‘Digital-first’ providers should set up new practices in deprived areas, says NHSE

NHS England (NHSE) has proposed that “digital-first” health providers should set up premises in deprived and “under-doctored” areas, in an effort to reduce health inequalities.

A consultation into the primary care sector was launched last week, in response to concerns over the operation of Babylon Health’s GP at Hand service.

From April 2020, digital-first providers would be able to set up practices in areas of England with doctor shortages through new alternative provider medical services (APMS) contracts if they can demonstrate a “credible plan” for bringing new GPs into the area.

They would be required to ensure the physical part of their service includes the most deprived areas of the Clinical Commissioning Groups (CCG) and must “actively promote their services to the most deprived communities”.  

Also, under the plans, when a practice exceeds 1,000-2,000 out-of-area patients in any CCG, its main contract would automatically be disaggregated, and a new primary medical care contract would be awarded in that CCG.

The consultation will run for two months until 23 August.


The NHS Long-Term Plan sets out that by 2023/4 every patient in England should have access to digital-first primary care.

According to NHSE, the development of digital general practice offers the new possibility “to expand GP capacity for patients in an area even when the GP sessions are provided at some distance.

By targeting under-doctored areas, it could help to bring additional capacity into these areas and deliver improvements in access.”

This, the consultation says, would support wider goals to reduce health inequalities.


Concerns have been raised about the expansion of GP at Hand, which offers digital services such as video consultations, a virtual symptom checker and chatbot triage.

Local MP Andy Slaughter recently criticised the service for causing financial problems for Hammersmith and Fulham CCG, by distorting patient list size and subsequent funding at its primary practice in Fulham.

The service has more than 50,000 users, of which only 5% are based in the borough. It also recently opened a new service in Birmingham.


“NHSE believe in a digital-first NHS and their new consultation is a sensible step in ensuring it rolls out in a way that best suits patients and allows people to choose the GP practice that works for them,” a Babylon spokesperson said.  “It’s also great to see a new plan that will solve concerns around the funding flows between CCGs.”

But Slaughter said: “These proposals may mitigate the most extreme effects of Babylon GP at Hand but don’t tackle the basic objections that this is a relatively untried system that is expanding across the NHS at a pace it dictates itself.”

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