The UK’s largest trade union is calling on health and social care secretary Jeremy Hunt to axe the model of care provided by NHS GP at hand.
In a letter to Mr Hunt signed by more than 130 health professionals, many of them currently working in general practice, Doctors in Unite (DiU) said the service ‘threatens the very survival of NHS general practice as we know it’.
Practices face a ‘financial threat from the new online service’ because when patients join the service – currently operating only in London – they are effectively de-registered from their own surgery, leading to a reduction in funding, the union said.
Fall in list sizes
In the letter, DiU said: ‘Practices have seen their list sizes fall for the first time in years due to patients registering with GP at hand.
‘There is no doubt that GP at hand will destabilise other practices, robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients.’
DiU said that since the service was introduced in November 2017 ‘around 26,000 patients have registered with GP at hand, most of these being between the ages of 20 and 39’.
The DiU commented that losing registration fees for the youngest and fittest patients ‘threatens the model of general practice relied on by so many patients’, a model that sees general practice funding for relatively healthy patients help finance care for those who are ill.
‘In practice, 70% of all patients are reasonably well. Their funding helps surgeries care for the 30% who are sick. It’s a system that works, because it’s fair. We all eventually end up in the 30%.’
Same funding as majority of practices
Responding to DiU’s calls, a GP at hand spokesperson at Babylon, the digital health provider that powers the service, said it receives the same funding as the overwhelming majority of NHS practice.
The spokesperson explained: ‘The cross-subsidy allegation shows a failure to understand the basics of how NHS practices are funded. Capitation funding varies from below £35 [for men aged 15-44] registered with a practice to over £190 for each person over the age of 85.
‘And by providing care 24/7 despite only being paid for the core hours of 8am-6.30pm Monday-Friday, GP at hand is supporting the rest of the NHS as well as maintaining continuity of primary care within a single provider.
‘People have the right to choose their NHS practice. GP at hand is an NHS service; paid for by the NHS [and] providing NHS services to all patients – just like the vast majority of GP practices throughout the UK.
‘In seven months, over 40,000 people living or working in central London have applied to join NHS GP at hand.
‘The average waiting time for an NHS GP appointment with GP at hand is 38 minutes, compared to waits for routine appointments in traditional practices of a week or more.
‘The reality is 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.’