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Gold, incentives and meh

200 GPs working for Babylon as 40,000 NHS patients apply

Babylon, the company behind the GP at Hand online app, now has 200 GPs on its roster, it has been revealed.

This includes GPs working across its private and NHS services, remotely or from its London headquarters.

Pulse has learned that Babylon offers a full-time salary of around £90,000 to work from home, or £108,000 if office based.

But GP leaders warned the company's rapid expansion risked spreading the rest of the NHS GP workforce 'more thinly'.

The GP at Hand app, which launched across London in November, pledges an online appointment 'within minutes' and a same or next-day face-to-face appointment at five London bases if required.

GP at Hand, which operates using a host GMS practice and the out-of-area registration scheme, has signed up over 20,000 patients to date. But the company told Pulse it is processing applications that would take it to 40,000 users.

Meanwhile, the private Babylon service currently has 575,000 members across the UK.

The news of the company's expansion comes as GP leaders are still attempting to put a stop to its business model and as its London host CCG has revealed it is threatening its financial balance.

Tower Hamlets LMC chair Dr Jackie Applebee, who said practices in her area have so far lost around 1,500 patients to GP at Hand, expressed concern about the wider implications of swathes of GPs going to work for Babylon.

She said: 'It's just going to spread the NHS workforce, for the rest of us, more and more thinly. I suppose it goes back to the same old argument, that the rest of us are going to be left looking after the more complex patients.

'I can see why it is attractive to go and work for them, because they are offering flexible working hours, I imagine a good salary, and it's an easy workload if it's young single-issue patients. But it's the long-term impact of dividing the GP workforce into those who look after complex patients and those who look after the more simple patients. It de-skills us as a profession.'

BMA GP committee chair Dr Richard Vautrey told Pulse that they are 'continuing to review' the development of Babylon's expansion 'very closely', 'including the legal basis under which the practice is operating'.

Although Dr Vautrey said Babylon can legally use the out-of-area registration scheme in the way that it does, the BMA is petitioning NHS England to amend that scheme.

The BMA's concerns include patient continuity of care, as well as the future of the registered patient list system.

Dr Vautrey said: 'The fact that they’ve got so many GPs involved would cause the question how much continuity of care they are able to offer individual patients and what the impact of that is in the long term.

'We have repeated our concerns about the undermining of the registered list system by this particular service model, with its emphasis on out-of-area registration.'

Dr Vautrey added that while 'individual doctors make their own decisions about how they want to work' they 'need to ensure they are working in an environment where it is safe'.

RCGP advice to GPs about working for online providers included closely considering their safety ratings.

What Babylon says

A Babylon spokesperson told Pulse: 'We believe it is high time that everyone respected people’s right to choose the NHS GP service that works best for them. GP at Hand is one of the most successful and fastest-growing NHS services in the country. Over 40,000 people living and/or working in central London have applied to join GP at hand, which was launched less than six months ago, with over 90% of users who have rated our service giving us either a 4- or 5-star satisfaction rating for our digital appointments (which are available 24/7 – most often within two hours of requesting an appointment).

'Additionally, Babylon can support GPs to be better able to provide high-quality care effectively and efficiently, in a way that is simply not possible for GPs working in a traditional general practice. That's just one reason why 95% of GPs working for Babylon agree that they can "usually manage the amount of my work well" whereas the BMA found that 84% of GPs across the NHS were reporting that workload pressures are either "unmanageable" or "excessive" (Source: “Patient safety under threat from Pressures in General Practice”, BMA 2016).'

 

Readers' comments (34)

  • goodbye relationships with patients, sometimes spanning years
    goodbye longterm commitments to communities we work and live in
    goodbye the 'social capital' we earn that makes the system work
    goodbye continuity of care
    goodbye efficiency, and productivity in all areas apart from immediate access to discuss your 30 minutes of sore throat
    goodbye professional status

    hello to call centres
    hello to job insecurity
    hello to replacement by inadequate algorithms and 'computer says no'
    hello to replacement by outsourced HCAs working off those algorithms: what's a few patient 'incidents' compared to the cost savings and increased profits?
    hello to giving the customer what he or she wants, not what she needs - gotta get those 5 star reviews
    hello to a private personalised service - only for those who can afford it

    'would you like fries with that?'

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  • DT’s analyses are uncomfortable but accurate! To increase professionalism within Family Medicine will be hard slow and difficult. RCGP and BMA will need to face this challenge urgently

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  • This is the stark reality of our times and there is no escaping it. It's like legalizing marijuana - the dealers then lose their jobs. Has it's positive side though as at present we are slave driven by NHSE and cardigans in CCGs and LMCs. This is the other option, good or bad,but a choice that is ours to make.

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  • Dear All,
    We should not be fighting this, we should be working to safely incorporate it into the existing structures of the NHS.
    Regards
    Paul C

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  • Vinci Ho

    No surprise
    No blame on these colleagues

    ‘’When the hierarchy lost its way , people have already been desserting for long . If you understand the reasons in and out , you should be only sympathetic rather than being excited in tracking down ‘abnormal behaviour’ ‘’.
    Analects

    (上失其道,民散久矣。如得其情,則哀矜而勿喜)

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  • The Government has worked hard to enable this to happen. They are very foolish as it will cost much more and satisfaction for both patients and doctors will be less.

    Litigation costs are likely to increase due to the lack of personal relationships, and as the Government is likely to be funding the pay outs, it is a big lose lose situation for society.

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  • GPs gave up with relationship with patients years ago. This is the result. We went part-time, gave up being responsible for out of hours when in effect stopped being GPs for 3/5 of the week. Of course Babylon and GP at hand are disruptive, that the point as it seems it is what 18-40 years olds want from their health service. Most never knew the GP service use used to provide, hands on, take history, examine, and know the family and patient. It's over. I have to work in remote Scotland to practice as a GP in the way I know and prefer.

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  • existing GP practices need to be funded to allow us to take on this sort of work rather than creating a chaos of systems. Any experienced doctor knows that good medicine cannot be delivered in this way but I guess money is what is driving it.

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  • The decline of primary care accelerates with this Babylon, hanging gardens for GPs. It is a short term fix to satisfy the "needs" of patients to who T Blair and his cronies promised you can every service you want all the time, not that the current lot of miscreants have done anything to preserve the jewel in the crown of the NHS. primary care.
    It is clear that this is a get rich scheme to benefit it's creators with no thought for the consequences for the patients or those who are stupid enough to wok for them. One of the many slow train crashes occurring under our current, rudderless leadsers.

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  • Babylon is making huge financial losses, just like Uber and Tesla still do and Amazon did, until relatively recently. These companies are in the disruption business where they aim to take business from traditional providers using the internet and rapid access to their services. Babylon’s business model is to become the leading world provider of Uber style on-line medicine. The expectation is that this will take years, but that it will happen. Because of this the value of the company is very high, just like Tesla, which has been valued far higher than General Motors despite Tesla eating investors cash and making no profit.

    Babylon does have competitors in the UK, like Push Doctor among others, but there are a number of medical companies based in California that are already turning over far higher volumes of patients and cash flow. The Internet has brought about a huge change in business models and AI is about to change it again. It is pointless being a Luddite. Throughout history business models have evolved. This will continue. Cogora’s delivery of Pulse reaches further on-line than by printed word and I presume at a cheaper cost. What we should all be doing is looking at our own future to see where we will fit in if we can not retire.

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  • I said it before - where are the makers of Hand Knitted Socks now?

    Prescribing privilege will be the next to go.

    And when it happens it will happen very quickly. "GPs-r us" must face the writing on the wall

    Upskill and diversify..

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  • David Banner

    The issue is NOT a bunch of Luddite self-interested GPs facing obsolescence (the recruitment crisis has already sealed that deal), but that Babylon are allowed to discriminate on which patients they will take, whilst traditional GPs cannot. This is totally unacceptable and presumably illegal. Why is this being allowed to happen??? BMA, where are you???

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  • AlanAlmond

    I don’t believe this is safe. Show me the evidence that someone has proven this model of care to be an appropriate, safe and effective way of delivering primary care. How can it be right that a wholesale reorganisation of primary care has been introduced without proper analysis? How can it be that we have a massive oversupply of medical regulatory bodies and none of them has bothered to analyse and state what they think of this model? It’s like we are passive recipients of something that is just happening. Work for them if you like but you are practicing crap medicine and I will shed no tears when I read about the inevitable wave of medical negligence claims coming your way. You see the Drs working for these people hold all the risk. Ponder on that .. it’s the individual Drs working for these people who will shoulder all the blame when mistakes happen. If you think otherwise you are a total fool. Take their money but you are personally responsible for the consequences ...no one else. Mugs. But there are plenty of them...200 at least.

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  • Safety v convenience. Consumers are not so stupid at assessing safety as you might like to think. Foe extreme convenience they may well be prepared to sacrifice a little in the safety margin and may soon get pretty good at assessing where the safety margins lie.

    As the product changes so consumers will earn to use it in different ways and appropriately.

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  • Presumably the vast majority of the work those 200 GPs are currently doing is private work, because 20,000 patients between 200 GPs is only 100 patients each

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  • there must be a fair margin of gp down/slack time in order to have drs immediately available on demand or within the times advertised-probably another attraction of the job description

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  • I can see why this job could be attractive. Can stay at home - err on the side of caution and give antibiotics for example - deal with young patients with usually minor problems - no visits - less hassle

    It’s the practices that are loosing patients where the problems is - one practice ha lost 1500 patients - if that happened to us we would have to close down it cut doctor time

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  • AlanAlmond

    policenthieves | GP Partner/Principal18 Apr 2018 1:22pm
    The safety issue is nothing to do with consumer assessment. This is about the Doctor. It isn’t safe to practice as a Dr...and on what basis do you asume ‘consumers aren’t so stupid at assessing safety as you might like to think’ ...where do you get this from? Quite a large number of the average patient population are exactly that - pretty clueless. That’s exactly why they need to see a Dr , they don’t know what to do and they need your advice. If you are the one dispensing that advice, you are liable for any errors that occur and you can’t even lay a hand on the patent, the stupid one is in this scenario is actually the Dr.

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  • AlanAlmond

    I think what’s being lost in the whole discussion about this issue, amongst the convenience, and the distruptive tech, and the working from home and the money that people will make , is the stark fact the the entirety of the risk associated with the new model of care lies solely with the Dr. Yes people like the convenience, of cause they do. The cost is a risky consultation model, the punters don’t care because you are the one to blame if it goes tits up. Not them.

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  • Alberto @3.47

    I am not sure that you are completely correct. Babylon pays the indemnity costs of GPs working for them. So this is analogous to a NHS hospital Doctor being covered for work at an NHS hospital. I am not sure regarding the Health Ombudsman and the GMC. There is undoubtedly a risk when one cannot physically examine a patient, but in my experience of performing telephone consultations over many years I have never had a complaint related to a telephone consultation. Of course like everybody else I have had other complaints.

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  • Until someone proves in court that ‘I Skyped the patient your Honour’ is a valid examination I’ll be sticking to the old fashioned F2F way thanks very much

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  • Terribly sad that hard pressed London GP's are having to subsidise this service as the capitation fees of the young and fit are taken from them, and they are left with the frail and complex.

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  • AlanAlmond

    Tony | GP Partner/Principal18 Apr 2018 4:21pm
    It’s completely irrelevant who’s paying the indemnity fees, it makes no difference to the risk you carry and doesn’t make consulting without possibility of examination any safer. I’m sure you’ve consulted by phone, so have I and just about everybody else. 95% of the time you do so with their full medical record in front of you, quite possibly personal knowledge of the person you are speaking to and if not you are triaging and have the real option of getting them down to the surgery to see them in person. Babylon is patently not the same thing all.

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  • This is all to do with the funding mechanism.
    Lowest risk well patients probably receive about £20 of care/year from a traditional practice on average and attract £90 of income. This £70 / patient helps contribute to the £300 spend on moderately ill patients and £1000s on nursing home and complex patients / year.
    Babylon could well spend £60 per year on this easiest of cohorts, costing the NHS 3x more yet still make a profit, as they have successfully filtered out complex patients under a cloak of 'tech'.

    The answer is to use existing risk tools to assign a payment per patient each year to primary care. Thus the fittest well patients will attract £25 of funding with complex end of life nursing patients £1000 / year.
    Patients are still eligible to care as needed, but the average funding will be more equitable. It would enable some practices, for example, to even specialise in nursing home and housebound patients, whilst others could focus on the worried well, albeit without the artificially high income Babylon's patients receive.

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  • DoH and NHSE are happy to pay to private providers but absolutely adamant that GMS Practices which are underfunded cannot be given a penny. So if you are GMS, you get paid a bare basic rate of 87 paid for only 75% of your list size. However, if you are a DMC in Medway you get an APMS Contract from the same CCG with £140 pounds per patient plus £5k per month for interim support and additional undisclosed sums which are not specified.

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  • Alberto @10.11

    I hear what you’re saying. And I do agree, there is an increased risk when one does not know the patient or have the past medical records, but outside the UK patients do not register with just one GP or practice and frequently move between different GPs. I worked in Canada as a GP in a small town with just 3000 people. However the practice had over 20,000 patients’ records. We frequently saw new patients with no medical records.

    In addition GPs working on-line for Babylon can advise a patient to be seen in one of their sites for a f2f consultation, if felt required in the same way that we do in our practices.

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  • Alberto & Tony

    Overall I do agree with Alberto guys. The issue of risk is context-specific. Sure, in other countries patients move around, so that means the risk is largely the same for all the drs, and all the patients. Here that is not the norm. So the risk is greater, relative to "normal" practice here in the UK, with medical records and the higher likelihood of longer relationships. Additionally it is getting very litigious here in the UK, and as we have all seen recently, indemnity does not stop the GMC taking a knife to you the practitioner, regardless of any failings in the system within which you are working which may have contributed to a negative outcome. Babylon is therefore a more dangerous place to work than any other established primary care setting.

    Drs who work for them are choosing to look away from that risk for their convenience, fair enough, that is their choice. Patients however, they are now informed. UK patients aren't used to acting like consumers and in their healthcare, and the may young who will be signing up for Babylon, who are preferred by Babylon, they don't know any better either, because (good-for-them) a lot haven't suffered much ill health yet. But when they do, they are likely to suffer from much worse continuity problems than current primary care. This kind of care is untested and that is a problem. People do tend to assume that the NHS wouldn't allow these services if they weren't tried and tested, and that's a shame, because their trust is clearly misplaced. They deserved services with an evidence-base.

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  • Big and Small.. spot on!

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  • Latest report is that total sign-up to GP at Hand has dropped I.e. patients are leaving. Babylon are offering corporate explanations. More likely that patients are unimpressed with the new, instantaneous, futuristic, impersonal service?

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  • I reckon Babylon is also going for the old too-big-to-fail model. They're trying to soak up as many patients as possible despite their host CCG saying that their finances are getting thrown out of whack by all these out-of-area registrations (haha suckit naive and greedy CCG), so what are they going for? Some kind of bail out from NHS England or central gov when it starts to look like they'll collapse and cause a massive shockwave in suddenly unregistered patients.

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  • The sad truth is that a GP is not really viewed as a valuable asset anymore .Noctors and Physician Asociates can be used to mop up a large amount of the daily dross that GPs face at cheap cost . Yes , they may make more clinical errors and there will be more significant events but the monetary gains will keep the politicians and suits rubbing there hands with glee . GP will be left to burn out dealing with the complex multimorbid high risk community patients bounced by the noctors!

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  • CENSORSHIP?

    Love it DT..
    WORK FROM HOME
    Basically OOH phone triage
    Teleconsultation??
    No safe examination and measurement of parameters

    Goodbye .. Safe examinations
    Hello .. Higher medico legal indemnity

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  • CENSORSHIP?

    Howe much does a Babylon appt cost ...
    or are they the new OOH provider?

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