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Expanding GP at Hand ‘could destabilise care for patients’

Service mainly attracts young and healthy patients, critics claim.

Expanding the digital GP service GP at Hand could destabilise care for patients with the greatest needs, an expert has warned.

Writing in The BMJ, Martin Roland, Emeritus professor of health services research at the University of Cambridge, asks whether smartphone consultations could replace traditional approaches to accessing primary care, and whether the new service will make the NHS’s current crisis in primary care better or worse.

Babylon, which runs GP at Hand with a group of London GPs, provides remote consultations with doctors and healthcare professionals via text and video messaging through its mobile application.

Almost all initial contacts are through smartphone consultations. Only if the problem can’t be sorted out on the phone do patients travel to one of five clinics in London for a face-to-face consultation.

Some fear that the new service will undermine traditional general practice, leaving GPs with sick and complex patients to look after as fit young patients move to GP at Hand. The new service has proved popular, with over 50,000 patients now enrolled.

A recent independent evaluation confirmed that GP at Hand caters principally to a healthy, affluent, young and working population.

However, Roland points out that a quarter of GP at Hand’s newly registered patients move back to a conventional NHS practice, many within two weeks.

The Care Quality Commission recently rated GP at Hand as “good” in most areas but found it needed to improve its performance in cervical screening and childhood immunisation coverage. 

“The service clearly meets the needs of some patients who value a fast convenient service, but it falls short of providing comprehensive proactive primary care,” said Roland.

He argues that the current NHS funding formula does not adjust adequately for the costs of providing a comprehensive primary care service and the NHS needs to review its arrangements that have allowed a private company “to cream off fit young patients from existing NHS practices.”

If the GP at Hand model became widespread, “it would risk destabilising care for patients with the greatest needs and those who need regular proactive care,” he concludes.