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Gold, incentives and meh

Revealed: How online GP company Babylon can sign up millions of patients

Pulse looks at how the private company was able to launch its scheme

Private GP provider Babylon has caused shockwaves with its plans to sign up patients from across London to its online 'GP at Hand' service.

It has started offering its online GP service on the NHS as a replacement for regular GP practices across London, with plans to expand the service to the rest of England.

Babylon promises that patients will be able to 'book an appointment within seconds' via its smartphone app and have 'a video consultation with an NHS GP typically in under two hours of booking, anytime, anywhere'.

Now, Pulse can reveal that Babylon is working with a GMS practice, and plans to use the Government’s flagship ‘GP Choice’ scheme, which allows GMS practices to sign up patients from outside their traditional boundaries. Crucially, they are allowed to ‘cherry-pick’ such patients.

GP leaders said that this model is a ‘cynical exploitation’ of the GP Choice scheme, and warned that other people would look to replicate it – leaving other practices to deal with more complex patients.

Babylon has been subcontracted to GMS-contracted GP practice Dr Jefferies and Partners, based in Fulham in West London.

Under the arrangement, patients technically join the list of Dr Jefferies and Partner but Babylon has promised that patients who sign up to the practice will have access to its ‘GP at Hand’ service – a video consultation within two hours of reporting their symptoms online.

However, it has advised that patients with frailty, dementia, pregnancy, drug addiction, learning disability and complex mental health problems may be advised to register elsewhere.

Referring to the conditions, the GP at Hand website says: 'To be prudent during the early phase of the rollout, the NHS has suggested that the service may however be less appropriate for people with the conditions and characteristics listed below.'

Dr Jeffries and Partners' business partner Rita Bright told Pulse this did not mean that the practice would 'exclude' patients.

She said: 'Our service is open to anyone within the initial London eligibility area, we don’t exclude people. The NHS has asked us to advise patients with certain conditions to seek advice before registering and our team are on hand to provide that advice.'

She added that based on pilots of the GP at Hand service, 'a broad range of patients' had benefitted from 'being able to see a GP quickly and at the patient’s convenience', including 'elderly patients who find it difficult to get to surgeries because of mobility problems and families with young children'.

However, NHS England (London) suggested that it may be of particular benefit to patients who are ‘digitally confident’ or who find it difficult to access services near where they live. But it added that if a patient has more complex medical conditions, the practice will want to see them in person.

Both the RCGP and BMA criticised the scheme for 'cherry picking' younger, healthier patients, leaving other GP practices to deal with patients requiring more complex care.

Dr Robert Morley, Birmingham LMC executive secretary, said it was 'cynical exploitation' of the GP Choice scheme, which he was sure 'lots of people' will now look to replicate.

He said: 'It stinks, because it’s rotten, and the fact that NHS England appears to be endorsing this is particularly nauseating.'

'The main implication is that practices not signed up to this will lose young and healthy patients on their list whilst becoming relatively more overburdened with sick patients with complex needs.

'The balancing mechanism in terms of the funding/workload mix of their patient list will be lost and these practices will inevitably struggle even more than they are now.'

Health select committee chair, and former GP, Dr Sarah Wollaston said on Twitter that the scheme ‘clearly has implications for wider primary care and will leave other practices with thinner resource to cope with more patients with complex needs’.

A spokesperson for NHS England (London) said: 'This particular GP practice has developed this patient offer which is included as part of their existing standard GMS service for their registered patients. The practice is subject to all the data protection and information security rules applicable to any NHS practice.'

What is the GP Choice scheme?

Under the GP Choice scheme - hailed by the last Government as a ‘significant improvement’ for the NHS - patients can register at any GP practice they want, although it is voluntary for practices to decide whether they take part.

GP practices who do accept patients not living in their area do not have to do their home visits but are still paid as much per patient.

In order to ensure patients registered elsewhere could see a GP if they were too sick to travel from their home or home area, NHS England introduced the special enhanced service.

In areas where take up was poor regional teams instead had to look to other providers to ensure patient safety.

The scheme has attracted widespread criticism from the GP community since it was first floated, with the GPC being successful in delaying its rollout once on patient safety concerns but failing the second time.

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Readers' comments (45)

  • Is the answer for practices to change their practice boundary to within 10 metres of their front door, then register all patients under the ‘patient choice’ scheme, effectively sticking a middle finger to anyone housebound or who they can’t be assed to see?

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  • This is utterly scandalous, the fact that is supported by NHSE speaks volumes. The worried well can have a cosy Skpe chat with a clinician. Meanwhile those that are actually in need of medical care, will of course be best dealt with elsewhere. As with OOH, there be many patients diverted to emergency departments, because you really cannot assess illness without knowing vital signs. Truthfully you would be as well of with Dr google or asking a mate.

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  • National Hopeless Service

    I am ‘digitally confident’ and I have a two fingered confident response to this morally bankrupt abuse of the system. I hope it fails miserably.

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  • AlanAlmond

    So tax payers are going to be subsiding a convenient health care add on for the well healed, affluent, digitally savvy metropolitan cafe brigade, all nicely laid on by a wonderful bunch of Drs in the notoriously disadvantaged and over burdened area of Fulham, London. Rubber stamped by their buddies high up in the NHS administration
    I am going to vomit

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  • Vinci Ho

    Bravo
    Clever , very clever
    When there is a 'will' , there is a 'way'.

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  • Cobblers

    "However it has advised that patients with frailty, dementia, pregnancy, drug addiction, learning disability and complex mental health problems should register elsewhere."

    But the practice does not exclude people, oh no.

    Rank mealy mouthed hypocrisy. Sophistry.

    No wonder NHSE is full of it.

    Anyone going to complain? Any legal challenge? Anybody who is frail who gets the bum's rush from this surgery going to go for breach of contract?

    As, if this spreads, why the hell should any practice take on the high users, the frequent fliers, the ones who take the time?

    Is this how the NHS ends?

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  • So patients register with this scheme andrequire home visit...now to do so NHSE has to have a contract in place to see these patient and as a GMS practice this scheme has to provide reasonable needs...... of course if no scheme for HVs in place as round here or patient wont travel to Fulham then this wont work....as for see local GP...well if not registered and at home address local GPs dont have to see

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  • Surely this is where the BMA and RCgP need to do something (for a change)

    Discrimination law should not let you discriminate against these patients. They should set up a legal challenhe to stop this happening

    This potentially will change the face go primary care in London and other areas.

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  • RCGP and HSL will do nothing as usual..... will say its contractual and nothing to do wth them.......

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  • Vinci Ho

    All the technocrats are hyper-anxious to find 'solutions' to crises right now, particularly Londonian ones .That includes those 'solutions' betraying the virtues and social norms traditionally honoured by a big institution like NHS. Yes , there is a statement of 'doing things differently' . But it does not mean renouncing the code we have been serving for long time.If general practice is really , as proclaimed , the jewel of the NHS's crown , these virtues and norms should have even more protection against any ideology for the sake of providing a political solution.

    Confucius was very much emphasising the 'WAY' (道)a regime was governing its people . When it lost the WAY , people suffered and deserted amid all the signs of the times.
    If you look at this government on the whole , you wonder where and what is its WAY?
    The domino effect of faltering offices within the government is astonishing :
    *Home Office led by a Home Secretary plagued by multiple terror attacks around general election arguably related to resource cuts in intelligence and police force by her big boss when she was doing the same job. 'Poor Amber' also had to play 'deputy prime minister' in front of television every time there was a crisis ( as the PM went AWOL so often). Like the US Secretary of State (who constantly found himself contradicted and embarrassed by totally opposite comments against his public announcements, from his big boss ) , I worry that they will soon develop generalised anxiety disorder(GAD). Poor Amber certainly looked really uneasy on TV.
    *Then , MOD when the long established Defence Secretary had to resign in face of this nuclear bomb called 'sexual harassment' just dropped in Westminster. The number of potential casualties in all parties is rising and the devastation to the ruling party and its cabinet is undoubtedly unfathomable.
    *Almost simultaneously, the Foreign Office underwent two bankruptcies of credibility in just a few days . First , you have Foreign Secretary failing to do his homework properly before speaking to the select committee in House of Commons on foreign affairs , now found his comment being used by Iranian government to convict a British-Iranian lady a crime of subversion while she was on holiday with her little daughter since April last year. A sentence of five years or more is now on the table. This is , of course , in addition to numerous embarrassing comments in public made by the Foreign Secretary as well as his arguably treacherous 4000 words essay in Daily Telegraph about Brexit.
    Even worse to the Foreign Office ,the secretary of international development had to resign tonight because of a series of secrert meetings with Israeli politicians during her holidays , without informing the office.

    All these(including the unanswered responsibility questions in Grenfell Tower disaster )happened in merely just five months .
    One can blame to some degree on the distractions from Brexit but the objective conclusion is the government has lost the WAY.
    While we(GPs) have already got used to NOT believe anything said by our longest serving health secretary, you wonder where is trust on this government going to come from? Perhaps , just perhaps , the prime minister does have the 'heart' to do the right things but this political circumstance is certainly beyond her capability to remedy.

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  • I'd be interested to read NHSE's Equality Impact assessment which they no doubt conducted as part of this procurement. I should also be keen to understand how they will ensure that this GMS practice does not decline any patient seeking to register, nor unreasonably de-register any patient. Of even greater interest, if this initiative really takes off, will be the unintended consequence of thousands of low demand patients migrating and leaving other practices with the uneconomic residue of high demand, sick and frail patients. NHSE could be faced with a wave of practice closures and difficult reprocurements, which they will have brought on themselves.

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  • Shit . Wasn't it just last week Hunt was saying GP's couldn't abandon their contract with the NHS. Just exactly what fucking contract?

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  • Who ever allowed this to be contacted in NHSE is a complete f**kwit,this is a morally criminal act the needs to be opposed forcefully.Where are our “healthcare leaders”,they need to lead,where are you the silence is deafening,can you live with your complicity in this act.Morally hollow,no wonder the flowers of our profession are abandoning this cesspit.Inam honestly saddened.

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  • Unethical, shameful and discriminatory ...........

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  • Personally i think its a great idea for young busy metropolitan essentially wealthy and well patients- I think they could find great benefit from it. The mistake is to ignore this benefit to an important group of patients and focus on the effects on the rest of the service- it looks as if it will lead to almost the same clinical workload of ill, aged, young, disabled, housebound, demented, complex multi morbid patients which is now the bread and butter of GP but without the capitation fees for the rarely attending patients who sign up to Babylon and who we will have to take back when they get a real problem. Get that sorted seriously and properly and look on the bright side. Otherwise health inequalities will rise and normal GP work will become even less sustainable.

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  • David Banner

    So....
    A healthy woman signs up to Babylon for the convenience, depriving her old GP of a capitation fee. She then becomes pregnant, and Babylon "advise" her to register elsewhere. She approaches her old GP, who quite rightly turns her down. She complains and the GP is forced to take her back. A year later a healthy mother and baby re-register with Babylon.
    Or a previously healthy Babylonian develops terminal cancer. Will Babylon throw him to the wolves now he needs home visits? Totally immoral.

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  • Cedric
    I am going to be as polite as possible here but you are talking mince.
    I suspect that you are either Dr Charles Alessi or Dr Butt and I claim my £5.
    David above nails the problem.

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  • to 1148 and 0727, completely agree with you but unfortunately I am just jobbing GP not one of the celebs you mention above- the point I trying to make is that the health service should offer appropriate care to everyone and there is nothing intrinsically wrong with Babylon's model (it may not work, just look what happened with Hitchbrooke Hospital) but our fight and resistance to it should focus on its destabilising potential on existing practices, the inability of the most needy to use it and consequent worsening of existing services for those most in need (remember the inverse care law)- otherwise we will just look like a bunch of Luddites.

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  • That spinning Jenny - it's outrageous

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  • Just Your Average Joe

    This idea will potentially lead to other practices folding, as they will have to cut staff as they will loose capitation from young infrequent attenders which effectively subsidises care for the sick, elderly and care home patients.

    Also the less heavy worload of the type of patients which sykpe can deal with, are exactly the shorter easier consultations which subsides the multimobidity complex patients with 4 problems that allow 10 minute consultations to continue without being soul destroying for a GP.

    Unless the funding for this Worried well and potentially NHS destroying policy is found elsewhere and turns this Babylon project into another White elephant Walk in like situation. There it just unearths hidden unmet demand - and duplicates services already given, where they are told see your GP for review/examination anyway often.

    Destroying the NHS piece by piece, and this will take another chunk.

    Cynically the thought of a 10 m boundary and take all young patients and leave sick and elderly without care will be the future if the precedent of Babylons model of discriminatory care is not stopped now.

    Of course NHS England will try and allocate patients to other practices, but Babylon will be allowed to cherry pick easy work, which is exactly what the private sector did when sent in to help hospital wait lists and took all the quick easy cases leaving the sick and challenging cases for NHS trusts, unbalancing their books, leading to deficits as they couldn't earn money from the easier cases.

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  • This is an existential threat to traditional community-based general practice, to the ethical delivery of healthcare to the whole of the population, and to the profession.
    This is now the moment that the GPC and the RCGP need to take a stand. Their entire credibility as organisations representing the interests of the profession depends on this one single matter. Richard? Helen? Where are you?

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  • What happened to all the politically correct key words like equality and tackling variation? Guess reality has struck and in the real world nothing is free.

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  • lets hope a million people register and watch how they cope with demand then !

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  • Blatantly discriminatory and in breach of the GMS contract. NHSE should be held to account for not enforcing an important part of the contract, included to protect patients from just this kind of behaviour.

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  • Simply change the way we are paid . £10 per week for complex cases . Cost of a local phone call for the babble-on-a-lots. Job done

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  • Appalling!

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  • I think if Babylon is allowed to choose patient then we should also have a choice who do we register and there should be different payments for different patients. for eg for healthy young patients which Babylon wants to register they should be paid 20 pounds/ year and for more complex patients rates can go up depending upon need to 100-200-300-500 pounds. then only it will be fair

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  • Single handedly the most disgusting thing I've ever witnessed that involves the NHS, and that's saying a lot.

    Where are BMA and RCGP on this? Oh yeah probably busy buying shares in Babylon

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  • https://www.hsj.co.uk/technology-and-innovation/nhs-england-picks-babylon-for-flagship-patient-app-pilot/7020968.article

    Read through the article to see that two Apps have been selected by NHSE. I understand the other one is owned by Clare Gerarda and Arvind Madan? Might there be a story here, Pulse? Also it might be interesting to know who has shares in Babylon?

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  • Who are the GPS working for Babylon? How are they paid? Where are they based? Is it like s massive call centre? Sounds like a profession devaluing itself again in the eyes of the general public. Would have made more sense if some fee involved.

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  • The doctors doing this will be under massive more clinical risk,
    .

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  • There is no clinical risk because there is no clinical need.

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  • Write to your MP!! This will be like a wildfire through primary care. No one will pick up the frail elderly that are left behind, £120 a year isn't going to pay for that. I don't think even the idiots at JC HQ would do that intentionally. It would be near psychopathic!

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  • How does this work under UK and EU procurement law? The GMS contract quite rightly outlaws discrimination with regard to registering patients. By turning a blind eye to this part of the GMS contract, it seems to me that NHSE are effectively awarding a substantially changed/new contract. Given the potential high value of this service, I am wondering whether procurement laws have been appropriately followed.
    Pulse - any chance of an FOI asking for the evidence which shows due lawful process has been followed? And on DT's earlier point, how about an FOI asking about declarations of conflict of interest at NHSE in relation to this and similar services?

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  • Dear All,
    Just think about the economics here. Dr Jefferies and Partners get the standard NHS capitation fee for whoever they reguster under this scheme, thats approx £120 for the first year. They get paid this quarterly. They then subcontract to Bablyon to provide a Skype and on-line service. A practice I know was offered the Babylon service for approx £100 per patinet per year or about 75% of the capitation fee. The patients they are attracting may well be less ill than most but when did abscence of illness stop people consulting? They are from the "me me everything instantanoeusly" generation, they have worries whetehr or not they are ill. My ball park estimate is that its going to cost at least £15-20 to provide the GP to take each Skype call so it does not take many skype consultatiosn per patient to render this service uneconomic. The avergae national consultation rate is 6, thats £120 per year at £20 per Skype. If these screen adicted patients find this service convenient and acessible then i begin to wonder how thin that profit margin might be. Remember of course that Dr Jefferies and Partners are not allowed to charge their NHS patients for anything they may need so they can't monetise that way.
    Finally Dr Jefferies and Partners only get paid according to the patients on their list on each quarter date, so patients who regster, have a couple of Skypes, don't allways get the ABs they want and then register elsewhere before the end of teh quarter will consume all that resource but result in no NHS income at all.
    I'd say lets see how this pans out.
    Ali Parsa has raised £60m to run Babylon, interest rates are rising and few other private providers have ever made a profit from the NHS. Lets see if Dr Jefferies and Mr Parsa can.
    Regards
    Paul C

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  • Paul cundy, more likely once you are near your consultation 'limit' they'll just make up some BS to remove you and keep the profit. Given that NHSE are allowing such blatant discrimination I doubt they will care.

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  • Paul-you will have to remember that the patients they are 'poaching' will likely have much lower annual consultation rate that the elderly frail with as previously mentioned the fallout for remaining practices on consultation rates and financial instability. Seriously NHS England get a grip.

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  • I need some help understanding this as I don’t understand contracts well (having skipped the whole partnership thing so far). If they can do this i.e. claim GMS money whilst being allowed to cherrypick patients then surely any GMS provider can? And whilst I know the majority of practices would not pursue this either through compassion for their patients or actually wanting to do more than pander to the worried well, I can help but think less scrupulous providers will do so and this will destabilise an already decimated primary care?

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  • Paul,
    Normally agree with most of what you say, but a sit and wait approach too risky here with so many practices close to the edge.
    For patients it is discriminatory - and equally so for practices for whom now different rules apply.
    One for BMA to make a big noise about.
    Practicing in Scotland I don't have a dog in this fight (currently), but this is batshit bonkers and should be easy to fight.

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  • Two of the practice partners are also medical directors at Babylon. Seems reasonable.

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  • Just Your Average Joe

    I am going to get a stack of Babylon leaflets and hand it out to patients who want repeat prescriptions for controlled drugs, sleeping tablets and those who are suicidal and ring for advice at 6.24pm.

    They are all part of the population who will benefit from 24/7 access to a GP.

    Also the ones who come in with a sore throat for 27 mins, and the just in case brigade.

    Once I help them find the access they strive for, I will open up some space to see the chronically sick and unwell - what I trained to do!

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  • So presumably when the out of area bods decide they want to be seen at their "regular home" practice they will have to be welcomed with open arms and seen as TR's - otherwise known as "for free" as I dont think anyone has had a TR payment in the last 10 years.....

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  • AlanAlmond

    If you have a smart phone go to the App Store , down load the Babylon app and write a review giving it 0/5 and explain why this is such an evil resource diverting waste of NHS resources

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  • Here is to hoping the indemnity fees for any GP that signs up this are upwards ob £30,000 per annum.

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  • Looks like an obvious breach of the equality act.

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