The collapse of Babylon Health doesn’t spell the end of digital healthcare, but it does show we need to understand our patients better, argues Dr Jay Verma
As a practising GP, I am all too aware of the intense pressure our profession is under. Data from earlier this month revealed we delivered 29.4 million appointments in June this year – a number which is equivalent to winter-level demand.
Yet, one of the biggest complaints from patients is about their problems accessing their practice. So it’s no wonder when Babylon Health offered a digital service, which allowed people to interact with healthcare professionals online, it was heralded by users as ‘the best thing ever’.
I am hugely grateful to Babylon for leading the way and making digital access a reality. The ability to contact your practice online is now ubiquitous, and personally it makes it much easier for me to triage patients and ensure that we don’t allocate appointments based on who dials in first in the morning.
But I believe there was a fundamental flaw in their business model: they increased patient access but didn’t review their patients to better understand their need or design pathways to help optimise their care. This, of course, is harder to do if your patients are spread throughout England.
Babylon went after the younger patient, who is tech savvy, busy and – on the face of it – healthier than their parents and grandparents. The spread of their registered patients shows a huge cluster around London and the South East, overwhelmingly falling into the 20-44 age bracket. But age does not mean good health – nor low demand.
An insider at Babylon Health told me that one of their biggest problems was underestimating the mental health needs of younger patients. Even a cursory glance at mental health statistics shows that younger people are more likely to contact their GP for their mental health. For example, NHS data from 2014 found 26% of young women aged between 16-24 report having a common mental health problem in any given week, and the prevalence is rising.
It is one thing improving access – as we should all be doing. But the only way we as a profession will be able to sustain this is if we understand our patients and what motivates their interactions with health providers. If you make the door wider, you need to have the right infrastructure in place once you are inside. To provide sustainable, equitable healthcare, we need to understand what drives our patients to contact us and how they can best be helped in the short and long term.
Data analysis I undertook at my practice to help me understand patient demand found that in one month, 80% of staff activity was provided to only 14% of our patient list, and 60% did not contact us at all. Some – but not all – of that was driven by older patients with more complex needs. A percentage was driven by younger patients, demonstrating that in the current environment, you cannot try to cream off the patients you feel will be ‘cheaper and easier’ based on their age and income.
It is not just about health needs, but also meeting – and managing – expectations. It is often the younger, better educated patient who will speak out to demand what they want, whether that’s a freebie in exchange for visibility on Instagram or a same-day GP appointment.
And, dare I say it, for the general practice NHS model to cope, we need to be able to prioritise patients according to their need, not their wants. That is not to say that no one under the age of 40 needs an urgent appointment – of course they do. But when you offer a service to anyone and say that they can always get a video call with a doctor ‘anytime, anywhere’, then your patients expect that service and you run the risk of demand that is unaffordable and unsustainable.
Babylon commercialised primary care by increasing their list size to increase their funding. Despite being championed by Matt Hancock when he was health secretary, founder Dr Ali Parsa complained Babylon’s NHS work failed to turn a profit. They made the mistake of not looking at lowering the cost per appointment or developing smarter ways to provide treatment. The patient journey was never central to their model. It was short-termism.
The Carr-Hill formula means that younger patients attract a lower payment. Babylon’s model as it stands would require payment per interaction. Their target patient group, being used to consuming other services through digital channels, used the service considerably more than Babylon had modelled, meaning that the revenue they got from an increased patient list size couldn’t cover the cost of providing the service as they did not change patient behaviours. It wasn’t a relationship, it was a transaction.
The lesson here is simple: in order to provide good quality care to your patients, you need to first understand, not generalise them.
Dr Jay Verma is a GP in London and president-elect of the general practice and primary care section at the Royal Society of Medicine
Babylon thought it could cream off the easy profits from young healthy patients leaving the poor saps in general practice with the complex hard stuff. What they found was a cohort of patients who will shop around to try and get what they want, as politicians promise vacuously, rather than what they need. I assume they also found in a market that is short of Drs the cost of Dr time was greater than they expected so nothing left for them. Just as all general practice has nothing left after Drs are paid. The only thing to thank them for is making the next round of vultures think twice before helping a tory break up the NHS in the search of profit. I personally hope they lost millions and will not mourn them one bit.
I think that’s partly right Jay. I think that they overestimated the margins in primary care and failed to monetise or develop the decision support tool that promised to outperform GPs in the early days of its development and about which little has been heard since. One day soon machine learning will lessen our errors and that must be a benefit. I am also sure that there is a large cohort of patients who will favour this sort of service in future but it does not suit the current funding model and may also be biased in favour of the lifestyle consulting preferences of GPs. Careful attention will need to be paid to building a long-term career in a working week dominated by these kinds of interactions and the commoditisation of careers in general practice may also carry some risks in terms of our future replacement by dare I say it cheaper options (commoditisation is defined as the process by which goods that have economic value and are distinguishable in terms of attributes ( uniqueness or brand) end up becoming simple commodities in the eyes of the market or consumers).
PS The answer to all that is not to neglect continuity, long-term trusting relationships and sound population and community healthcare in the (tbh legitimate) rush to cheer up Gen X.
How they thought increasing availability to outperform a contract model which is already poorly resourced and then encourage consumerism is beyond me 🤷🏻♂️
“Sorry I couldn’t read the article because I have ADHD according to the 16 hours of TikTok videos I consume daily.”
Is the typical interaction with a Babylon patient.
Are there any publicly available data on referral rates for Babylon patients for this and other crap? Must be through the roof.
MG👍😂
Impressive analysis, Jay! Your dissection of Babylon Health’s digital foray highlights the nuanced dynamics of patient engagement. Despite their amazing growth in the early stages, their digital-centric strategy failed due to a one-size-fits-all approach. A tech-driven ethos demands personalised insights to align user expectations with viable healthcare solutions. Kudos for emphasising the imperative of data-driven patient understanding for sustainable tech-enabled healthcare ecosystems.
‘ Babylon’s model as it stands would require payment per interaction ‘
General Practice also needs this for it to survive. You cannot have unlimited workload for limited funding.
I used to work for Babylon and very much agree with this article. A large number of our calls were from young people with anxiety and work, life, relationships to name a few. In addition, their model meant that you would almost never be consulting with a patient you knew and we all know the drawbacks of poor continuity of care.
MG – sad but true
“In November 2017, Babylon launched GP at Hand, providing a free at-the-point-of-care, NHS-FUNDED service”.
NHS 75 England:
Babylon GP at Hand – Fact Sheet
NHS England (London) wants to ensure that all our patients have access to high quality primary care when they need it. As set out in the Long Term Plan, the NHS will see an increasing use of digital technology and from 2021 every patient in England will have access to online and video consultation – if they choose it.
It is free at the point of use for patients.
It is subject to all the usual information governance and information security rules – just like any NHS practice.
The service is designed to benefit people with episodic, well defined needs, those who are digitally confident, and those who find it difficult to access services near where they live.
As set out on their website, the Babylon GP at hand service “is designed to provide high quality NHS primary medical services for people of all ages, and whether in good health or not.”
Is there an investigative journalist to tell us what the taxpayer’s contribution was towards this certain to fail Babylon’s third attempt?