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Independents' Day

The true privatisation of general practice

Editor’s blog

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To borrow a phrase from this digital age, making someone number one on the Pulse Power 50 doesn’t imply endorsement.

Dr Mobasher Butt might not be the most popular GP in the profession, but the power of Babylon – where he is medical director – is immense. As we report in our cover feature this month, Babylon’s GP at Hand model has precipitated changes to the GP contract, caused its host CCG to borrow hundreds of thousands of pounds from neighbouring CCGs and request millions from NHS England, and created ‘anxiety’ among traditional practices.

Yet I believe the most salient – and concerning – aspect of the GP at Hand model is the private sector philosophy it is bringing to general practice.

Some will admire the way Babylon and its competitors work. The beauty of the GP partnership model is its ability to innovate, and there is no denying Babylon and its partner practice, Dr Jefferies in west London, are innovating. They have taken advantage of a change to regulations in order to extend their reach to patients outside their practice boundaries, and used it to full effect.

New providers have seen the opportunity presented by NHS underfunding

Babylon hired an advertising firm to focus on two London boroughs with a high number of 20- to 39-year-olds, according to media website The Drum, and devised a plan to target young commuters on the capital’s Overground line and those who cycle to work. And, like all successful big businesses, it is looking to expand.

I can’t think of too many practices that have used such tactics to increase their lists. But now other private providers are looking to partner with GP practices, offering video consultations or symptom-checkers in a bid to improve services to patients and give them a competitive advantage over neighbouring practices – with, of course, benefits for the companies themselves.

So what is the problem with this? Putting aside the lack of evidence for increased use of technology, we need to ask whether we want a private sector philosophy. Innovation is great and should be rewarded – but in the context of improving patient care, not having the best-targeted marketing campaign or aggressively registering those patients who provide the best profit margins.

But it may be too late to ask this question. It is coming at a time when NHS England is encouraging large-scale working, with the incentive of major contracts to provide various services. Managers may talk about collaboration, but the effect will be large groups competing for contracts and – yes – for NHS patients.

It also comes at a time when practices are struggling. The new providers have seen the opportunity presented by NHS underfunding. Babylon’s success is based on instant consultations that are beyond the capacity of hard-pressed, under-resourced GP practices – unless, of course, they partner with private providers.

Last month, The Guardian reported Virgin Care had won £2bn of NHS contracts. In my view, though, the rush to introduce this private sector mentality is a far more pervasive form of privatisation than anything conjured up by Richard Branson.

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

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Readers' comments (10)

  • Vinci Ho

    I am glad that you clarify your stance , Jaimie. I can accept that ‘Power’ refers to both White Kinights and Dark Knights; Saviours and Destroyers .
    This is a historic moment in our history of family medicine/general practice in this country. While we are already up against oppressive technocrats and politicians , one could only hope the castle would not be conquered by those from inside ......

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  • Let common sense prevail

    We (the NHS) need to embrace what is good about GP at Hand, rather than adopting an ostrich-like posture. For me it will not replace traditional general practice, but it could revolutionise NHS111, which is currently both expensive and ineffective. That's where the focus should be.

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  • @Let common Sense Prevail:
    Although there may be some merit in what you say the trick would be to make sure that GP at Hand and its like do not destroy traditional general practice in the meantime by creaming off the fundingin a grossly iniquitous way.
    I don't have any respect at all for the likes of Dr Butt because he knows exactluy what he is doing, and it is not principally for the benefit of the patient. i have ecven less respect if that is possible , for where NHSE lie in all of this.

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  • Let common sense prevail | GP Partner/Principal30 Aug 2018 8:59am
    "We (the NHS) need to embrace what is good about GP at Hand"

    Hear! Hear! Let's keep on our lists only the 20-39 year olds and get rid of the rest (a bit of Euthanasia will be helpful)

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  • Time to make the funding structure more complicated.Age,pathology, need waiting.The fit worried well need a lesser waiting.Money needs to follow need no want.We could always do what the rest of the world does,co-payment anyone.GP at hand getting the same payment as a GP slogging their days out with high prevalence elderly and mental health patient is grossly unfair that dealing with worried wells on the phone or internet.Equity.If we all had the choice of selecting our list in the current regime we would get rid of loss making patients.

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  • weighting

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  • AlanAlmond

    You grossly over state the power of these people. As a publisher who spends his life on a laptop, probably monitoring twitter and social media generally, like the whole media caboodle, all based in London, just up the road from these guys, it’s easy for you to think you are at the centre of the universe and it’s all happening right there on your computer screen, because this my friends is ‘the future’. I think you guys generally are all a little deluded.. that’s you folk who do media. Life exists elsewhere. You are forever smelling your own backsides. These London based money grabbers perform a tiny fraction of GP work and a toxic and destructive one at that. You obsess over them because they are doing this just up the road from you and it’s “digital” - wow how you love that. You buy into this because it resonates with you , and your kind, you distort everyone’s reality by over stating their importance and build up their power by pushing it again and again until everyone shrugs their shoulders and starts believing this rubbish is inevitable. It’s a self fulfilling thing which is being repeated over and over. It’s bull shit. This isn’t reality, but it seems it has been decided, at least in the media, soon we are all disappearing into a nasty, binary world.

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  • Does anybody actually know what they do?

    85% managed over the phone,or internet!

    In an NHS drowning in academics,where regulators live under every stone,with endless meaningless publications,where is the book of babylonian clinical practice.

    Certainly all the current textbooks need rewriting,the exams restructuring and the hierarchy replacing.Actually that might be one positive out of this.

    If this guy is so powerful and influential could he please publish something,anything,guiding the rest off us as to how to manage a cough etc over the phone.

    Don't the GMC have some requirement to spread innovation to colleagues

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  • Great essay in this weeks BMJ A challenge to rekindle an altruistic spirit rather than profiteering from the NHS. Where is general practice heading? Where are we being led and who is leading us?

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  • Just Your Average Joe

    Babylon and all the private services looking to skim off money from the NHS - need to be reported to the GMC for effectively breaking the requirement to do no harm.

    If the RCGP criteria of community orientation is look at - they are harming the overall health economy and directly causing harm to patients at neighbouring practices - as they steal valuable resources which in turn will reduce the ability to recruit and keep staff who may also be poached off.

    BMA report them and help your members by protecting them from this DOH led and supported policy - as the GMC can for once show itself to be protecting patients and supporting doctors.

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