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Gold, incentives and meh

Online GP provider makes push for patients to switch from their practices

Babylon Health has started offering their online GP service up as a replacement to regular GP practices across London, with plans to expand the service to the rest of England.

But GP leaders warned that the company was 'cherry picking' patients, 'creating a twin-track approach to NHS general practice'.

The company has launched its service to London patients, via a GMS contract, with plans for 'rolling out across the country in the near future'.

It promises 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 says patients will also be able to have 'an in-person appointment if needed at convenient city centre locations on the same or next day' as well as having precriptions delivered to 'a pharmacy of their choice'.

In a letter to patients seen by Pulse, Babylon said: ‘Anyone switching their registered NHS GP practice to GP at hand will continue to get 24/7 access to all the Babylon features with the additional benefit of being able to see an NHS GP in minutes on their phone for free.’

When patients need to see a GP in person, they can choose GP clinics in Canary Wharf, Victoria, Liverpool Street and Euston and get an appointment on the same or next day, Monday to Saturday.

Babylon Health said that it had trialled the service in Fulham with ‘thousands’ of patients and the service had now been launched across London with ‘other cities to follow’.

Babylon said, however, that patients with the following conditions could be excluded from the service:

  • Women who are or may be pregnant
  • Adults with a safeguarding need
  • People living with complex mental health conditions
  • People with complex physical, psychological and social needs
  • People living with dementia
  • Older people with conditions related to frailty
  • People requiring end of life care
  • Parents of children who are on the ‘Child at risk’ protection register
  • People with learning difficulties
  • People with drug dependence

Babylon Health medical director and GP Dr Mobasher Butt said: We can put patients in front of a GP within minutes on their phone, so the days of ringing frantically at 8am for an appointment should be long gone.’

Dr Charles Alessi, a GP and senior advisor at Public Health England said: 'The GP at Hand service is a true NHS primary care service - helping people stay healthy as well as looking after them when they are sick. People want to be in control of their health, and through Babylon's technology GP at Hand makes that possible. '

But RCGP chair Professor Helen Stokes-Lampard warned of unintended consequences of the new service.

She said: ‘Some patients will see this as a "golden ticket" to get quick and easy access to a GP - and for younger, healthier commuters it could prove a solution to long waiting times for an appointment.

'We are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being ‘cherry-picked’, which could actually increase the pressures on traditional GPs based in the community.'

She added that the RCGP was concerned patients were 'being given the option of switching back to their local surgery if they are not satisfied with the level of service offered by the app'.

'As well as issues with patient confidentiality and the safety of the patient record, it is hard to see how this could be achieved without adding to the huge burden of red tape that GPs are already grappling with,' she said.

'While this scheme is backed by the NHS and offers a free service to patients, it is undoubtedly luring GPs away from frontline general practice at a time when we are facing a severe workforce crisis and hardworking GPs are struggling to cope with immense workloads,' she added.

BMA GP Committee chair Dr Richard Vautrey said: 'While these proposals appear to be focused on making access to a GP easier, in reality it will divert patients away from their GP and practice and leaves them receiving care from doctors who don't know them as well as their own GP would do.

'This approach risks undermining the quality and continuity of care and further fragmenting the service provided to the public. It is also delivered by a private company that is primarily cherry picking younger, generally healthier people and excluding many others.

'It will do nothing to help the growing number of older, vulnerable patients who need well funded services that can provide the specialist care they need in the community.'

But Babylon Health said pilots had seen 'a broad range of patients benefiting from being able to see a GP quickly and at the patient's convenience, including elderly patients who find it difficult to get to surgeries because of mobility problems'.

A spokesperson told Pulse: 'The RCGP are completely incorrect to say certain groups of people are not eligible or excluded for this service.

'As in line with NHS guidance, for patients with certain conditions, as with any other care provider, our doctors will assess patients needs and in some circumstances may recommend other care is more appropriate and guide patients through getting that care, at all times putting the needs of the patient first.'

Babylon has previously aimed to replace call handlers in the NHS 111 service with a pilot of its triage app using machine learning to hone the accuracy of the recommendations it gives to patients.

Readers' comments (63)

  • Their exclusion list basically means they are seeing young and healthy patients!!

    Surely NHS England and the law means they cannot allow thhem to discriminate!!!!!!!!!

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  • Another nail in the coffin for an NHS GP service provision
    If we had a decent day job with workload control then none of us would be available to work for these companies
    When will our leaders secure us a control on our workload?

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  • How is it possible to hold a GMS contract with all those exclusion criteria?? Anyone know how we can all start setting up exclusion criteria in our own practices? I'm thinking of excluding everyone with whole body pain...

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  • The current setup is grossly skewed towards people who have illness or other health needs. It is about time that we had a service for the large number of healthy people who have previously been neglected by the NHS.

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  • So they will only see those patients who probably don't need to see a GP.

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  • This is pretty outrageous, really. Babylon really are predatory. Do not let them anywhere near your patient lists or contracts.
    They are only offering a service to the young and healthy.
    Easy to provide a quick and accessible service under those conditions.
    As soon as someone develops a complex issue they will be farmed back to us.
    Firstly, this is clearly discriminatory against patients and also anticompetitive. Why else have we not all been able to reject patients who aren’t ‘cost effective’ to manage?
    Secondly, if allowed to practise surely they should be being offered a significantly lower sum of money per patient per year, as our per head funding has to cover far more complex and unwell patients as well as the fit and healthy. Let’s see them run on 30% of our costs and the rest reinvested in supporting practices who are managing the sick.
    Finally: let’s see GPC and RCGP properly challenge this, in court if necessary (on grounds of discrimination and also anticompetitive behaviour). If we don’t, it will spell disaster for our patients and the profession.

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  • It is a shame that promoting equity isn't a more key criteria when it comes to these services being commissioned. I don't think anybody on my list this morning would have met their strict criteria to be seen.

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  • wow so basically they see nobody that actually needs a GP.

    how this is allowed on a GMS contract is mind blowing and shows the incompetence of NHSE and the GPC/BMA for allowing this omnishambles and blatant discrimination in health care.

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  • Cobblers

    Babylon pseudobabble. "The RCGP in incorrect".

    Really Babble-on?

    So the exclusion criteria exist or do not exist? For if they do then Babylon must fess up and say they are cherry picking. And that is not allowed under the NHS contract.

    But Babylon is being sub contracted by what I assume to be a standard GP practice in Fulham. Is this how Babylon have a 'get out' excuse? If so then it is the Fulham practice that is descriminating against those more unfortunate by excluding them from all the services offered by the practice.

    Breach of Contract for the Fulham practice? NHSE you should be acting for the disadvantaged not crowing for the cherries!

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  • So the complicated patients that take so much of our time will remain with us and the easy patients that can be dealt with quickly will be cherry picked. Presumably, as it is a GMS contract, they are rewarded with the same amount of money per patient per year for far less work. Having left their previous GP practice would those same GP practices automatically re-register patients that were dissatisfied with the Babylon service?

    Why can’t all GP practices cherry pick? If we had no complicated patients we could double our list sizes and double our income! That is probably their business model.

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  • Dr Alessi.
    Isn't he the GP who dumped a whole load of complex patients when his PMS budget was cut? No wonder NHSE get things wrong

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  • Playing into the hands of middle class google searching people who worry about there health and will take no responsibility for themselves .The worried well and cherry picking like the private hospitals do with surgical procedures. Creating another access point which will always get used. Good luck staffing it Babylon health !

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  • This is discriminatory under the NHS constitution:

    You have the right to choose your
    GP practice, and to be accepted by
    that practice unless there are
    reasonable grounds to refuse, in
    which case you will be informed of
    those reasons.

    Type of illness is not reasonable grounds. The CQC have to jump on this as per the law.

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  • Although I'm now retired and I recognise that things have a habit of moving on, I really can't think of many patients that I used to see in my surgery who would have been sorted out in a video consultation.
    Will all of the patients have their own 'Fisher Price' doctor's kits to take their BP and measure their temperature?

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  • I think that the GMC should take a view on this, utterly scandalous, er what happens when a female patient becomes pregnant?? Chuck her off the list? Unbelievable, disgrace to our profession

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  • About Dr Charles Alessi:
    http://www.surreycomet.co.uk/news/kingston/9726233.Practice_dumps_elderly_and_disabled_patients/?ref=rss

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  • Change in delivery of health care will occur however much we bleat about it. I sit her at my desk and apart from the computer and a sats machine it looks pretty much the same as when i first sat here 32 years ago. So when the changes come they will be fast and furious and be seriously disruptive to what is now a very antiquated process. If I was a patient I'd be in a state of barely suppressed anger most of the time that I couldn't access any medication without the rigmarole of a prescription. Wait until this professional right gets swept away as it surely will. And yes clients may well have their own diy app on their phones to do a lot of clinical examination and when we finally achieve the Star Trek hand held scanning device (amazed its not her already to be honest) you can kiss goodbye to all our jealously preserved professional privilege. (Babylon are flooded with calls today)

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  • AlanAlmond

    Wonderful ... a GP service for people who aren’t ill but still want to see a Dr. If it removes some of the 20/30 somethung worried well time wasting fools I cant see this is anything but a good idea. If people want a second rate on-line GP service with face to face back up with a Dr they’ve never met in a walk in clinic and no home visits let the idiots have it. It brings me no pleasure seeing patients who aren’t ill but who insist on immediate appointments to discuss their navel. Let them self select out of the consultation room and on to the internet. I’ll be interested to see how this impacts indemnity fees over the longer term. I can imagine registering with an on line Dr might be a very attractive idea to a subgroup of less than honest patients and folk with atypical personality traits that is sure to lead to some pretty sticky situations...the Drs responsibility naturally, they’ll take the fall for screw ups..not Babylon. They’ll take the cash.

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  • So a patient who has been a long term GMS patient - then develops something on the list, what happens to them?

    Are they kicked off the list?

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  • AlanAlmond

    ...a GP practice that can’t take its patients blood pressure, or temperature. A GP practice with Drs that can’t listen to their patients chest, smell their breath for alcohol or place a hand on their abdomen. A GP practice that can’t dip a urine sample, can’t measure the circumference of a swollen calf, can’t palpate for a hernia, or even see how somebody walks into a room. A GP practice that can’t assess a peak flow, check an oxygen saturation or palpate a pulse. How many conditions can you confidently initiate new treatment for when someone falls ill without ever having laid a hand on your patient? Great for repeat scripts...no monitoring required.
    Wonderful.

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