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A Babylon cat amongst the pigeons



Babylon are due to launch in Birmingham this month. It’s expected that NHS patients will be able to register with them, perhaps through their partners in Hammersmith and Fulham, to access an Uber-style, video consultation-mediated form of primary healthcare. No doubt NHS England are going to have to find another sizeable chunk of money to pay the capitation fee for those who register with them, as well as the tariffs for emergency and outpatient attendances. I can’t see NHS Hammersmith and Fulham CCG paying for patients to visit the Queen Elizabeth Hospital in Birmingham.

It’s obvious that NHS England don’t believe that there is a crisis in general practice in England. Otherwise, they would have closed a loophole that enables Babylon to siphon off funding from general practice. Decreasing funding seems a certain way of exacerbating workforce and workload issues, as well as squeezing partner profits.

Babylon are being allowed to exploit the out-of-area registration loophole, because that is exactly what NHS England wants them to do. Babylon are using market forces to apply pressure on general practice to deliver a vision of digital primary care that has been dreamt up at the highest level.

And I don’t think this has all been Matt Hancock’s idea. It seems to me that it has been decided that the best way to force GP practices to provide near-instant access to video consultations is to unleash a fully formed corporate cat amongst the dozy pigeons. It’s a rocket up our arses to push us into adopting new technology and even sharing records across practices so that patients can request a video consultation at any time between ‘normal’ working hours with someone with access to their medical record.

The only other alternative is to let the whole house of cards collapse. But we won’t, because we never do

It’s unlikely that practices and at scale organisations are going to risk or feel able to afford to advertise their own services at the same scale as Babylon. If practices in Birmingham don’t quickly adapt what they can offer, then marketing forces could mean that patients drift away from their local GP and log on to Babylon, taking with them the funding that is attached to their registration.

So once the emergency meetings and wringing of hands have finished, we are likely to conclude that the only things that can be done is to invest time in non-clinical digital development, to the detriment of patient care, but in order to enable patient care to continue and hope that the inertia and faith keeps our patients with us. The only other alternative is to let the whole house of cards collapse.

But we won’t, because we never do. When NHS England are satisfied, they’ll stop paying the deficits, Bablyon will disappear and we’ll all be left with a more consumer-based healthcare system than ever.

Dr Samir Dawlatly is a GP partner in Birmingham