Out-of-area GP rules should be ‘withdrawn’, BMA says

Out-of-area GP registration rules should be “withdrawn” to prevent digital providers prioritising healthy patients, the British Medical Association (BMA) has said.

The regulations “are not in line” with wider NHS England policy on population-based health management and are no longer required due to the rising number of telephone, and in the future digital consultations, the association argued.

Instead, NHS England and commissioners should invest appropriately in all practices in England to achieve “fair and consistent digital first offer to patients”.

If the out-of-area registration rules remain the same, a reduced payment should be applied to patients who have registered with a digital first provider, the BMA added.

The comments come in response to NHS England’s consultation on digital first primary care, launched in June, to review funding inequalities between local GP practices and digital first providers, while also addressing high patient churn associated with digital services.

“The out-of-area regulations should be withdrawn, they allow digital providers to prioritise largely healthy patients and short-term care over patients with more healthcare needs and continuity of care for a local population in order to profit from this arrangement,” the association wrote in its response.

“The regulations, furthered by the proposals in the consultation, give the potential for largely healthy patients and short-term care to be prioritised over predominately multi-morbid patients and continuity of care for a local population in order to profit from this arrangement.

“Providing the funding, resources and ability for all practices in England to provide safe and appropriate care via a digital first platform would negate the need to introduce the proposals within this consultation and would cause the out of area regulations to become redundant.”

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The consultation proposes to:

• Amend out-of-area registration rules so when a practice exceeds a threshold of out-of-area patients (possibly between 1,000-2,000), their contract is disaggregated
• Change the allocations system to allow quarterly recalculation of CCG funding to reflect patient movements of the sort which have been stimulated by registration with digital-first practices in London
• Make no changes to the GP payment formula for new patients at this point, but only pay if a patient remains registered with a practice for a defined period, likely to be between six to 12 months
• Use practice entry rules to address inverse care law – NHSE suggests allowing digital first practices to register patients in under-doctored areas, for example CCGs in the bottom 10-20%
• Potentially remove the need for most local Alternative Provider Medical Services (APMS) procurements by looking to PCNs as the default mechanism for maintaining primary care provision

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Arguably, one of the biggest reasons for calling the review is the rapid expansion of Babylon’s GP at Hand, which has now reached more than 60,000 registered patients. But the consultation could see Babylon stripped of its primary care network by April 2020.

Babylon’s GP at Hand has caused “considerable difficulties” by “exploiting” out-of-area regulations, the BMA argued in its consultation response.

To resolve the problems, the BMA suggests linking Babylon with NHS 111 as patients are “clearly using GP at Hand in the same way”. That would include triaging and, where appropriate, treating patients or refer them to their registered GP.

Addressing the BMA’s response, a Babylon spokesman said: “The BMA are once again showing how out of touch they are by comparing completely different services when they could be backing the public to have a choice of convenient and high quality primary care.

“Babylon GP at Hand is a full NHS general practice with over 60,000 patients, making it one of the five biggest practices in the country and evidently meeting a demand for accessible, round the clock care.”

NHS England was unable to comment while the consultation remains open, but said it would review all comments when the consultation closes on 23 August.