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GPs buried under trusts' workload dump

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)

  • 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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