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GPs buried under trusts' workload dump

BMA considering 'all legal options' to challenge GP at Hand rollout

Exclusive GP leaders are considering 'all legal options' to challenge the rollout of Babylon's 'GP at Hand' service while also participating in regular talks with NHS England and NHS Hammersmith and Fulham CCG over its safety.

Dr Richard Vautrey, chair of the BMA's GP committee, told Pulse that the BMA has now ‘taken legal advice around a range of issues’ concerning GP at Hand and are looking at ‘all legal options at the moment’ but would not confirm whether a judicial review or other legal challenge was still on the cards. 

This comes after LMC leaders voted in favour of a motion calling on the GP committee to ‘seek urgent legal advice’ on the ‘potential judicial review’ at the England LMCs conference in November.

He said: ‘We’re having regular dialogues with NHS England, also with the CCG, involving the local LMC as well, and have taken legal advice around a range of issues.’

He added that NHS England and the CCG, 'need to be taking action' to ensure those who register as patients with the service 'fully understand what they’re doing'.

Patients who join the online GP at Hand service leave behind their former GP practice and join the patient list of Dr Jefferies and Partners' Lillie Road Surgery, which is able to take them on under the ‘GP Choice’ out-of-area registration scheme.

Dr Vautrey's comments come after board papers revealed that NHS England initially delayed the roll out of the service with concerns that patients 'are likely to self-select in a way that results in a younger, healthier, more mobile population registering for the new service'.

However, GP leaders have previously said that this model is a ‘cynical exploitation’ of the GP Choice scheme, and warned that other people would look to replicate it.

A Babylon spokesman said: 'The NHS belongs to the people, not vested interests in the BMA. Thousands of people have already chosen the convenience and high quality care offered by GP at Hand.

'Attempts to block people’s right to choose need to be exposed for what they are, particularly when the NHS is so greatly in need of innovation to cope with the increasing pressures on it.

'We are making our technology available to GP practices up and down the country, and it would be much better for patients if advances like ours were welcomed by the BMA rather than attempts made to block them.'

Since the launch of the GP at Hand app in London, nearly 12,000 patients have signed up to Dr Jefferies and Partners, the West London practice working alongside Babylon.

But NHS Hammersmith and Fulham CCG, alongside NHS England, have suggested a 'thorough on-going evaluation of the impact of the GP at Hand service'.

At a board meeting earlier this month, the CCG outlined that the evaluation would 'include consideration of the CCG financial risk as well as how the development of GP at Hand would be considered in light of national policy around accountable and place-based care', as well as 'patient safeguarding'.

An initial review completed ahead of the launch by NHS England and the CCG, which saw the rollout delayed 'due to a formal objection issued by NHS England', concluded that the app was 'innovative and had the potential to benefit patients and the wider care system'.

The team behind GP at Hand agreed to a more 'restricted rollout', to four sites outside Hammersmith and Fulham instead of a proposed nine.

They said they would also restrict it to patients living or working within 30 to 40 minutes of a participating practice and only use locations which offer 'full GMS services' and where clinicians can see a full NHS medical record during appointments.

A Babylon Health spokesman said: 'GP at Hand is going from strength to strength, delivering round the clock healthcare to thousands of people across the capital on a daily basis.

'Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.' 

What is Babylon's 'GP at Hand' service?

Babylon launched the 'GP at Hand' service in November, promising that patients will be able to 'book an appointment within seconds' via its smartphone app and have 'a video consultation with an NHS GP typically in under two hours of booking, anytime, anywhere'.

It seems to have proved popular with patients, with 7,000 joining the practice involved in the first month and a further 5,000 since then (according to the latest figures available).

But the service has encountered fierce opposition from GP leaders, in particular RCGP chair Professor Helen Stokes-Lampard who warned that the scheme was ‘cherry picking' patients. The RCGP has since decided that it would no longer accept Babylon Health to sponsor its annual conference and the BMA is looking at the possibility of legal action.

Babylon had previously suffered a setback after CCGs in London decided not to proceed with plans to use the company's 'symptom checker' app to triage patients when testing revealed there was a risk of 'gaming the system to achieve a GP appointment'. But since launch, its service's popularity among patients means that it is rapidly gaining ground despite what the GP profession think of it.

Readers' comments (23)

  • I am all for GPs earning a high income provided that they provide a high standard of service, and that the income is not generated to the detriment of their colleagues. Babylon steps WAY OVER the line and should be deplored by us all.

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  • There is a slight difference of interpretation here; PUN

    Patient Un-met Need or Patient Unnecessary Need?

    Aside from all the nice bits like being able to see the patients records while consulting rather than working 1/2 blind?

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  • Patients who can’t get to see a GP for several days, will vote with their feet. GPs are starting to have to operate in a market.
    The government will see this as injecting competition .

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  • NHS logo- Babylon NHS- NHS Babylon- wicked marketing gimmick!

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  • For BMA - the answer if fairly simple. You just need to renegotiate the balance of capitation payments to make things more even. That does not need to cost the government money and does not need and legal action.

    At the moment, if you asked people from a purely selfish, business sense, would you make more money if you swapped 1000 patients 85+ for 2000 patients aged 18-25 - then most people would go for the swap.

    If you said 1000 85+ for 10000 18-25, most people would say no.

    If you find where the tipping point is (where the split is 50/50) then that should be the difference between the capitation of a 20 year old and an 88 year old. I personally think it is something like 5:1 - which means reducing capitation for 20 year olds to 30 pounds and increasing capitation for 80 year olds to 150 pounds (or something similar based on keeping the costs equal).

    You can do a similar thing based on medical history (particularly mental health).

    Thus ends GP at hand picking the 'high value' patients.

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  • There is nothing wrong with delivering healthcare by phone or video, where appropriate, but being paid the same as other practices and cherry picking the easy patients is wrong. The question is whether all practices should be allowed to cherry pick. Now that MPIG and PMS is going it already seems apparent that a young affluent patient list, such as in a University town could also be seen as unfair compared to less fortunate practices working in poor areas with many old patients. Similarly it is unfair comparing a rural practice that has extra income from dispensing to non-dispensing practices.

    Then life has always been unfair. Besides other practices could copy Babylon.

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  • This is straight from Wikipaedia..
    In Jewish tradition, Babylon symbolizes an oppressor against which righteous believers must struggle. In Christianity, Babylon symbolizes worldliness and evil.

    Nuff said.

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  • Babylon have set a precedent. Cherry picking is OK for now, at least.

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  • National Hopeless Service

    Telehealth was going to solve the NHS a few years ago. That fell flat on its face and so will this.

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  • Cherry picking is wrong but in risk management you'll have to.

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  • It will implode with the first missed sepsis

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  • If GP services met patient need, Babylon wouldn't be a threat. As it is, those of us needing antibiotics for, say a UTI that hasn't responded to several days' conservative measures, and who have demanding work responsibilities, can't wait more than a week for an appointment at our local surgery. And I'm afraid out of hours provision is grossly inadequate. Far simpler to speak to Babylon within the hour and have an electronic script sent to the chemist around the corner a couple of hours later, rather than schlepping across London while feeling unwell to wait for hours with people brewing contagious diseases to be seen. Babyon is delivering what a certain demographic wants and thereby freeing up NHS appointments for other people.

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  • All Babylon will do is stoke demand.And with the inevitable first disaster will be torpedoed be the medicolegal need to make an adequate assesment of the patient.

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  • Babylon = patient discrimination.

    And yet they say that the NHS belongs to the people. How strange.

    Anyway- looks as though legally we're all entitled to cherry pick now if we don't allow something as yesterday as morals and ethics to get in the way.

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  • ANOn7mu5 - could I recommend you revisit the logic of your comments and have the courtesy of discussing your perspective on primary care provision in the UK within, the well known financial and workforce constraints, with GP colleagues. How on earth does a Babylon consultation free up NHS appointments for other people. It is still a consultation with a GP.... just a favourable one enabled by pump priming in favour of the less needy demographic you seem to think is a priority. Just about to start an urgent surgery with 2 telephone calls for UTIs in young people. They will have there prescriptions sent ETP soon after.

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  • @1:28 pm your comment does indeed not make sense. A GP is required to see you either through Babylon or traditional general practice. Choosing Babylon is enabling discrimination against sicker people. It’s a bit like an NHS hospital saying it will only see elective patients who are low risk but receiving similar or better funding than the open to all hospital down the road.

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  • AlanAlmond

    This comment has been removed by the moderator

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  • NHS is wasting money on IT. Systems that have been working well are being dismantled and money is being siphoned away to companies like Babylon. We've had multiple IT projects, so called pilots- Ever heard of Eclipse or Shrewd - money down the drain and let's don another one as another crony wants some cash.
    At present the online access is quite good with Emis and patients are able to book and order scripts - why another Babylon? Is NHS too rich or are the NHSE Managers too greedy and trying to squeeze blood out of the tombstone NHS is headed to become?

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  • In some areas like Medway- GPs are not allowed to refer to Rheumatologist,Physios or Orthopaedic Consultants. This is part of the 'transformation agenda' we are told. The fact is that all referrals are to go to the local Cooperative who runs a triage service and forward referrals to the above agencies. One can only guess why you need a private cooperative to forward referrals which ordinary GPs are incompetent to do. Wonder how much per forwarded referral the Cooperative is being paid considering the volume of msk referrals we make. Ingenuity of the corrupt is unfathomable.

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  • Took Early Retirement

    It just needs a couple of cases to go really wrong. Anyone fancy diagnosing a Melanoma using the screen on a phone? Well, one might be able to, but I preferred a close look with a magnifying glass.

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