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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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  • yes but there is a gap in the market and an opportunity to make some quick money.

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  • National Hopeless Service

    We have decided to become a sunglasses practice. We will all wear sunglasses so we cant do any dermatology, Ophthalmology or anything else with a 'scope and cervical smears. And I cant do feet, I just dont like feet.

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  • How does the service meet contractual requirements, GMC requirements, CQC requirements and not fall foul of anti-discriminatory law? RCGP, BMA, GMC, CQC and patient support groups should be jumping all over this.
    “You may on occasion develop an urgent illness which requires a face to face appointment, and not be able to visit one of our GP clinic locations. In this circumstance, we may ask you to call 111 who will direct you to the most appropriate local service which may be a GP practice near to where you live, the local walk-in or urgent care centre, A&E or minor injuries unit.” So, other practices and A&E will have to see their urgent patients and other practices will be badgered for a home visit by non-registered patients, with no source of remuneration for those contacts.
    If people want to pay money for this service as a top up for NHS care, that’s fine. But this is not an NHS GP service that offers cradle to the grave universal care and should not be allowed to practice in a way that is advantageously different from the 99+% of other GP practices who contract their services to the NHS.

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  • Bob Hodges

    Being a GP is a tough job, but take away the list of people that Babble On are excluding, and you've taken away ALL of the intellectually interesting and vocationally rewarding work from the job.

    I'd seriously question anyone who thinks that that a 'differentiated' patient population can provide sufficient exposure to actual disease to remain registered to practice as a GP.

    Aside from that, it sounds like Babble On have peddled the eEmperor's iClothes to the DoH, and now they're dancing like they got their disco pants on.

    The rest of us who understand that General Practice and continuity actually involves being in the same room as a patient some of the time, will sit by bemused whilst this dies the silent, excruciating death it deserves.

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  • Jeremy Hunt loves this info-capitalism so much his middle name is iMac.

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  • I've just had a look at the Babylon Health website and I honestly don't know how we have ended up in this truly shocking situation.

    What I would really like to know is how are these shysters paid for cherry picking well patients? I'm sure they do not receive the pathetic global sum of £85.35 a year for limitless consultations, day or night. I bet they have a payment by activity model - something which is considered vulgar for us minions.

    And how the hell does this pass equality and diversity laws? Someone with drug addiction or complex health needs is being denied access to an NHS service - how is this even possible? How did we get here?

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  • Dear All,
    ....and Dr Ali Parsa, didn't he do something with Circle in Cambridge?
    Regards
    Paul C

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  • Agree with all the above
    Most of us went into GP to care for ALL patients regardless of complexity.
    First year medical students learn the ethical principles of equality justice benificence non-malificence
    Notwithstanding this sad state of affairs, the current GP shortage , burnout , and threats to leave NHS are the sad results of years of underfunding and governments squandering the remaining vestiges of goodwill.
    Doctors do need to ask themselves however, if working for such an organisation is ethical or a dereliction of what GP is about. You will have a pretty boring job as a salaried lackey pandering to the ‘me now ‘ city types
    While at the same time building profits for businesses cashing in

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  • Dear Shaba , It is happening because Mr Hunt wants it to happen.
    It is such an immoral excluding set-up who else would allow it to take off.

    It will have no impact on health care because anybody who is ill can't join up.

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  • How did they get a GMS contract for this service ?

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  • If anyone is given as much rope as Babylon have been handed, there will only be one outcome.

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  • Babylon just invented ‘capitated patient sickness arbitrage using tech’ as a way to make money.

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  • All what these guys will be doing is giving out antibiotics for sore throats. It’ll be a disgrace if they get away with their exclusion criteria. What they’re offering is NOT general practice! What’s the college doing to address this? Will practices in London left with the extra work get Etta pay?

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  • Scarcely credible, even with the current DOH politics.
    Highly dubious that it would meet contract requirements. Also medicolegally dangerous. Urgent CQC inspection required?
    As regards the exclusions, perhaps other practices in the relevant areas of London should adopt the same list of conditions which could exclude new patients from registering, advise their local health authority and see what happens!

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  • Vinci Ho

    You see
    I have been too busy dealing with these patients on this list of exclusion today and only now I can sit down to have my tea as well as reading this properly.
    As I always wrote , sign of the times . This phenomenon is totally unsurprising to me .
    Supported by Charles Alessi , typically this is the role model we all should be looking upon accordingly . We all have to develop a smartphone appt and provide video consultations , as in line with Agent Hunt’s obsession of smartphone technology. We all should develop Facebook accounts for our surgeries. (Mark Zuckerberg will be so f***ing delighted!)
    Obviously, informations provided in this article are limited. If the service is legitimately recognised by NHS . One will be more than intrigued to know exactly what are terms and conditions laid down for Babylon from the government.
    Yes , this is perhaps one ‘logical’ Londonian solution to satisfy those patients who spent mega hours on smartphones everyday .But again , like all stories repeated under the government: one size will fit all!
    For the sake of discerning the facts of this matter before applying our ethos of true general practice to respond, Nigel, please provide more details and facts on this ‘deal’ between Babylon and the government.

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  • Vinci Ho

    PS
    Is the beginning of our end ,as Luke Skywalker said in the forthcoming Last Jedi trailer , “I only know one truth: It’s time for the Jedi to end.” ??

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  • I can feel an FOI request coming on, maybe 'could NHSE/CCG supply a copy of the equality impact assessment which was hopefully undertaken as part of the procurement process?'

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  • Vinci Ho

    *Private hospitals provide surgical procedures for NHS with their strict set of exclusion criteria.
    *APMS private provider can operate under different terms and conditions , and leaves the table anytime they like(yes, one can argue we can do the same as well).
    *Now you have these new smartphone GP variant, but with a strict exclusion criteria of patient types , presumably being paid ,at least ,the same rate as other practices which will be left with a concentration of more patients with complex problems but with no extra resources from government.

    One thing so far we have learnt from the cause(s) of this current world messy situation is :
    Neo-liberalism with globalisation ,advocated by elites ,had encouraged liberty . But liberty had taken equality for granted and exaggerated instead of resolving inequality in various aspects..........

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  • Saw it advertised on the tube. 24/7 access to GP any time any where and for free. Massively undervalues GP care. How much do the GP slaves earn??

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  • Vinci Ho

    For those who are missing Dr Alessi, revisit this on this platform exactly three years ago:


    http://www.pulsetoday.co.uk/clinical/more-clinical-areas/neurology/gps-to-diagnose-and-care-for-dementia-like-other-long-term-conditions-says-government-advisor/20008568.article

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  • Vinci Ho

    And this :

    http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/councils-could-hold-gp-contract-says-alessi/20007112.article

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  • Knowledge is Porridge

    Someone trying something different and everyone is upset?
    Of course the exclusions look dodgy, but they are trying something innovative which we may all learn from. It may not work but I am much more offended by the NHS billions wasted in litigation.

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  • IDGAF.Ltd is ahead of the game; I have set up a similar service and my exclusion criteria have been stringently established. I will provide sicknotes only, 24 hours a day, and simply on the basis of a WhatsApp message with no need for even having to look at the patients miserable face on video. Needless to say, my MSF patient feedback has been a cinch to achieve for revalidation. I love progress,I do.

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  • Does this mean I can register as a temporary resident and use this service for free?

    I think I can.

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  • 'Babylon's burning'.
    A hit song by The Ruts circa 1979

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  • These days you often have to pinch yourself to make sure this shit is actually happening.
    So therefore if Babylon health can cherry pick on a GMS contract, then so can everyone else?
    Not that I am suggesting for a minute the same fascist principles espoused by NHSE here of course.

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  • Well done to all the commited GP partners, salaried and locum GP's still sticking at it at the real coal face. At least you can sleep at night.....

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  • Are there not parallels with how the new primary care model is destabilizing the hospital by focusing on low hanging fruit? We need an integrated system, where the level of complexity is appropriately recognized and remunerated.

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  • @Virtual Nobody
    They wouldn't look good under the trade descriptions act.
    Unless they change name to something more appropriate

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  • This comment has been moderated

  • We can start drawing up our own exclusion criteria. The precedent has been set.

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