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NHS has 'a lot to learn' from 'phenomenal' Babylon model, says RCGP chair

The NHS has ‘a lot to learn’ from Babylon’s ‘phenomenal’ GP at Hand app, the chair of the RCGP has said.

According to Professor Helen Stokes-Lampard, GP leaders did not see the ‘disruptive innovation’ coming. However, now that it is here, the NHS has to respond by rolling out similar technology across general practice as a whole.

She also suggested the model via which GP practices are paid needs to change, in order to protect practices from being destabilised.

GP at Hand uses the GP out-of-area registration scheme to sign up NHS patients from across London and beyond to a GP practice in Fulham in south west London. Patients are promised an online GP consultation within hours, and a next-day face-to-face appointment if required at a number of London hubs.

Professor Stokes-Lampard told delegates at a King’s Fund conference in London: ‘GP at Hand - disruptive innovation at its most disruptive at the moment. Phenomenal technology, phenomenal business mind behind it, actually some very good clinicians, some great training for the doctors who work in it.

‘An amazing model in fact, they look after their GPs well. There is a lot we have to learn from.’

But, reiterating allegations that GP at Hand ‘cherry picks’ young and healthy patients, Professor Stokes-Lampard said this destabilises other GP practices because their funding is based on an ‘ethical compact’ whereby they are given ‘a modest amount of money for everybody, with a very modest uplift for the most weak and frail and vulnerable’.

She added: ‘Therefore if some people cherry pick the healthy and the well, then inevitably those who are left to look after those who are very expensive are doing badly.’

And she said: ‘This is a huge warning and if you're not aware of it, you need to be because there are practices now being destabilised.’

According to Professor Helen Stokes-Lampard, NHS general practice needs to act in response, with the RCGP involved in ‘lots going on behind the scenes’.

She said: 'So you have to do one of two things. You've got to totally adopt that technology, right throughout the NHS for everybody so it destroys the business model and it is normal across the whole of general practice - tech tsunami stuff. Or you have to tear up the financial model by which we pay [GP practices].’

She added: ‘One of those things has to happen fast. I would suggest we need to do both. It's really difficult to do, difficult conversations are happening…

‘It's very stressful for those practices who are now really feeling the pinch and we're absolutely on it.’

Professor Stokes-Lampard clarified to Pulse that she was not suggesting GP at Hand should be rolled out across the NHS.

Instead she said: ‘New technology needs to be expanded. We need equitable access to innovation technology across the NHS.

‘When you have a new provider coming in, who is only prepared to look at certain sorts of people, who by definition are fitter and more healthy than the rest of the population - you are unfair to the majority.

‘So what I want is the whole of the NHS to adopt innovation, to adopt new ways of consulting.’

Her comments come as GP at Hand continues to expand it list size with over 30,000 patients signed up to the service as of the end of last month.

A Babylon spokesperson said: 'We are very pleased to hear Helen Stokes-Lampard’s supportive comments. Helen has long championed the power of technology to support GPs.

'Patients and doctors are flocking to GP at Hand because they recognise the potential that high quality, digital-first 24/7 NHS GP services bring. The hundreds of GPs who have already joined Babylon do so because they are treated with respect and not put under the levels of pressure all too common in other practices...

'NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man. But much more important is the founding principle of the NHS - a universal service, free at the point-of-need. That’s why GP at Hand is available to everyone, young or old, in good health or not, and we provide appointments 24 hours a day, seven days a week. People are choosing GP at Hand, never the other way round.

'We look forward to working constructively with the RCGP and indeed everyone who is committed to great services for patients and fulfilling roles for clinicians.'

The patients flocking to use GP at Hand

Since November, Babylon's GP at Hand service has been signing up NHS patients from across London by making use of the out-of-area registration scheme.

Patients have signed up at a rapid pace, with 30,000 registered to date and a further 20,000 applying. However, south west London CCGs have said a fifth of patients switched back after joining.

The main concern from GPs has been GP at Hand’s ‘cherry-picking’ of young and healthy patients, which they say leaves other practices to care for patients with greater needs.

The service does not block anybody from using the service, but has suggested people who are frail or elderly (or pregnant or have severe mental health issues) may be advised they are better serviced by a local practice.

The GP at Hand model is still pending an evaluation which has been commissioned by London commissioner NHS Hammersmith and Fulham CCG, where Babylon's NHS host GP practice is based.

Ipsos Mori recently won the the £250k bid to review the service's ‘outcomes and impacts’.

Readers' comments (39)

  • ‘NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man.’

    Eh?

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  • Perhaps H S-L's comments were a little premature.....the Pandora's box of inevitable medico-legal claims hasn't yet been opened or filtered through yet.

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  • NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man.
    This sentence is nothing but playing with words and absolute Bullsh--
    I agree that 85 + year patients are weighted at 6 times as compared to 18-40 years but money doesnot increase because if that sentence was true then we should get 85 £ per every patient who is 18-40 and then 530 £ for every 85 tears old ,but does not happen.

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  • 'NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man."

    So the man who took over Hinchingbrooke hospital while CEO of Circle, now given another shoe-in by NHS England as CEO of Babylon, has no clue how NHS General Practice is funded.

    Is this ignorance, or meant to be deliberately misleading? I've heard it quoted repeatedly, which suggests the latter.

    The worst aspect of these disruptive innovators is that they think chaos is great and so are wilfully blind to the damage that their greedy business models inflict.

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  • I am sorry but this is a complete and utter betrayal.

    please hang your head in shame! HSL, please go and join Maureen and Clare.

    please look at Dr Murphy's tweets about babylon. They are destroying general practice. how dare you call them phenomenal. I think that a GP sat in a practice tending to his patient cradle to grave night and day is phenomenal.

    I have never ever in my entire life span met a clinician on the ground that would call them phenomenal.

    Professor Lampard, I think that you need to reflect on your choice of words.

    I am speechless and incensed.

    - anonymous salaried

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  • some consultancy post down the road for someone leaving office?

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  • I would love to cherry pick and just see nice and easy young patients who actually can recover and has less clinical risk but who is going to see the elderly with complex medical problems and polypharmacy? Maybe the Professor would instead of working at the college seeing nobody.

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  • I hope her words have been taken out of context

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  • Food for thought: Would any medical student be admitted if at interview they were to say I want to be a doctor so I can make unworkable rules and increase the risk and paper work for everyone and work in the GMC, colleges and the CCG and I do not want to see any patients.

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  • Unhelpful comments - it is not a good business model - it is for the company but not for the NHS and patients

    Unless they take an equal amount of elderly and offer services as we do in general practice - it is not right

    Or all practices use the It solution and insist on all patients are seen via the app first.

    The funding has to change - you cannot be paid £130 for an 85 year old.

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  • I am utterly flabbergasted by this comment by HSL. She apparently has no concept of how disrupter startups like Babylon are able to keep the lights on and grow at an unsustainable rate.
    Babylon is funded by venture capitalists. Period. They are investing in the hope that one day Babylon will be big enough that economies of scale kick in and they can cash out with a return of 100:1. It is their money which is keeping the lights on, take away venture cap funding and Babylon is bankrupt. It is running at a loss and will continue to do so for the foreseeable future.
    Maybe Dr. Parsa (PhD in physics - don't let it fool you) will take it public, list it on the stock exchange and devour pension fund and mum and dad's money in the future.
    But, the bottom line it is a loss making outfit. How can HSL say that it is phenomenal is beyond me or perhaps it isn't. There is a money and people trail to this dog and pony show, which you can easily trace using the power of the internet. It is only a matter of time before they go out to their venture cap buddies to get more funding.

    https://www.crunchbase.com/organization/babylon-health#section-investors

    What the NHS is paying them for its patients simply cannot sustain Babylon, so how is it phenomenal?

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  • Arent there equality laws that come into play when a public service is blatantly weighted in favour of one group of people over another?

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  • What I want to know is as the GMS regulations say that one cannot decline a registration on grounds of age, illness, pregnancy etc. how can Babble-on get away with it?

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  • It is really interesting looking at GP at hand reviews on the Internet. It is essentially a giant online triage service. Most patients get advice and reassurance and some get a prescription. Lots of moans about how it doesn’t work once you actually need to be physically seen. Apparently only one place in London to get the bloods done. Lots of comments about how amazing it is that this service is available for free and likening it to private healthcare as it is available weekends and evenings at their convenience. No one questioning how this can possibly be done or how it is paid for or consequences. And is this surprising? Give away free stuff and you get sucked in. BUT there is ALWAYS a cost. This cannot be done for ‘free’ this will cost us all more ultimately. How anyone can believe the person who handed back the Circle contract early as it didn’t add up? It’s 21st century snake oil. Dr Parsa is clearly a very very charismatic and think out of the box, persuasive person but that doesn’t make him right.

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  • Dear Babylon,
    Can you please explain this statement?

    "NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man."

    I have no problem with disruptive technology but i may have with your statement.
    Regards
    Paul C

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  • General practice is - and always has been - based on a high volume/low margin business model. And Ali Parsa is really only the latest in a long line of business people who believe that margins can be squeezed even further from exploiting the economies of scale and the application of technology-based process change. He wants to go straight from what he sees as a corner-shop model, past supermarket, to an Amazon style model.
    Good luck, is all I can say. I don't believe it'll work. But I do believe it has heavyweight political backing - both in HMG and in NHSE. They are too scared by any other alternative - indeed they don't see any alternatives.

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  • Vinci Ho

    Ha ha ha , Bravo,well said Helen .
    Once again , you fulfill and tick the box of one sublime quality of being the chair of RCGP , called total ignorance of politics. (Remember those words ‘ no better time to be a GP’ by her predecessor ? David Cameron absolutely loved that)
    This is a war we have been fighting ; there is nothing called right or wrong , I am afraid , at least politically. Obviously, she may be already thinking about how to ‘please’ the prime minister who said ‘every penny is well spent’ if tax is to be raised for funding NHS.
    History has taught us repeatedly about any war and conflict: the fortress was always conquered from the inside.....
    My advice , if you are really on our side , speak less than more , my love .

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  • Vinci Ho

    And responding to your ‘ has a lot to learn’, you have a lot to learn about politics , Helen .

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  • AlanAlmond

    It’s an empty gimmick. The leader of the RCGP can’t see it for what it is, she thinks it’s phenomenal. Sad. I didnt vote for this woman, I don’t pay a subscription to the RCGP. This woman does not represent anyone but a small minority. Yet here she is making pronouncements. Our profession is representd by idiots.

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  • “they look after their GPs well. There is a lot we have to learn from”

    RCGP you are a joke. Nothing more.

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  • I would suggest that Helen has not taken into account that these services are likely to be increasing activity within the same budget. GP-at-Hand wont care about this as they are cherry picking the most healthy people, but if rolled out across all practices it could cause significant additional workload for no additional funding and no additional health benefit. It is akin to what happened with the Darzi WICs. the Kings Fund report demonstrated that by making access even easier they created additional workload for no health benefits.

    These services respond to patient demand and not need. This would be OK, if the public were willing to significantly increase the NHS budget to pay for it (well above the 3.5% offered as this is insufficient to keep the lights on in the long term).

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  • Who’s still paying subs to the RCGP? HSL is playing the game of ‘coming to America’ privetization. I got glaucoma by the way and I’m off to get me some medicinal cannabis 🤠

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  • Muppet

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  • Took Early Retirement

    I was so disgusted by this outfit that I told them to stuff their Fellowsip somewhere dark and moist. My wife did too.

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  • Took Early Retirement

    "Fellowship"

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  • Bob Hodges

    So 'a great business model' is one that is totally dependent on no renegotiation of the Carr-Hill formula (the one she refers to that gives a 'modest uplift' for doing actual work that actually needs doing).

    My practice has 30,000 patients too.......but more than 2,000 of mine have type 2 diabetes and more than 300 of them have NINE or more chronic diseases.

    The 'has a smart phone' set and the 'actually need experienced GP to help me manage my frailty/chronic disease or I'll end up in the big expensive hospital' set do not over lap much on the Venn Diagram.

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  • Feels like HSL would like a consultancy post when she gives up the RCGP.Glad I stopped my subs.

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  • Conflicts of interest declared?

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  • typical. a system that works in London must "work" for everywhere else? How many more times does the rest of the NHS and country have to bow and concede to what happens within the M25 and the enclosed yuppies? When will the system learn. What people want and what NHS should provide are not always the same. What they actually need is a stable Primary care system accessible to all on equal terms. - Anything else then PAY.

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  • 'App' based general practice will not work in the long run because of the medico-legal risk.

    In my mind, the only question is "who will carry the can?" - the owners of the internet based business or the doctors that gave online advice. (I think we all know the answer!!)

    The RCGP is unwise to have associated itself with a project that will, almost certainly, end in tears.

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  • I stopped my subs quite literally the day I got my CCT.

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  • Stopped my subs too.....
    HSL has nothing to offer......

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  • In defense of Helen Stokes-lampard, she did not say Babylon was phenomenal. She spoke of the phenomenal uptake by patients but she was also mindful that nhs should be a needs based service and not a want based service. But never the less she said we needed to respond to this technological change and urged for revision of how practices are being funded based on the level of needs of the registered patients. She did say the business model of Gp at hand was good - Good at maximalising the funding formula of registered patients who are generally younger and less labour intensive in their care needs but that’s not saying it is Good or phenomenal (in a good way). The rep from ‘gp at hand’ claiming support from her is frankly misrepresenting her sentiments as I heard it. She stated it was very wrong for ‘cherry picking’ at the expense of stripping resource from other practices who are left with diminished funds to care for the more complicated patients who are not mobile. At no time did I hear her describe ‘Gp at hand’ as phenomenal. Disruptive yes. Perhaps the rep from ‘Gp at hand’ can respond to comment on ‘cherry picking’ rather than the words ‘phenomenal’. I think Pulse should revisit what they are reporting regards to the event. I was there and her words were in response to my question and I think I heard every word as she was literally 1 metre away.

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  • Council of Despair

    ‘GP at Hand - disruptive innovation at its most disruptive at the moment. Phenomenal technology, phenomenal business mind behind it, actually some very good clinicians, some great training for the doctors who work in it.

    sorry, but how does she know, where is the evidence and research to back up such a claim?

    it sounds as though she is trying to get a job with them??? let's wait and see....

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  • Vinci Ho

    I do believe Helen probably did not want the message to be ‘interpreted’ in this way . However , as I wrote under Jaimie’s editorial, it is about being an highly educated and prestigious scholar NOT to be used and exploited by people with own underlying agendas (politicians, technocrats as well as businessman; the worst combination of these called Donald Trump). Political wisdom and sensitivity are far more important in time like this . People should learn from history. The painful lesson of what Maureen said and the exploitation of that in House of Commons by David Cameron , was clearly forgotten.
    As it was being alluded above , the rep from’GP at hand’ wasted no time to exploit what she said .
    You can still criticise that I am too confrontational and belligerent but this is still a war we are fighting against this morally corrupt government . Every inch of ground matters.......

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  • Helen.....Helen.....Helen.....please shut up dear .....have a cuppa !

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  • Card Igan....you did the first 2 right things...got CCT....stopped subs....now it is time for the 3rd thing.....Emigrate....get out of this sh@t

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  • Dear Babylon,
    No answer yet.

    Can you please explain this statement?

    "NHS practices receive six times more funding for each 85-year-old woman than they do for a 15-44 year old man."

    I have no problem with disruptive technology but i may have with your statement.
    Regards
    Paul C

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  • @Paul Cundy
    Don't hold your breath.
    The world is full of serial liars these days.

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