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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)

  • 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.
    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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