NHS to slash payments for 'digital first' GP practices by 20%

GP practices operating 'digital first' models - such as the controversial GP at Hand service - could see their funding per patient reduced by 20% under reforms proposed by NHS England.

The proposals come amid widespread concern among GPs about the impact of services such as GP at Hand, which has registered thousands of predominantly young patients over recent months.

The rapid growth of GP at Hand, which has used the out-of-area patient registration mechanism to open up a video consultation service to patients who live or work in London, has left the local CCG warning that it could need an £18m bailout. It has also triggered concern about the destabilising impact of patients quitting their existing practices to join the service.

Documents published by NHS England on Wednesday said: 'One of the challenges is ensuring that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers – ensuring that new technology is safely integrated into health and care pathways, whilst not unfairly destabilising existing services.

Rapid expansion

'There are concerns, for example, that the rapid expansion of digital-first practices is leading to patient selection effects not being adequately captured in the GP funding formula.'

Proposals set out on Wednesday by NHS England would see amendments to payment mechanisms designed to reduce funding for 'digital first' models of general practice. Overall, the impact of the changes would be 'a reduction of approximately 19.5%' in funding for practices working in this way.

Documents debated at NHS England's board meeting reveal: 'We conclude that three specific aspects of the current funding arrangements may lead to excessive redistribution to digital-first models.'

The following proposals are set out to tackle the problem:

  • amendment of the rurality index payment to apply to patients living within a practice catchment area only, rather than to all patients;

  • the amendment of the London adjustment to apply to patients resident in London, rather than registered in London;

  • a reduction in the payment to practices for patients who live outside of their catchment area (and to whom they are therefore not obliged to provide home visits).


GPC chair Dr Richard Vautrey said that while the BMA 'recognises the many advantages that technology and innovation can provide for general practice, it is important that the implications of its implementation are carefully considered'.

He added: 'We welcome the move from NHS England to engage on how this is best achieved.'

He hit out at the GP at Hand model, warning: 'For too long this provider has been able to unfairly exploit the out-of-area registration arrangement, cherry picking largely health young adults who often only want brief episodes of care, which risks destabilising other practices and the funding they receive to treat patients in their local community.

'The BMA recognises the many advantages that technology and innovation can provide for general practice and would like to see all practices supported by NHS England and their CCGs to improve what they are able to offer to their patients, but funding models need to adequately account for the changing health landscape.

'We are therefore glad that NHS England has finally listened to our concerns and started work to address this. As we respond to the consultation we will need to consider the various proposals carefully to avoid adversely impacting other practices who are delivering the full range of services to their patients.'

GPonline reported last month that pollsters Ipsos Mori had been handed a £250,000 contract to evaluate the impact of the GP at Hand model. Initial findings are due this autumn, with a final report expected by March 2019.

GP at Hand and Babylon, the company whose technology it relies on, have said repeatedly that 'patients and GPs are flocking to GP at Hand because they recognise the potential that high quality, digital-first 24/7 NHS GP services bring'. A spokesman said they did not wish to respond to BMA comments about GP at Hand, or to the proposed funding overhaul.

NHS England is inviting comments on its proposals to overhaul payments for 'digital first' GP models until 31 August.

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