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GPs go forth

'We have a number of serious concerns about the GP at Hand service'

Londonwide LMCs chief executive Dr Michelle Drage has reservations about Babylon’s bid to attract Londoners to switch to its online ’GP at Hand’ service

We have a number of serious concerns and questions that need to be answered: Who is ultimately responsible for NHS England commissioning the service?

What evidence from pilots has been published in recognised journals to suggest it is of greater benefit than similarly resourced general practice, A) to patients? And B) to GP practices serving their current registered patient populations?

How is this not promoting cherry picking of comparatively healthy patients ahead of those with complex needs, when both are assigned the same level of funding while local general practices are forbidden from doing so?

How is good for continuity of care that a patient who has been encouraged to switch their registration to a new provider via an extensive advertising campaign can then be told to de-register if their medical needs increase to the point where they can only be effectively served by a local general practice?

Dr Michelle Drage is chief executive of Londonwide LMCs

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Readers' comments (10)

  • I think Dr Drage should be contacting the Fawcett society ( a campaigning group for women) as excluding pregnancy discriminates against women, and MIND , Mencap as this will disadvantage the mentally ill and Scope etc who argue for disabled. If we allow this where else will discrimination appear ?

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  • Vinci Ho

    All the technocrats are hyper-anxious to find 'solutions' to crises right now, particularly Londonian ones .That includes those 'solutions' betraying the virtues and social norms traditionally honoured by a big institution like NHS. Yes , there is a statement of 'doing things differently' . But it does not mean renouncing the code we have been serving for long time.If general practice is really , as proclaimed , the jewel of the NHS's crown , these virtues and norms should have even more protection against any ideology for the sake of providing a political solution.

    Confucius was very much emphasising the 'WAY' (道)a regime was governing its people . When it lost the WAY , people suffered and deserted amid all the signs of the times.
    If you look at this government on the whole , you wonder where and what is its WAY?
    The domino effect of faltering offices within the government is astonishing :
    *Home Office led by a Home Secretary plagued by multiple terror attacks around general election arguably related to resource cuts in intelligence and police force by her big boss when she was doing the same job. 'Poor Amber' also had to play 'deputy prime minister' in front of television every time there was a crisis ( as the PM went AWOL so often). Like the US Secretary of State (who constantly found himself contradicted and embarrassed by totally opposite comments against his public announcements, from his big boss ) , I worry that they will soon develop generalised anxiety disorder(GAD). Poor Amber certainly looked really uneasy on TV.
    *Then , MOD when the long established Defence Secretary had to resign in face of this nuclear bomb called 'sexual harassment' just dropped in Westminster. The number of potential casualties in all parties is rising and the devastation to the ruling party and its cabinet is undoubtedly unfathomable.
    *Almost simultaneously, the Foreign Office underwent two bankruptcies of credibility in just a few days . First , you have Foreign Secretary failing to do his homework properly before speaking to the select committee in House of Commons on foreign affairs , now found his comment being used by Iranian government to convict a British-Iranian lady a crime of subversion while she was on holiday with her little daughter since April last year. A sentence of five years or more is now on the table. This is , of course , in addition to numerous embarrassing comments in public made by the Foreign Secretary as well as his arguably treacherous 4000 words essay in Daily Telegraph about Brexit.
    Even worse to the Foreign Office ,the secretary of international development had to resign tonight because of a series of secrert meetings with Israeli politicians during her holidays , without informing the office.

    All these(including the unanswered responsibility questions in Grenfell Tower disaster )happened in merely just five months .
    One can blame to some degree on the distractions from Brexit but the objective conclusion is the government has lost the WAY.
    While we(GPs) have already got used to NOT believe anything said by our longest serving health secretary, you wonder where is trust on this government going to come from? Perhaps , just perhaps , the prime minister does have the 'heart' to do the right things but this political circumstance is certainly beyond her capability to remedy.

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  • I thought we weren't allowed to advertise? Is there something fishy there as well?

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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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  • Just Your Average Joe

    This should have discussed and resolved before they were given the go ahead for this model and started their advertising campaign.

    They didn't as they knew it is harder to put the genie back in the bottle.

    Whoever authorised this should resign immediately.

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  • Perhaps a capitation model that reflected the likely primary care needs of a patient would be the answer for those who wish to continue a single payer model?
    So healthy well patient is worth £20 a year and nursing home multimorbid patient is worth £500/year.
    If the £20 patient develops chronic diseases their existing practice still manages them, but in the next year their NHS supplement goes up to the appropriate band.
    Thus practices are incentivised appropriately, but may also choose to specialise in particular patient groups, without that penalizing practices who offer a good service, or who put barriers in the way of the truly ill such that they register with another local practice.

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  • The only answer is payment per activity. You do more, you get paid more. You do less, you get paid less. This payment should be a reflection of the type of activity as well.

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  • Michelle, you need to stir GPC and RCGP into taking immediate action.

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  • DT - tomorrow is the England LMCs conference - I'm guessing Tea Time might be a good time to check it out - they always save the best til last.

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  • What are these consultations over Skype etc going to be about? What can you deal with over the phone that is a first presentation, actually needs medical advice and doesn’t need face to face assessment. Colds and sore throats? Don’t need any assessment, maybe a rash might work. Even contraception you need a BP most of the time. I can understand using phone calls to follow up or maybe titrating meds’ for known patients etc but what is the actual point of this service??? It seems like a massive amount of money to spend on doctors for people who don’t need doctors

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