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Who will take the digital-first throne?

Plans to develop digital-first primary care are driving innovative partnerships between GP practices, NHS providers and technology suppliers.

The NHS Long Term Plan set out a vision to offer digital-first primary care to all patients in England within 10 years including new digital GP providers allowing patients the choice to register with them directly. The ambition is to provide straightforward access to primary care services, eliminate variation in the pathway of care, and help patients manage their own health better. It is suggested this will help address workforce shortages, particularly in under-doctored and deprived communities and that clinicians will have more time to be able to focus on those with the greatest need.

In June 2019, NHS England and NHS Improvement (NHSE/I) undertook a public consultation on proposals to develop digital-first primary care including the reform patient registration, funding and contracting rules to ensure patients have both choice as well as access to integrated care.

NHSE/I intend to take forward the proposal for CCGs to disaggregate a practice list and award a new Alternative Primary Medical Services (APMS) contract when a (digital-first) practice registers over 1,000 patients from another CCG. NHSE/I intend to create new opportunities in around 20-25% of CCG areas which lack GP capacity and/or have poor patient access, NHSE/I will develop a national assessment process and the criteria with commissioners and providers, to create a new national digital-first provider list in 2020/21.

In September 2019, NHSE/I published its response: The consultation also found that there was support for a “partnership approach” to forming digital-first GP models, and the response stated:

”We (NHSE/I) expect the approved providers’ list could include a range of partnership models. This may, in the first instance, include partnerships between NHS trusts or foundation trusts, whether acute or community and digital providers. It could also include groups of GPs who want to set up their own new independent partnerships on a digital-first model. We expect this route will provide a useful opportunity for people wishing to innovate in primary care.”


The Emerging Market


We have started to see innovative partnerships between GP Practices, NHS providers and technology suppliers emerge and some are positioning themselves in what is a new and increasingly competitive market place.

In August 2019 LIVI announced a collaboration with Our Health GP Partnership in Birmingham and Shropshire building on their existing partnership in North-West Surrey to bring digital GP access to over 1.85 million NHS patients. 


“We expect the approved providers’ list could include a range of partnership models”.


In November 2019 a GP surgery in Newham, east London partnered with Docly to provide an online consultation service to avoid closing its practice as a result of most of its clinical staff going on maternity leave at the same time.

In January 2020 Babylon Health and the Royal Wolverhampton NHS Trust announced a 10-year partnership to develop a new model of digital-first integrated healthcare – with services set to launch before the end of the year.

Whilst it is early days, and many variations may emerge, it looks very possible that NHS Trusts and/or large nationwide primary care companies eg Virgin Care, Totally Health etc could partner with new digital suppliers as ‘disruptors’ and compete with ‘incumbent’ GP practices in the 20-25% of CCG areas forming the initial digital-first market.


What will it Mean?


How the market develops will very much depend on how ‘attractive’ the new digital-first specification and associated investment is to new entrants. How NHSE/I and local commissioners use the provider list to develop a market and encourage competition will also be a factor. However, assuming this happens both digital providers and GP practices will need clear strategies on how to respond to the emerging market.

Digital providers will need to give careful consideration who to partner with – whether to support existing GP practices, PCNs and Federations or look to collaborate with the larger NHS providers. It maybe technically possible to partner and compete in both market segments – albeit in different CCG areas – however this potentially creates a tension between a suppliers core value proposition and how it is authentically positioned.

The key decision for digital providers will be whether to position their offer as a tool to help existing GP practices to deliver improved staff satisfaction and patient experience, therebye retaining their loyalty. Or do they partner with new entrants to help them quickly grow their business and register patients from local GP practices.

A full market analysis including payer priorities and challenges and local drivers will be critical to the successful implementation of a suppliers strategy. The new market will be driven by patient choice and existing GP practices must not be complacent about the impact of this. They will need to consider carefully how to prevent the new entrants from ‘cherry-picking’ their patients with exciting offers. Practices will need a robust approach to how they will compete with much larger and arguably more commercially mature organisations.

“Digital providers will need to give careful consideration who to partner with”

GPs have everything to lose and will need to really understand what service their patients want and then create the right offer/s to retain their loyalty. This will need to include a digital channel but also how they will provide a personal service and continuity of care.

They will also need to consider how they compete at scale which might include forming or further developing digital-first federated arrangements with other practices and PCNs. GP practices should develop a strategy for partnering effectively with digital providers.

“GP Practices will need a robust approach to how they will compete with much larger and arguably more commercially mature organisations”

Only by doing this can they identify and leverage their combined capabilities on where they can best serve patients and consumers, identifying unmet needs, and discovering new and innovative ways of addressing them together that create additional value. The first step is for Practices to identify the digital providers that they think they can best work with and that most closely align to their values and ambitions. Then together the GPs, Practices and providers will need to determine if they have the right leadership, systems and processes, staff competencies and culture to become the most effective partnership of choice.

Published in the Hospital Times –

Conor Burke

Conor Burke

Founder and Managing Director

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