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GPs buried under trusts' workload dump

Babylon GP appointment app raises fears of patients 'gaming' system

CCGs in London have decided not to proceed with plans to use Babylon Health’s 'symptom checker' app to triage patients after testing revealed there was a risk of 'gaming the system to achieve a GP appointment'. 

The app uses artificial intelligence to ask patients questions about their illness using a 'chat bot' interface before directly booking patients in for a GP video consultation, if necessary.

But according to board papers from a London CCG - first reported by HSJ - instead of reducing GP attendance, testing of the app raised a concern that patients who used the app may do so to get faster access to a GP appointment.

This is not the same scheme that saw Babylon accused of ‘cherry-picking’ patients by offering an online GP service as a replacement to regular GP practices across London, after which LMC leaders voted in favour of a motion calling on the GP Committee to 'seek urgent legal advice' on a 'potential judicial review'.

The scheme was being considered by the CCGs, and is separate to the pilot project being worked on with NHS England as part of the health secretary's NHS Online challenge.

According to CCG board papers from the North West London CCGs Collaboration Board published earlier this month (and recently updated - see box below), the initiative - run by Babylon - was tested with focus groups to 'to see if the technology could drive reductions in demand for GP appointments'.

The paper says: 'Work over the summer with focus groups to gather insights around perceptions had raised a concern that patients who might use the app could mainly do so because they believed it would get them faster access to GP appointments.

'The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment.

'The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand on GP services. This reduced the intended benefit of the system significantly. Following questions and further discussion, the Board agreed not to proceed to the pilot stage.'

A separate paper, the November 2017 report from the chief officer of the CWHHECCG Collaborative report (which is a subset of the North West Collaboration Board), says: 'As part of the online consultations development, a small group of patients has been testing the symptom checker during September 2017, spanning six patient focus groups and a wide demographic area. As a result of this valuable exercise along with our partners, the decision has been made to not proceed with the proposed Babylon pilot.'

A spokesperson for the CCGs said: 'The CCGs considered the merits of this app as a tool to help manage demand on GPs – particularly through the symptom-checker feature.

'We worked closely with patients to find out what demand there was for the app. We found that patients were typically most interested in using the app to speed up GP access, rather than the symptom checker.

 'In the end, the information gathered from talking to patients was successful in informing the ongoing work of the sector as we explore this area further.'

A joint statement from Imperial College Health Partners (ICHP), Health Education England in North West London and Babylon said: 'We worked in partnership with the North West London Collaboration of CCGs and Health Education England working across North West London, to consider the merits of the app as a tool to help manage demand for GP services – particularly through the symptom-checker feature.

'We worked closely with patients and the public to find out what demand there was for the app. We found that patients were typically most interested in using the app to speed up GP access, rather than the symptom checker.

'The insights gathered from engaging with patients and the public was sufficient in informing the ongoing work of the sector as we explore this area further.'

The paper from the CHWECCG group said that ‘17 pioneer GP practices’ along with Imperial College Health Partners and Health Education England are ‘all working to develop an alternative’.

It said: ‘During November 2017, GPs are being invited to give input on the next steps and how we might shape digital access to general practice.’

Please note:

  • This story was amended at 11:45 on 22 November 2017 after Pulse was made aware that the CCG board papers incorrectly said the app was piloted.
  • This story and headline were amended at 11:05 on 23 November 2017 to remove references that the pilot group had 'manipulated' the app after Pulse was alerted that the CCG had changed their minutes to different wording. 

Readers' comments (15)

  • This was announced and dumped in less than a week. How long was it planned for?
    Was it a private company and a Practice or was HMG behind it?
    Another waste of precious NHS money

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  • The problem is always going to be the numbers of doctors who are actually available to do the work. The more different ways you create to access these doctors (apps, telephone calls, Urgent Care Centres, GPs in casualty, triage etc) which involves doctors the less time they will have to see patients and sort them out properly. I am surprised they needed "a pilot" to find out something that was blindingly obvious to anyone with a brain. We need to invest in our existing workforce and pamper them so that they feel valued again. I am off next year.

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  • Dear Michael,
    You sum it up well, anyone with a brain has or is leaving, leaving the brainless to run the show.
    It fills my heart with sadness but my conscience is clear, there comes a point when you have to look after yourself rather than an entity that has been actively abandoned by its political masters. It is now unfortunately time to leave the emperors clothes to the acolytes.
    Regards
    Paul C

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  • Vinci Ho

    Typically , the obsession of using IT as answer to everything. The ethos and telos of general practice are a lot more than these technocrats can ever imagine.
    ' I would rather have questions that cannot be answered than answers that cannot be questioned.' Richard Feynman

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  • 'to see if the technology could drive reductions in demand for GP appointments'.

    Yes, that is why most retailers have apps and easy online access . Because they want to reduce demand for their goods. ha ha.

    "We found that patients were typically most interested in using the app to speed up GP access, rather than the symptom checker."

    Joking aside, this does show there is a lot of unmet demand for GP appointments. It might be a minor ailment to us but the patient still wants an opinion from an expert. Can you imagine dentists, opticians, pharmacists, solicitors etc turning customers away ? No. Because the more customers, the more income. We are allowing our knowledge and experience to be underused, when we have a real service which we can offer and people want.
    Can Pulse do an article on how to start an app and what are the medicolegal basics of online consultations? This could be a new trend in private medicine.

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