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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)

  • 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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