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Independents' Day

Expanding GP at Hand app is a full frontal attack on general practice

Dr Kailash Chand

Dr Kailash Chand

So the new health secretary has joined the political bandwagon to destabilise general practice.

It started when new labour adopted the Polyclinic model. Subsequent Tory administrations, with Andrew Lansley’s Health Act compounded by Jeremy Hunt’s pitching of GP against GP, has starved primary care of necessary funds and resources.

Now it is Matt Hancock’s turn, turning this steady war of attrition into a full frontal attack through Babylon’s ‘GP at hand’  app.

The crisis in general practice is unprecedented. Mr Hancock’s ‘solution’, to roll out GP at Hand across the country, could finish it off for good.

The aim of these measures can only be to grind down the current model of general practice

Babylon is happy to provide its services to anyone. Except it advises a woman who is, or may be, pregnant that it might not be suitable for their needs; nor for someone with complex mental health conditions; nor for a person with complex physical, psychological and social needs. And those with dementia or other old age conditions related to frailty or end-of-care needs are gently reminded they might need a GP closer to home.

In short, GP at Hand will readily register patients who provide the best profit margins but not necessarily those who need more resources. What this means is the funds for these healthy and worried well will boost private shareholder profits, while the traditional GP is left with dwindling funds to look after the needs of ill, old and vulnerable.

The new GP in Hand app undermines the basis on which GP practices achieve financial stability. Each time a patient registers with GP at Hand they become deregistered from their current practice, and the funding goes with them.

GP practices in London have seen their list sizes ‘shrink for the first time in years’ as a result of the app's expansion, which is destabilising them financially. The aim of these measures can only be to grind down the current model of general practice until it fails and large private providers can be brought in to take over.

No app or algorithm will be able to do what a GP does. Patients need continuity of care and rightly expect a personalised service from their own GP rather than an appointment with an anonymised distant call centre. The GP at Hand model threatens the very survival of NHS general practice.

Dr Kailash Chand is a retired GP in Tameside

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Readers' comments (12)

  • AlanAlmond

    It’s not up to you what happens. That’s the politicians job. You need do as you are told. The tax payer votes in the politicians and they run the NHS. Nurses, Doctors, HCAs, everyone - are employees and it’s not up to them how things are organised. Don’t like it? Go work for somebody else. Oh, I almost forgot responsibility lies with you. Don’t screw up because it’s you that’s accountable, no body else. So this app thing...not really your business to mention it. Just do the job or p£&s off..and stop making suggestions, no one in a position to do anything is interested.

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  • Milton Friedman said - I do not believe that the solution to our problem is simply to elect the right people. The important thing is to establish a political climate of opinion which will make it politically profitable for the wrong people to do the right thing. Unless it is politically profitable for the wrong people to do the right thing, the right people will not do the right thing either, or it they try, they will shortly be out of office.

    How do you change the political climate, I hear you ask lol You vote for the TRUE conservative/classic liberal parties, you influence and convince anyone who will listen, through rational debate, of the downfalls of socialist policies, and if you have to, you leave, i.e. braindrain

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  • "New... powerful... hooked into everything, trusted to run it all. They say it got smart, a new order of intelligence" a quote from Babylon??? a quote from The Terminator movies.


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  • This kind of article always brings to mind the Japanese holouts of WW2, fighting on not realising the war was lost a long time ago.

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  • Large private providers already dominate general practice. Believe it or not some are GPs who large providers. General Practice needs a wholesale reform so that there is a level playing field for all. Let the first reform be that it is easier for new comers to open new practices.

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  • LOCUMS are doing the big companies' dirty work by destroying partnerships. The short-termism of locum work makes sense for the elderly and some middle age GPs (good money, flexibility, no administration and no responsibilities). But what baffles me is the young GPs' attitude. Do they not realise that once partnership is dead and the big guys have the monopoly, they'll make them work double for half the money?

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  • If they want GP at Hand and Practices fail: so sad but so be it. At least it becomes their fault. We warned them. The patients have an entitlement to Primary Care from their CCG: if they can't procure this via local contractors they get the final corporate manslaughter wrap....stop propping them up. The hard bit is stepping away, especially in a last man standing scenario. I did it and I now sleep well! Stop feeling responsible. Some CCGs really understand this balance of power. If they do, stay put and it will be fine. If they don't, walk away and come back as a sessional on double pay. Take control of your work / life/ responsibility. You are supposed to be smart for g*d's sake....

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  • The important issue is this: GP runs on a capitation fee per patient. Some patients are cheap to care for others less so. If a new provider takes JUST the well ones (cheap), other GPs will struggle. In a system already struggling, most will have to drop the amount and quality of care.

    If voters knew this, it might be easier to debate it.

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  • Market forces kicking in like in the rest of the world but everybody seems surprised. How long did we expect to go on the present payments per patient? it was nor real, was it. That some Practices had it better than others doesn't make a difference.
    Just received a leaflet inviting me to join another GP co-op that allows Locum work from home paying £100 per visit during the day and £150 in the evenings and night. This is the system, I've worked in the past in Australia and it's convenient, lucrative and good for the GP.
    Change is coming and cardigans especially those who earned a lot more that the ordinary GPs don't like it - how could anybody earn more than them - sacrilege ain't it !

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  • Why does everyone run around in circles here? It's not rocket science.

    The basic question is: how can government stabilise payments to GPs so that it is appropriately profitable for them to continue to provide services to patients who aren't suitable for telemedicine solutions?

    In essence it simply means a decent re-tweak of the Carr-Hill formula. My suggestion would be reduce the remuneration somewhat for patients who are being seen via telemedicine, because they are likely to be far less demanding on time, and increase the remuneration hugely for those who are still seen face to face. This would be fair and just all round, allowing the benefits of new technology to take place, suitably rewarding those who do the telemedicine while also appropriately remunerating those toil away seeing the much more intensively demanding clinical situations that remain.

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