Soaring costs linked to GP at Hand as more than 50,000 predominantly young patients have signed up for the video consultation service - most from outside the local area - have left Hammersmith and Fulham CCG facing a growing deficit. In 2019/20 alone the service is projected to add £21.6m to the CCG's costs.
A spokesperson for Hammersmith and Fulham CCG confirmed to GPonline that the CCG had ‘been in discussion with NHS England’ and that they had ‘reached agreement that the costs of GP at Hand will be met for 2019/20’.
‘We are finalising the mechanism by which this will be achieved,’ she added.
Hammersmith MP Andy Slaughter - who has called for a parliamentary investigation into GP at Hand - has warned that the CCG could be forced into special measures by the gaping 'financial hole' left by the digital-first service.
Including the projected £21.6m cost for the current financial year, additional costs incurred by Hammersmith and Fulham CCG since since GP at Hand was opened up to out-of-area patients in November 2017 could total £35m by the end of 2019/20.
Mr Slaughter said his constituency’s CCG was treading a ‘fine line’ financially and ‘may well be in special measures soon’ due to ‘the level of deficit they’re dealing with and because of the GP at Hand problem’. He warned that the bailout deal for 2019/20 ‘still leaves about £13m-£14m unaccounted for’.
An open letter, published last week in The Guardian and co-signed by both Labour MP Mr Slaughter and Hammersmith councillor Ben Coleman, says: ‘To date, Hammersmith and Fulham CCG has not been reimbursed for any of the patients registering with Babylon GP at Hand from outside north-west London.'
GP at Hand
Extra costs incurred by the CCG because it was hosting GP at Hand meant 'money lost to patients who live in Hammersmith and Fulham', the letter warns. It adds: 'The unacceptable costs of Babylon GP at Hand should immediately be paid to Hammersmith and Fulham CCG whose budgets are being significantly undermined.’
Cllr Coleman, a council cabinet member for health and adult social care, told GPonline that ‘anything less’ than a full £35m refund from NHS England for the ‘full cost of the [GP at Hand] service since it started’ would be a ‘disgrace’.
He argued that it was ‘simply immoral’ that the CCG should have to take on any costs related to Babylon’s service, and called for the GP funding system - which makes clear that CCGs are responsible for commissioning services for patients on the registered list of their local GP practices - to be revisited.
‘The GP funding system was never built for a digital disruptor like GP at Hand,’ he said. ‘What’s happening now was never imagined when the NHS was founded and we’re being hit squarely in the eyes.’
He added: ‘The NHS needs to take a long look at the GP funding model and decide what to do about it but that will take a long time. And meanwhile they should reimburse Hammersmith and Fulham CCG in full for the extra costs incurred by GP at Hand.’
Mr Slaughter highlighted that - even with financial assistance from NHS England - Hammersmith and Fulham CCG would still be in a ‘bad state’ because of historical CCG deficit.
But he added that if a proposed merger of eight CCGs in north west London - including Hammersmith and Fulham - went ahead, future costs relating to GP at Hand could be spread across the group.
A CCG spokesperson said: ‘Even without the costs of GP at Hand, the CCG faces a deficit in this financial year. North-west London CCGs are increasingly working together so we would not expect a CCG to be placed in special measures without reference to the wider position of the other seven CCGs in north-west London.’
NHS England agreed to review out-of-area patient registration rules and to look at whether the existing GP funding mechanism delivers fair funding for digital-first providers as part of the five-year GP contract agreement published earlier this year.
An NHS England spokesperson said: 'Patients have always had the right to choose their GP, and if patients transfer from a GP practice in one CCG to another CCG then their funding will transfer with them.
'Like every other CCG, Hammersmith and Fulham is expected to return to a position where it manages within the resources allocated to it on the basis of patient need and we are working closely with the CCG and its neighbours to support it in doing so.'