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CAMHS won't see you now

GPC to 'seek legal advice' over Babylon's attempt to register London patients

The BMA is set to look at a potential judicial review regarding the online 'GP at Hand' service that was launched in London this week.  

LMC leaders voted in favour of a motion calling on the GP Committee to 'seek urgent legal advice' on the 'potential judicial review'.

However, it was unclear whether such legal action would be taken against NHS England London, the commissioners of the practice that is running the scheme; the practice itself; or Babylon, the private provider of the GP at Hand app.

Proposing the motion, Dr Susie Bayley from Derbyshire LMC said: 'A centrally commissioned service that favours the well above the ill is contractually and morally questionable.

'Whatever your feelings on the nature of the future of NHS general practice, we cannot allow public monies to be used to commission a service that favours patients with no complex problems and only if they have access to certain technology. This will lead to huge inequity.'

Dr Emma Rowley-Conway from Lambeth LMC added, speaking in favour: 'I think online technology has great potential but it is an adjunct, people actually really want a human being to consult when they are really unwell and technology like this is useful alongside core general practice but it isn't a substitute.'

No delegates came forward to speak against the motion.

Private GP provider Babylon has caused shockwaves with its plans to sign up patients from across London to its online 'GP at Hand' service.

It has started offering its online GP service on the NHS as a replacement for regular GP practices across London, with plans to expand the service to the rest of England.

Babylon 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'.

Pulse revealed that Babylon is working with a GMS practice, and plans to use the Government’s flagship ‘GP Choice’ scheme, which allows GMS practices to sign up patients from outside their traditional boundaries.

GP leaders said they would ‘cherry-pick’ patients, and the GP at Hand website said some patients with certain conditions may not be advised to use the service during the rollout. Dr Jefferies and Partner, the GP practice involved, said no patients would be 'excluded'.

GP leaders said that this model is a ‘cynical exploitation’ of the GP Choice scheme, and warned that other people would look to replicate it – leaving other practices to deal with more complex patients.

BMA spokesman said: 'It is important that any new system of registering patients does not damage the financial stability of GP practices and delivers safe, effective care on an equal basis for all patients wherever they live .

'This motion reflects the need for greater clarity on how these new proposals should work and the BMA will be seeking to meet those involved to discuss a way forward.'

The motion in full

DERBYSHIRE: That conference, with regard to the 'GP at Hand' service launched this week and any other similar services:

(i) deplores the use of public funds, including any GP Forward View monies, to promote inequitable access to NHS-branded GP services

(ii) demands that GPC commences urgent negotiations with the [health secretary] to compensate practices from which registrations are switched for the loss of practice income incurred as a result of any patient registering with such services

(iii) demands that the GPC seeks urgent legal advice regarding the options available and the potential for a judicial review, to challenge the decision to introduce this service

 

Readers' comments (28)

  • Jonathan Pywell 7:22 morning has hit the nail on the head

    If they have been awarded a standard GMS contract then clearly most other GMS providers will be up in arms.

    The thing about traditional general practice is two things
    1. It is almost limitless in what it can “Manage” - almost...
    2. Registration has next to know limitations which meets the rights of almost all residents of the UK to have a registered GP - almost

    The Babylon Service is, with its commissioners, establishing a disruptive technology into the mix which is, while providing a Primary Care type service, clearly saying that significant elements of general practice can be delivered differently.

    The key elements are:
    Registration
    GMS contract
    Limitations
    Manage

    To manage patients using remote technologies has limitations and to register patients under a standard GMS contract would I suspect, but I don’t know, challenge the service when it came to complexity, blended physical, mental and social morbidity, housebound and the very young and those whose presentation behaviours are bound into complex personalities. Thus any service like this in mitigating the risk would have to have mecnahnisms in place pre/at registration or at the point of clinical contact to manage these types of patient.

    Most people have been saying that something needs to change in general practice and the thing is to at least embrace the possibility that a disruptive technology might be part of the solution.

    The question remains is whether a traditional GMS contract is fair and the right framework. Maybe the only safe way to run such a service IS to filter patients at registration or have a mechanism to rapidly connect complexity and cases unmanageable online to a face to face service. There then remains the question as to whether certain patients can be managed by doctors way out of their area, knowledge zone. And finally, does it heighten inequalities where the new inequality divide is whether you are tech savvy (Happy) or not.

    So many questions that deserve answers... this comes at a time where there are so many sensitivities and challenges for the future of general practice in the UK..... difficult.

    Not being cognisant of all the details behind the placement of this new service I simply make some observations...

    P:)

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  • Oh and to add...
    Isn’t the solution a new form of dual registration?

    This answers one of the elements in the motion about loss of income and would address the need for locality and face to face hands on consultation where required...

    I wonder where this will go?

    P;)

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  • I think you will find no award of a GMS contract was necessary as the practice(s) already exist. We GPs are in the main too busy looking inwards to see the ‘opportunities’ out there - these GPs have been practicing with a non-traditional model for some time - within GMS with their own call centre and trained up HCAs - a model with rather more sustainability than those practices run with GPs seeing all and doing all.
    I don’t know anymore than anyone else about the new Babylon / NHS app model but some are taking a punt on doing things differently rather than moaning about their lot. Sure there are possible threats to us GPs and patients but hopefully they’ll be resolved over time - if it works and workload can be better managed we can all benefit - if it doesn’t then we can move on to something else!

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  • Kadiyali Srivatsa

    I think this app is not only dangerous but also infringed IP. I have been looking at ways we doctors can use IT to offer our service using IT, in hospital, I tried PAT (Paediatric Assesmebt tool) to systemise paediatrics but realised it is not safe.
    After testing various methods I created Dr Maya. Any doctor can create his/her Dr Maya to share info and also offer video, email, text and Skype links.
    Please stop IT companies using our profession to offer substandard care.
    Using link Maya.doctor, you can create your own Dr Maya. Please take control of your profession and stop people stealing our knowledge and experience to kill our profession

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  • Kadiyali Srivatsa

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  • AlanAlmond

    Innovation is great. Online GP access is probably wonderful news for some people...but subsidised by the tax payer?? Is Über subsidised by the tax payer? Is Deliveroo subsidised by the tax payer?
    WTF
    We really are a pathetic bunch to let our professions worth to given away for free, as a gimmick for a corrupt government and a few slick businessmen
    Do it privately by all means but I am revolted this inherently biased system should be paid for out of general taxation for the benefit of some of the least in need.

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  • AlanAlmond

    ...big posters all over the London tube today advertising free NHS GP 24/7 online ...with the NHS logo all over it, like it’s an official government initiative and a done deal.

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  • sadly in our patch this type of GP service will become the only game in town as practices fold and close never to be replaced by a traditional service
    is this what the public want?
    is our old fashioned gp service dead in the water?
    I could provide this service for Northern Ireland from our base in fermanagh, but as far as I am concerned, this is NOT primary care as commissioned through our GMS contract, it is something less and not as good IMHO, however, given the cost saving implications of providing this "service", then this is perhaps all that the NHS can afford us to provide nowadays......

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  • Re ‘We need some innovation in GP’ comment:

    ‘We take cash and the following cards’ would be innovative enough for me!

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  • The scheme is immoral and shortsighted but I doubt it can be successfully legally challenged. The GMS contract is, of course, held by the participating practices and GP at Hand is simply contracted by them to provide an additional service for the contract holders.

    I wish the practices luck in attending to the demands of their newly swollen practice lists. I’ll be interested to see how out-of-area home visits are satisfactorily dealt with, how they maintain continuity and balance safe against resource-efficient care.

    Consumer driven primary care is gathering pace and whilst the Babylon/AI approach is superficially appealing for patients I fear that the byproduct will be a 24/7 churn of diagnoses and prescriptions, to the detriment of our health service and patient wellbeing.

    What we should be focusing on is creating an appealing alternative which places the wellbeing of patients at its core, rather than sifting NHS money into the private sector.

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