Out-of-area rules behind rise of GP at Hand set for NHS England review

An NHS England review expected to start next week could overhaul the out-of-area patient registration rules behind the rapid rise of controversial digital-first provider GP at Hand.

NHS England chief executive Simon Stevens (Photo: Peter Macdiarmid/Getty Images News)
NHS England chief executive Simon Stevens (Photo: Peter Macdiarmid/Getty Images News)

Speaking at the NHS Confederation conference in Manchester on Wednesday, NHS England chief executive Simon Stevens said the health service would be 'consulting on proposals' relating to digital-first primary care next week.

An NHS spokesperson confirmed that Mr Stevens was referring to the review of out-of-area registration rules and patient choice of digital-first primary care, announced as part of the five-year GP contract deal in January.

In his speech to the conference, Mr Stevens backed the use of digital-first GP services, suggesting they could be a way of addressing the GP workforce crisis in under-doctored areas.

He said the NHS had record numbers of young doctors choosing to be GPs, but he acknowledged that many of them were opting to work part-time. Mr Stevens said there was ‘some evidence’ that the flexible working offered by digital GP services was encouraging part-time GPs to work additional sessions.

‘If we really can get more sessions worked on a flexible basis through these digital methods and target them to parts of the country where there are particular GP shortages this could be a way of dealing with the inverse care law,’ Mr Stevens said.

He added that 'this has to be one of the tests' as NHS England expanded digital primary care.

Out-of-area registration

Babylon GP at Hand is only able to exist because out-of-area registration rules allow patients to register with the service that is hosted by a practice in Fulham, west London even though they live in a different area.

As part of the five-year contract deal, NHS England agreed to review the rules. The contract agreement said that out-of-area registration was ‘originally set up to allow a relatively small number of patients to choose to register with a practice in a more convenient location than their home address. But the rules were not designed with digital registration in mind, and they need to be revisited.'

GPs have repeatedly called for out-of-area registration to be scrapped in the wake of GP at Hand's rapid expansion. At last year’s England LMCs conference GPC chair Dr Richard Vautrey said the regulations were being ‘exploited for profit rather than delivering comprehensive quality care’.

However, contract documents suggest it is unlikely that the rules will be completely abolished. The documents said the review would have four goals - to ensure digital-first models can have appropriate links with other local services; to maintain 'integrity of essential NHS systems including financial allocations to CCGs'; to develop appropriate mechanisms to allow patient choice of digital-first practices; and to ensure the flexibility for patients who currently benefit from out-of-area rules was maintained.

Workforce flexibilty

A recent independent report on GP at Hand found that the ability for GPs to work part-time, flexibly and remotely made it 'an attractive offer for some GPs with positive implications for recruitment and retention’.

GPs working for the service, mostly remotely from home, also reported satisfaction with the work-life balance it offered. However, the report by Ipsos Mori also warned that the model required 'considerable numbers of GPs' to sustain.

The report also highlighted that GP at Hand had attracted predominantly young, wealthy patients who use NHS services with above-average frequency despite being healthier than the average for their age.

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