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The true privatisation of general practice

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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