Labour MP for Hammersmith Andrew Slaughter, in whose constituency the online consultation service is based, told parliament this week he had become ‘increasingly alarmed’ over the growth of GP at Hand.
In a Commons debate Mr Slaughter cited concerns about 'cherry picking' of young patients, the rapid expansion of GP at Hand, public support for the service from health secretary Matt Hancock, and questioned the accuracy of diagnostics by the GP at Hand app.
The MP demanded a commitment from the government that Hammersmith and Fulham CCG, which hosts GP at Hand, would be reimbursed for additional costs related to the service that have left a multi-million pound gap in its funding. But health minister Seema Kennedy said the government 'cannot give that reassurance'.
Mr Slaughter told MPs: ‘The NHS is jumping to the tune that is being played by GP at Hand. One might suggest that it should be the other way around.’
GP at Hand investigation
The Hammersmith MP told the Commons he had written - with support from ‘a number of colleagues’ - to health and social care committee chair and former GP Dr Sarah Wollaston, ‘asking the committee to undertake an investigation into GP at Hand'. He said: ‘I know that [Dr Wollaston] shares a lot of my concerns, so I am hopeful that that investigation will follow.'
GP at Hand has been a contentious issue within the NHS since it began registering out-of-area patients in November 2017 - a move that has seen its host practice's list size rise from around 4,000 to nearly 50,000.
Mr Slaughter highlighted the 'distortion' created by the rapid movement of patients, and an estimated £26m funding shortfall for Hammersmith and Fulham CCG.
The Hammersmith MP warned that the large numbers of young patients switching to GP at Hand was creating problems for other GP practices. 'A digital app of this kind attracts a certain type of patient: younger, fitter patients,' he argued. 'Effectively those without complex medical conditions or co-morbidities. They do not take up a lot of the GP’s time, as their issues are relatively simple and straightforward to deal with. Often they do not contact the GP at all for long periods.
'Those patients effectively subsidise older and sicker patients. There is a perfectly understandable resistance from local GPs and CCGs to allowing those patients to escape, leaving them only with the most demanding and least cost-effective patients.'
GP at Hand has denied cherry picking patients, although the vast majority of those who have signed up are aged between 20 and 39 years old.
Mr Slaughter also raised questions about the safety of an app used by GP at Hand patients. He said: ‘Has it been sufficiently tested? Is it not a question of it perhaps being tested in a small area and got absolutely right before it moves on. It could be across the entire country in a year or two.’
Top GPs 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. Although the CQC has confirmed that it inspected the service early in 2019, its report is yet to be published.
Meanwhile, an Ipsos Mori report evaluating the impact of Babylon GP at Hand on patients, the primary care workforce and the wider healthcare system has been delayed until May.
A Babylon spokesperson said: 'Babylon welcomes scrutiny from any governing group or regulator, as we are proud to demonstrate how we can use our technology to work with the NHS and help it cope with the rising demands and costs that are impacting patient care.'
Health minister Ms Kennedy said: ‘The challenge for the government and NHS England is to ensure that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers, ensuring that the new technology is safely integrated into existing pathways without unduly destabilising the services it works alongside.
‘Two important principles within the NHS are that a patient can choose which practice they register with, and that funding follows the patient. The emergence of digital-first providers, which register patients who may live some distance from the practice, raises the question of whether these funding arrangements are fair. This year, NHS England is analysing and reviewing the out-of-area registration.’
She added: ‘NHS England does not believe that the CCG has had to scale back services because of any extra financial burden from GP at Hand, but we will continue to work with the CCG and other partners to explore options for maintaining the robustness of the commissioning system, both now, while GP at Hand is focused in London, and in the future.’