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The waiting game

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)

  • 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

    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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