Big interview: What is the future of England’s biggest GP practice?

Babylon caused shockwaves when it took over a West London GP practice and offered NHS patients the chance to have speedy remote consultations through its app. NHS GPs were concerned that it would ‘cherry pick’ young patients, affecting the sustainability of general practice in London and beyond. Some of these fears were justified – the ‘GP at Hand’ practice became the largest in England. However, it wasn’t to last long. Babylon became financially unsustainable, in part due to the realities of GP funding.

The GP at Hand practice remains the biggest in England, and now it has been taken over by eMed UK. Rhiannon Jenkins spoke to its president of global clinical services, Dr Tim Rideout, about eMed’s plans

General practice is struggling right now, especially in the UK. Why did you want to take it on?

Most of my healthcare career was in the NHS, and I have a really strong view: that primary care is the jewel in the crown of the health service. One of the reasons why I was happy to come to what was then Babylon was because it focused on NHS general practice – not just providing it, but thinking about how it can be improved upon in terms of quality, and particularly in terms of access. So, I’m really proud of the fact that Babylon established the fastest-growing NHS practice list in the history of the service.

Now, I think we work really hard to make sure that our patients enjoy really great quality and access as good as we can possibly provide within the GMS contract. I think it speaks to the future of our relationship as part of eMed because good general practice isn’t just about sick care, it’s about caring for our patients in a proactive way. That very much leans into eMed’s desire to be all about chronic care management and keeping people healthy. 

Going forward, will you continue the GP at Hand service?

Yes, 100%. We’ve done a lot of work on the operating model, and we’ve maximised the skill mix. We have a very diverse workforce so that we can get our patients to the appropriate clinician the first time. Back pain, for example, never goes to doctors; it always goes straight to physiotherapists for consultation. All of those things have meant that we can operate sustainably within the GMS contract. It’s not about generating significant sums of profit, it’s about developing operating models that work and show how we can contribute to the health of the broader NHS system. And eMed is very committed to that: when they were looking at acquiring Babylon, one of the things that attracted them to us was our support for the development of GP at Hand. So, unequivocally, GP at Hand is very safe with eMed.

Babylon had failed to make GP at Hand profitable and relied on money from the company’s private healthcare arm to keep it afloat. Will that arrangement remain the same? 

No, because even before the acquisition, we had got to the point where GP at Hand was sustainable in and of itself, and that will continue. We worked hard to improve the model to make sure that it was sustainable. Some of the things that were talked about in the past are no longer true. 

Under Babylon, it is reported that patients were booking more appointments than they were allocated. Do you think that may have contributed to the company’s financial problems? 

I don’t think it did contribute to Babylon’s broader problems. The main issue was the flotation on the New York Stock Exchange, and the expectation that that would generate sufficient capital until profitability for the broader corporate body. The UK has always been much more financially sustainable than the rest of the Babylon proposition, so the real issues were effectively overstretched in the US. The capital just didn’t materialise on the back of the flotation. Really, the UK didn’t in any way contribute to Babylon’s broader financial problems. We are a sustainable unit, and working with eMed now means that we’ve got really strong backing, which we can continue to develop. Particularly, we can pivot to our focus on lifestyle support and chronic care management, and we can now use this partnership to help our patients benefit from these things. But those broader corporate financial issues are now fully resolved with this acquisition. We no longer have any of those problems.

Some have criticised GP at Hand for favouring younger, easier-to-treat patients. Will it offer a more inclusive service, or will it still focus on digitally savvy patients? 

I think the idea is that we pick patients, and the implication of that is that you exclude others. That’s simply not the case. Our demographic is slightly different because we have more working-age adults than normal general practice, but we do have young children, and we do have elderly patients. Effectively, we provide care for people who live or work in support of our clinics, and that just means we attract a certain demographic. But we haven’t gone out and picked patients; any patient can apply to join us, as long as they live or work 40 minutes away from our clinics. In fact, as the practice has grown, and as people have enjoyed our service, word of mouth has meant our demographic is moving ever closer to the normal GP practice demographic because people are signing up and bringing their families and friends with them. And I think more and more, cross-generationally, people are digitally savvy anyway – and they’re choosing to use the access in that way. 

Your patient list is only open to people who live in the catchment area of the home practices. Do you foresee this continuing to be the case, or will it be widened to the rest of London again?

It’s constantly under review. We kept the list open in the terms that you’ve described, but it’s very likely that we’ll be opening the list wider again very shortly. You probably can appreciate that we kept it tight during the period of our acquisition because we wanted to make sure that our corporate foundations were solid. Thankfully, they are now that we’re part of eMed, so we can start looking at extending patient recruitment. We get a lot of people coming to us – we haven’t marketed GP at Hand for a long time, and despite that we get hundreds of applications to register every month. We know that the model is working for people, and we know that it’s attracting people.

Do you aspire to go beyond London? We know that Babylon had tried to take on a practice in Birmingham, but ended up having to close it down. 

I think London is very much where we are at the moment. One of the reasons why we struggled out of London was because we weren’t connected with all of the referral networks and the integrated care networks. We just weren’t part of them, and that’s why we struggled when we had the Birmingham practice. Since then, the system has moved to integrated care systems and integrated care boards, and they seem to offer new opportunities for us to think about how we can engage in those systems. But for the moment, our NHS focus – at least in terms of general practice – will be solidly on London.

What about taking on other GP practices, is that an ambition you may have in the future?

We wouldn’t rule anything out. I think it would depend on the opportunity that presented itself. I think one thing we are committed to is looking at how and where we can help with the overall NHS challenges. That may be around more general practice, but also working with secondary care. We have a really good tech platform and clinical operating model that can help with a number of NHS challenges, so we’re open to doing more with the NHS. But the core of our offer remains GP at Hand, and it remains in London.

Please note this interview has been edited for clarity