Any reports of the demise of GP at Hand as a result of the new requirements on it from next year are, at best, overstated.  More likely is the threat to local practices will be greater.  The question, then, is how should practices react?

From April 2020 when the number of out of area patients in any CCG area reaches a certain threshold (1,000 patients) the GP at Hand contract will be split and a new practice list will be created with a new CCG contract, where the company will need to provide premises, be part of local networks, and meet all services requirements.

At present GP at Hand exceed the threshold in at least 17 of the 32 London CCG areas, and there are reports that it won’t be long until this is the case in all 32 areas.  And it is not just London.  In February this year NHS England approved plans for the expansion into Birmingham, and only a few weeks ago the company announced plans to expand into Manchester.

While the suggestion is that GP at Hand will need to set up under new APMS contract arrangements I think this is unlikely.  My sense is they will instead seek to “partner” with an existing practice in each of the relevant areas (and rumours abound these discussions are already taking place).  This removes the need for any set up costs, or any of the recruitment problems that new APMS contractors generally face.  And of course, the ‘local practice’ label could accelerate further the expansion of the service beyond its current rate by giving it a credibility that an anonymous national organisation wouldn’t otherwise have.  Patients not prepared to de-register from their existing practice to register with an on-line provider may not have the same qualms about shifting to the practice down the road.

Will GP at Hand be able to find local practices open to their advances?  Given the challenging environment general practice continues to find itself in, it is hard to imagine there won’t be at least some who will find the promise of silver too hard to resist.

The main challenge this creates for practices is they rely on risk pooling and cross subsidy, where the capitation fee for younger, fitter patients funds the cost of caring for elderly and complex patients.  The way GP at Hand operates, as Hammersmith MP Andy Slaughter describes it, “is distorting the way primary care is going to operate by sucking the most profitable parts into a parallel digital system”.

How, then, should general practice respond?  There is going to be limited political support, as the Secretary of State for Health proudly announced at the RCGP conference last week he was a GP at Hand patient.  If the argument isn’t going to be won at national level, it may well fall to local areas to take up the fight.

But can local areas do anything with the prospect of such a juggernaut looming large?  Even though the situation might feel hopeless to some, there a number of factors working to the advantage of local practices:

• Consistently over 90% of patients say that they trust their GP, and there is not a clamouring from patients to move to a new service. If practices can keep patient satisfaction high, it is unlikely patients will leave en masse.
• The opportunity now exists for practices to put their own digital arrangements in place. In the new contract practices have to offer online consultations by April 2020, and so practices can significantly reduce the differential between the local offering and the GP at Hand offering.  Practices working together in Primary Care Networks (PCNs) provide the opportunity for practices to do this collectively, in a way that is tailored to the specific needs of their local population.
• Local practices are embedded in local communities. PCNs provide an opportunity for practices to strengthen these links further, and to create more reasons why being part of a local service is better than being part of a corporate, national service.
• LMCs have a role to play. There may not be national opposition to the roll out of GP at Hand, but practices need to be making sure their local LMC is mobilising opposition locally. GP at Hand may come in the package of a local practice, but it is up to the local GP leaders to ensure the local population is fully aware of the reality of the new situation.

There are probably lots of other factors that I have missed.  My point is that Babylon is coming, and it is important practices understand what is on the way, and think proactively about what they can do to minimise the impact on their own practice.  The head in the sand approach is unlikely to be the best one, and now is the time for local practices to get together and come up with their own plan to mitigate the forthcoming challenge.