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Independents' Day

Babylon suffers continued block on plans to expand GP at Hand to Birmingham

The London host CCG of GP at Hand has decided to maintain its position to block the service’s expansion to Birmingham.

The decision, taken at a meeting of the NHS Hammersmith and Fulham primary care committee this afternoon, was taken in response to NHS England concern about patients’ access to health screening.

Babylon, the private company behind the NHS app, had applied to launch a physical branch to see patients in the UK’s second-largest city but the plans were blocked by CCGs due to patient safety concerns relating to local infrastructure.

A GP at Hand spokesperson said NHS commissioners had been given plenty of pre-warning of its expansion and should have put necessary plans into action for the sake of patients.

Babylon offers its NHS app to patients across London via a host GMS practice in Fulham in south-west London since November last year. Via the app, patients are offered a same-day video consultation or a next-day GP appointment at one of five London hubs.

Under the plans, the service would continue to be offered via the London NHS GP practice, under the out-of-area registration scheme, but the added physical location in Birmingham would mean patients from that region could also sign up to the app.

But, as Pulse reported last month, concerns about patient safety related to the expansion were voiced by both NHS Hammersmith and Fulham CCG, from which GP at Hand operates, and NHS Birmingham and Solihull CCG.

NHS Hammersmith and Fulham board papers, published ahead of today’s meeting said the NHS England (London) medical directorate had advised it to uphold its position to block the expansion due to concerns with patients accessing necessary health screening.

The papers said: ‘[T]here continue to be outstanding concerns regarding access to clinical pathways and arrangements for GPAH patients accessing screening services…Access to local clinical pathways could be addressed as part of the mobilisation and prior to registering any patients in Birmingham. However, the concerns regarding patients accessing screening services and related follow up services is more complex to resolve at a local level and currently there is not a satisfactory or sustainable solution to ensure that patients will be able to participate in screening easily.’

The papers also said that despite the CCG having full delegated commissioning responsibility for general practice, the matter of the expansion was of significant enough importance to request that NHS England make the final decision. Therefore, the decision reached by the CCG is being ‘referred to NHS England for approval’.

In a statement following today’s meeting, the CCG said: ‘The clinical advice received from NHS England (London) medical directorate is that whilst further assurance has been received on the areas outlined in the July committee meeting, there continue to be outstanding concerns regarding access to clinical pathways and arrangements for GP at hand patients accessing screening services. It is therefore not reasonable to lift the objection until a safe and sustainable solution is in place.

‘The committee was concerned, for example, that arrangements for national screening services, such as mammograms, can only currently be accessed via the patient’s GP referring them to local services. So potentially patients in Birmingham may not be able to access screening services local to them.

‘Similarly, the committee wanted clarity on how referrals to local services in Birmingham, such as community mental health services, would work in practice. For these reasons, the committee’s objection remains in place at this stage.’

A GP at Hand spokesperson said: 'Commissioners have known for more than nine months of the proposed national expansion of GP at Hand. The NHS has not been able to put in place the screening arrangements that enable this. As a result, the choice of GP practice promised by the NHS to people across the country is being held back and the opportunity to reduce pressure on primary care and A&Es is being missed. We hope this issue will be resolved without further delay so that safe, effective and extremely convenient primary care can become a reality for anyone who chooses it.

'The CCG made it clear at today’s meeting that GP at Hand has done everything required of it in planning the expansion to Birmingham. We will continue to work with commissioners and screening leads to bring GP at hand to people across the country.'

Last month, Pulse revealed that Babylon had started recruiting GPs for its Birmingham expansion despite the current block by commissioners. At the time, Babylon said its intentions to expand to Birmingham remained and were subject to the consideration of commissioners.

It has already signed up over 30,000 NHS patients from the wider London area.

Pulse has approached NHS England to enquire about its position regarding the expansion.

Related images

  • smartphone - gp at hand - babylon - RF 525x350

Readers' comments (25)

  • Watch this:

    It used to be said that 90% of health care was self care and that the other 10% went to GPs. After initial enthusiasm for this Steve Jobs style presentation it dawned on me that Babylon are medicalising this 90% of self care and probably monetarising it too.

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  • Forgetting about whether people think this service is a good way to deliver healthcare, the future expansion of Babylon depends on Politics. Essentially there is no reason why the service could not expand outside London. It would not be difficult to set up screening programs across the UK that can be referred to by any clinician from anywhere in the UK, or from anywhere in the world for that matter.

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  • Let common sense prevail

    I assume that GP at Hand complete the QOF for all its registered patients, as well as most enhanced services, and that they have local community MDT nursing teams available, and that recall their patients for regular medication reviews and monitoring blood tests. If not then presumably the CCG and CQC will come down on them for lack of quality.

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  • Some are saying that "medical mafia" are blocking this expansion....remember "it ain't der turf, know whadya mean"...who knows????

    I am sick to death of the possibility that various people in the medical profession might be out there repeatedly misusing their position...this is England. What the hell is going on???

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  • Vinci Ho

    I honestly have cold feet on news about this organisation. The more exasperation one shows , the more public attention is given to the company. Of course , it will then expand. You see this in movie box offices all the time . Remember film like Waterworld , Hook , Pearl Harbour or even Fifty Shades of Grey?

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  • "I am sick to death of the possibility that various people in the medical profession might be out there repeatedly misusing their position..."

    Strange comment, especially if from a doctor.
    The people in the medical profession most likely to be "repeatedly misusing their position" are those who have bypassed evidence, peer review and consultation to have sanctioned this poor model of primary care, regardless of its inability to serve a whole general practice population.

    Whether I need a smear, Home Treatment Team, or midwife care, being 100miles away matters.

    If it can't serve the entire local population, it isn't general practice.

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  • Obviously Babylon cannot deliver a complete GP service through telephones or video links from 100 miles away. They will have additional clinicians locally-based to patients. However, in my experience, at least 60% of primary (and probably secondary) healthcare can be delivered virtually from anywhere in the world, subject to the necessary connections and language abilities. It is just about both patients and clinicians getting used to this form of healthcare delivery. It is already taking place all over the world and being increasingly used. Babylon already deliver virtual healthcare to African countries.

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  • There are many medical instruments designed specifically for use over the internet e.g. stethoscopes, ophthalmoscopes, dermatoscopes, auriscopes, ultrasound scanners... Obviously some of these require someone to position the instruments on the patient. All can be used in real time or recorded and viewed later.

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  • AlanAlmond

    Tony you obviously work for these guys
    If you cant touch the patient, can’t take their temperature, blood pressure, feel their pulse or indeed can’t even smell their breath you insult us all by suggesting this model of care is anything other than a cheap money spinner. You are fooling nobody but the punters and the politicians ..and perhaps your self.

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  • Vinci Ho

    I think after Madan Syndrome , we know this platform can be infiltrated by anyone with a GMC number , anonymised or not without the need to declare interests.Credits to present and past editors of Pulse , this magazine and platform is probably more famous than one can imagine . Hail to freedom of speech (well , not quite to those without GMC numbers).

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  • Alan, I do not work for Babylon. However I delivered telephone and video consultations to my NHS patients for more than 20 years. I retired a year ago. Temperature, blood-pressure, pulse rate and rhythm can all be done virtually when required. It is true that one can’t smell someone’s breath. I think one can get away without that. In reality the only real problem I had was with patients complaining of abdominal pain. Obviously one needs to exclude an acute abdomen and I am not aware of any virtual device that can detect rebound tenderness or local guarding. This was the main reason I asked patients to attend for a face-to-face consultation.

    I am perfectly aware that many clinicians hate the idea of delivering healthcare through video and telephone links. However it is definitely the future, regardless of what clinicians think. It is already expanding all over the world at a very rapid rate. We are in the midst of a huge change in healthcare delivery. There will still be the need for locally based clinicians though. What I believe is far more important is that patients must have regular access to the same clinicians as in existing traditional small general practice. This is where large groups like Babylon are going to have problems. They may be large, but need to form small sub groups of GPs and nurses.. where patients can have some degree of consistency.

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  • Tony, no one is disputing that video consultations / telephone consultations have their place.

    People are concerned the way a private provider is forcing its way into the resources of a public institution.

    There is not a fundamental difference between telephone consultations and video consultations in my estimation. Therefore the way Babylon is behaving seems abhorrent - it is the same as if BT positioned itself as a "medical phone provider" and started to get funded via a GMS contract by providing telephone consultations with a GP.

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  • Compare traditional face-to-face healthcare delivery v remote virtual healthcare delivery to horse drawn carriages v automobiles.

    Today we are around 1912 in comparison. Over the next 20 or 30 years there will be massive change in healthcare delivery, like it or not. There are masses of advantages in virtual health care delivery compared to traditional face-to-face.

    Automobiles took several years to catch on.

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  • The media is saturated with health stories. Try listening to the Today programme on Radio 4. As a culture we get more and more health neurotic. Having instant health advice at our finger tips will make us more so and reduce self care.
    I see that it is inevitable - its just endlessly depressing.

    This technology belongs in the third world where there is a genuine need.

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  • Rcho. I agree, it is abhorrent the way a large very well-funded private organization like Babylon, and Push Doctor, can push their way into normal NHS practice. However, this is no different to what Virgin Health, Care UK and a host of other private companies are already doing. It is all unpleasant, but is normal life. That is why I originally said that it is only Politics that is holding Babylon back.

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  • Tony, it is not like virgin health.

    Video via the internet should be treated as a commodity just like telephone lines are.

    It should not be a means to gain access to gain access to GMS funding.

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  • Policenthieves l agree with you. When I first started delivering virtual health care, initially only over the phone, I had no limit to the number of consultations. However only six years down the line patients loved it so much I had to put a limit on virtual consultation numbers. Patients grew to love the service as they didn’t need to come to the surgery. In fact on the occasions I asked patients to come in for a face-to-face examination, they often tried to get me to make a decision without them attending. It is very convenient for a patient just to wait for the doctor to phone them back.

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  • Rcho, on this occasion I do not agree with you. A health care consultation is a consultation regardless of whether it is face-to-face or done over the phone or video link. It is certainly not a commodity. Besides most GPs already deliver some telephone consultations to their patients. The only issue is that Babylon is expanding this to a larger geographical area.

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  • Tony, yes we disagree.

    However, I'm guessing that you would find it odd that if your telephone provider ended up taking over your GMS contract.

    Providing a way to see patients via video link is no different. Where is the flaw in my logic here?

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  • Sorry Rcho, I would not find it odd if BT decided to employee doctors and nurses and deliver healthcare in primary care in a similar way to Babylon. They could try and register my patients as Babylon is doing. Of course I may not like it, as I would not like anyone else taking over my patients. Such is life. It never has been fair.

    On another point Virgin already delivers telephone and Internet services. I wouldn’t be surprised if they start copying Babylon.

    Competition is going to increase.

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