it ‘shared concerns’ over the fact that Babylon’s technology ‘has yet to be properly evaluated’.

Londonwide LMCs chief executive Dr Michelle Drage said: ‘There is an urgent need for robust and independent evidence on the clinical effectiveness of this technology and the absence of that from the pending independent evaluation is disappointing. Any proprietary technology which exists to financially benefit a commercial company should have independent, peer reviewed research funded by that company. The NHS should not be left to pick up the bill.’

GP at Hand has attracted predominantly young patients to date, resulting in accusations of ‘cherry picking’ from some of the UK's top GPs. Now, Dr Morley says he is worried that the same could happen in Birmingham, potentially destabilising practices with younger populations, such as university practices.

Professor Stokes-Lampard added: ‘It is difficult to see how a practice based in London will be able to deliver meaningful population-based care to patients who live in Birmingham. The expansion appears to undermine the efforts to improve place-based care that are stated in the NHS long-term plan.

‘Technology has the potential to transform the NHS, and support GPs to be more effective but it must be implemented in an equitable way that benefits all patients and that is not to the detriment of the general practice service as a whole.’

NHS England officials are now working with NHS Hammersmith and Fulham CCG - which hosts the service in London - and Birmingham and Solihull CCG to agree a date for GP at Hand’s expansion.

A Babylon GP at Hand spokesperson said: 'Babylon GP at Hand is very happy to be inspected by the CQC whenever they wish and we are inspected regularly, just like any provider. We are proud of our services and are ready to demonstrate why.'

* This story was updated on 15 March because the CQC confirmed only after publication that its inspectors had carried out a visit to Babylon GP at Hand in January. Previously it had said only that it could not comment on plans to inspect individual providers. Our original headline was 'GPs raise alarm over CQC failure to inspect fast-growing GP at Hand'

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