I hesitate to add yet more commentary to what has already been written about the ‘GP at Hand’ service, but I feel that it reveals some fundamental truths about what general practice is for.
In case you missed the headlines, a service was launched last month by the private healthcare company Babylon that will see NHS patients offered the opportunity to register with what amounts to an online GP practice.
London is currently plastered with adverts promising patients they can ‘book an appointment within seconds’ via the service’s smartphone app, and have a video consultation with an NHS GP ‘in under two hours’. It is all perfectly legitimate, above board and arguably more convenient for some patients. But it has generated white-hot rage among GPs. Why?
Because although Babylon says the service is for ‘people of all ages whether you are in good health or not’, its site lists 10 types of patients that the service may be ‘less appropriate for’. When Pulse asked what this means, Babylon clarified that patients – such as those with complex mental health issues, learning difficulties or pregnant women – will have to ‘seek advice’ before registering. It is not clear what the advice will be, but it will come from Babylon itself.
There is a certain battleworn pride in the ethos of general practice that no one should be left behind
This is the reason so many GPs are angry, because it undermines a fundamental principle of NHS general practice: fairness. Everyone can come through the surgery door, no matter how ‘complex’ their needs may be. No one is offered advice about being ‘less appropriate’ for any service.
The funding practices receive is roughly equal for each patient, with healthier people who attend less often effectively subsidising the sicker ones so that those in most need are prioritised. That is how the system is meant to work. How on earth can the NHS approve a service that pulls the rug out from under this delicate balance?
Let’s be honest, if GP practices could ‘cherry-pick’ their patients, perhaps some would. But I get a sense from the GP outrage over the Babylon service that there is a certain battleworn pride in the ethos of general practice that no one should be left behind. This ethos is, rightly, a professional badge of honour but one that is widely taken for granted and misunderstood outside the NHS.
Yet this model is under siege. This time last year, Pulse devoted what has turned out to be a very prescient issue to examining the hidden privatisation of health in the UK, unearthing private hospitals taking on more NHS work, trusts cashing in on private patients – and an explosion of private online GP services, including Babylon.
If any conclusion can be drawn from this sorry mess, it is that we need much greater support for the publicly funded basis of general practice to preserve equity of access and protect vulnerable patients. As overworked practices struggle, patients wait longer for GP appointments and public dissatisfaction grows, private services will seize their chance and this kind of two-tier service will only get more common.
GP at hand may be the first of its kind, but I doubt that it will be the last.
Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities
A Babylon spokesperson said: ‘Our service is run under a GMS contract. The GMS contract sum is largely determined by the Carr-Hill formula, a formula which generates a weighted patient list according to a set of calculations about the expected workload generated by a patient, including factors of age, sex and additional needs of patients. This translates to more funding for registered patients who are older and less funding for younger (and hence on average healthier) patients. What this boils down to is that patients have a choice of how they want to receive their care.’