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GP at Hand isn't just a London thing

Editor’s blog

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I can understand if some readers might think we are being too London-centric by focusing so much attention on Babylon’s GP at Hand practice.

As you may or may not know, the practice based in west London has attracted more than 30,000 patients by offering speedy video consultations on the NHS. The official review of the scheme found that patients flocking to the practice tend to be young, fit, healthy, and candidates to become PM.

These patients are leaving their current practices, who are left with older and more complex patients, which is putting strain on them – and local commissioners.

It also seems that they have been allowed to do what many practices thought they couldn’t – start a primary care network that wasn’t based on geography.

This is not just a local issue

But this is not just a local issue. Babylon have made it clear that they will be branching out to other cities in England. And it won’t just affect those cities – as they use video consultations, their service is available to people living outside those cities too.

The report concluded what we already knew – that the funding model as it stands is not appropriate to deal with this new model of primary care.

As Babylon move outside of London, more young, healthy patients will be signing up to the service – and it may be your practice whose funding suffers.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (10)

  • Just provide a funding model that reflects appropriately.
    SORTED

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  • What determination of funding and costs would you want?

    Naturally? i.e. free market forces
    Artificially? i.e. as set by the state

    I know which I would choose, and which works better globally...

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  • The present funding model is based on money following patients with a few adjustments which used to make sense when the complexity evened out over list sizes. This no longer works and practices are going under. The funding should instead follow workload, the number one concern amongst GPs. In practice this would mean more item of service claims becoming available from the GMS contract. Free markets tend to work poorly in healthcare as exemplified by the USA model but the European co-payment models do seem to strike a fairer and more sustainable balance when appropriate regulation is in place.

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  • What's your definition of 'poorly'? The USA is not a 'free market system'. It is free-er than us, but contains the worst of both worlds - a highly regulated private sector, and a heavily subsidised public sector. Plus, they are unhealthier in lifestyle vs us. Therefore, their costs are higher and cost effectiveness is low. Plus, if you're happy to be underpaid by the state as a GP (vs global market value), in order to say oh the NHS is cost effective, then you're essentially supporting the continued wage suppression of your fellow professionals.

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  • https://www.commonwealthfund.org/press-release/2017/new-11-country-study-us-health-care-system-has-widest-gap-between-people-higher

    @Thursday
    Agree about the free market US healthcare system which despite its very high costs in terms of GDP relative to other countries, still manages to manage to price a significant percentage of its population out of basic healthcare.
    . As Dr Turner pointed out in his Pulse article the other day we have been driven to this point by a cynical Govt who are fattening up the NHS for a corporate takeover slaughter- probably lead by companies from the US.
    The irony is that the Tories have been using state control such as manipulation of workload and pensions, and organisations such as CQC and GMC to further destroy the availability of a previously successful national insurance system. They have also cynically stoked patient demand (that village idiot Hancock just another recent exemplar) and also continued with basic underfunding. No fuel, car won't go.
    That is how we got here, how do we get out? Perhaps if it could be reflected to patients how much they would stand to lose if they lose the system. It is amazing to think that patients currently have 'all you can eat' ticket to General Practice for less than a TV licence each year. I certainly would favour mandatory printing of the prices of prescriptions on the GP10s.
    I agree with the payment following workload principle but I can't see that happening when the current Conservative Govt are trying to destroy something by overloading it.
    My practice has a poor demographic and my principal concern about payments is how this would affect them and their access to healthcare, although I am sure this could not be beyond solution.


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  • Lol keep peddling the myth that US healthcare is 'free market', it isn't completely 'free market'. Ignore the pre-existing health/lifestyle differences demographically too.

    Plus, lets keep borrowing more to spend on healthcare/in general. No, we're not mortgaging the futures' of our children. Instead, the state will have more to spend on quangos like the CQC, GMC, etc, or locum clinical directors, or personal health budgets, or homeopathy, or religious circumcisions, etc. Sounds worth it.

    Also, lets not bother about the fact that taking responsibility away from the public encourages less responsible behaviour. Or that a 'free' service is valued less/abused more.

    Spending was already high before the current Tory govt. The NHS 'all you can eat' system was always going to be unsustainable as it grew. Yes the current govt are bringing the system down without being honest with the public, when they should be selling my argument honestly. Sure Angus, the solution that by all historical accounts helps the poor the MOST (i.e. lifting of ABSOLUTE poverty), is free market capitalism, a limited state/spending, and direct innate altruism/social virtue. As opposed to your/and the CWF's focus on RELATIVE inequality. If Venezuela/North Korea had less health inequality (i.e. everyone is poor), would you want to adopt their system?

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  • Just one question.
    In your vision how do you manage those who genuinely can’t afford it?

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  • 1. I've answered this for you before Angus. There will be less of those who 'genuinely can't afford it'. Smaller state, bigger economy, greater responsibility lying with individuals and family.

    2. Look at how other 'free-er' states do it. Australia & Singapore for e.g. has a base level medical insurance coverage. They also allow for family members to cover each other. What do you mean by 'it' exactly? Emergency treatment only?

    3. With greater liberty and spending power, the natural outcome is that innate altruism would flourish. E.g. Bill Gates Foundation, Jeff Bezos's Amazon employee training program, etc. At the moment, there's nothing stopping you personally Angus, from helping the worse off directly. Convincing the better off to help their fellow man directly for the good of all (humanism) is far more effective than compulsion via taxation through the state. And it doesn't harm the whole like the state does.

    4. Healthcare isn't isolated of course, and is closely linked with welfare, immigration policy, education, etc. Changing direction means fundamental reform on the role of the state in all these sectors as a whole. Now I'm not an anarchist, and not arguing for NO state, but clearly, our nanny state has gone too far to the left. End result? A £2trillion debt, frontline public service workers leaving an authoritarian regime, breakdown of the family unit, poorer education outcomes, the attack on free speech...

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  • So your answer is basically that there is no safety net.

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  • Jeez, I keep having to repeat myself with you... Is that really how you're taking/misrepresenting what I'm saying?
    By suggesting Australia & Singapore I'm advocating no safety net? My point is that our safety net is too BIG, and should be reduced.
    I've stated before I could be convinced for base level emergency treatment and access to primary care to be covered/subsidised.

    The safety net is also trust - in yourself to maximise your potential, in your family and loved ones to help each other, in the generally good nature of the wider public, and not the state. Who for every £1 the state spends, is 1 less £ in the market, and for every person the state hires, is 1 less person to grow the economy. Not to mention the less responsible way the state spends taxpayers' money...

    You don't really listen, and choose to misrepresent, and only respond to targeted points. You're possessed by the 'Animus of Ideology' as Jordan Peterson describes it, and it shows. Go watch his interview with Cathy Newman - "So you're saying....." lol

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