Under the five-year GP contract agreement published last month by NHS England 'all patients will have the right to digital-first primary care, including web and video consultations by April 2021'. Young patients increasingly 'forgo traditional GP appointments', the agreement warns - adding that 'progress on digital delivery will be important to maintain social solidarity behind the general practice model'.
The contract deal says that 'the best way of digitising primary care is to help existing practices' - and promises funding to support IT development in primary care, as well as a framework to help digital suppliers offer services to NHS providers.
But a government response to a parliamentary question reveals the extent to which existing practices will face competition from new digital-first providers for their patient lists.
Labour shadow health minister Justin Madders asked last month what estimate the government had made 'of the proportion of online GP consultations that will be carried out by private providers that do not currently provide NHS services' under the vision set out in the NHS long-term plan.
Conservative health minister Steve Brine responded that no estimate had been made and the proportion 'will depend on the preferences of patients and the extent to which existing providers of primary care take up the opportunity to offer online general practitioner consultations'.
The NHS long-term plan makes equally clear that practices will face competition, pointing out that when patients' right to video consultations takes effect this will be available 'usually from their own practice or, if they prefer, from one of the new digital GP providers'.
Meanwhile, NHS England revealed this week that it was set to allow the expansion of Babylon GP at Hand to Birmingham. The London-based digital-first service has attracted around 40,000 predominantly young patients who have switched from their existing practices over the past 15 months.
GP at Hand expanded
GP leaders hit out at the 'premature' and 'incredibly disappointing' decision to allow the service to extend into a second major English city. The expansion has been confirmed before results of an evaluation into the impact of the service - expected next month - are published.
GPC chair Dr Richard Vautrey said earlier this week: 'GPs would like to offer video consultations to their own patients. These patients would benefit far more from being seen by a doctor close by and with a full understanding of their medical history, rather than someone miles away from their home.
'But to make this a reality, there must be investment in practice IT infrastructure – including improved broadband capability in surgeries – to create a level playing field with private companies such as Babylon.'
The GP contract agreement says 'all patients should have access to digital primary care services as rapidly as possible'. It points out that 'a number of different digital models are rapidly emerging' that have been 'well received by practices and patients alike'.
Health secretary Matt Hancock is a staunch supporter of digital primary care - the West Suffolk MP is himself registered with Babylon GP at Hand, and has drawn criticism for saying publicly that he wanted to see it rolled out across England.
The contract agreement sets out proposals to change how GP funding is allocated to 'improve fairness' between digital first providers and existing practices. GPonline reported last year that the GP funding formula could be overhauled to accommodate models such as GP at Hand.
GPonline reported last week that GP leaders were demanding equal treatment for traditional practices and new digital-first providers as a ban on NHS providers holding private patient lists in parallel takes effect. How the rules will apply remains subject to negotiation - but while the BMA says it will mean providers must choose to 'either provide NHS GP services or private GP services, but they can't do both', a statement from Babylon suggested it was confident it would not be affected.