Babylon: GP at hand - all thoughts welcome

[MichaelMumsnet]

Hi folks,

Mumsnet is looking to team up with Babylon to promote their free NHS "GP at hand" service (available to people living or working within 40 minutes of a GP at hand clinic) and Babylon’s paid online doctor (available to all UK residents).

Babylon offers both a free NHS and private 24/7 GP service, which lets members have virtual doctor’s appointments from their mobile, arrange prescriptions for local collection and get specialist referrals.

To get the service for free, you need to live or work within 40 minutes of a GP at hand clinic and switch your registered NHS GP practice to GP at hand, Babylon’s NHS offering. When you register for GP at hand, you will be de-registered from your current GP practice. If you’d prefer to stay with your current GP, you can use the Babylon service on a pay as you go or subscription basis for quick, easy access to doctors anytime.

If you’re not sure whether you need to see a doctor, Babylon offers an AI symptom checker which you can access for free via their app. The app also has a handy tool called Healthcheck, which creates a free health report for you and suggests changes you can make to live a healthier lifestyle.

We think these services could be genuinely useful to parents (and non-parents) and we'd love to know what you think too – all thoughts and comments gratefully received!

MNHQ

I don't know enough about how the NHS works. Why is funding denied from GP surgeries if 'easy' patients register elsewhere? And why can't patients register in two places? I'd love to have both a physical GP where I work and the option to access a 'virtual' GP if for some reason I can't get to the surgery or they have no appointments.

However I am not in favour of online symptom checkers. I don't believe the technology is good enough and the stakes are too high.

GPs surgeries get a flat fee per patient, regardless of complexity. Therefore they rely on the some of the money from the generally well “easy” patients to cover the shortfall of the more unwell or complex patients.
If you register with GP at Hand instead, that practice gets your funding rather than your previous GP. You can’t be registered with 2 places at once but I believe you can use the online Babylon app (paid for) without de-registering from your own GP

I work in digital healthcare for the NHS. Lots of valid points on here about how services such as Babylon are a backdoor to privatised two tier services.

The AI technology has not been peer reviewed to be shown as safe.

www.pulsetoday.co.uk/news/gp-topics/it/ccgs-block-babylons-expansion-of-gp-at-hand-to-birmingham-on-safety-grounds/20037085.article

The company are cutting their teeth in some countries in Africa honing their model, which I find morally questionable given the lack of evidence around safety (though I do think there are 2 sides to it in terms of access to doctors in rural areas).

It should also be noted the service is financially unsustainable for the NHS.

www.pulsetoday.co.uk/news/commissioning/commissioners-provide-1m-bailout-to-ccg-after-influx-of-babylon-patients/20036869.article

Partnership with mumsnet...am . Can't fathom why mumsnet would support this.

I very much sympathise with those who say they are struggling to access GP health services within the current system, unfortunately this model drains away more GPS as it's more lucrative income, and could create a two tier health economy whereby those who need services the most may not be able to access them at all.

Surely it actually raises questions over how GPs are funded...

Patients have been able to register with a GP near work rather than home (or indeed near anywhere else they want to) since 2015.

I fully welcome online services to stay in touch with my practice - I once had to drag my DH into the surgery (almost literally, he was in a wheelchair but the car park was knee deep in snow) simply to be told his liver function test result was too high and we needed to book an appointment with a nurse for repeat bloods and then return for a third time to get the results. Only one of those required a face-to-face interaction. But god knows Babylon wouldn't touch my DH with a bargepole, what with his complex health needs and huge monthly drugs bill.

This is the Bounty of general practice, but sprinkled with the fairy dust of 'AI in healthcare', the latest craze in healthcare tech. I see that Babylon have been raking in investment cash, I wonder why that is? (Clue: it's not because investors want to improve the healthcare of the British public).

GPs surgeries get a flat fee per patient, regardless of complexity. Therefore they rely on the some of the money from the generally well “easy” patients to cover the shortfall of the more unwell or complex patients.

This seems to me to be a failing of the NHS funding allocation, not the fault of any 3rd party. Our population is not evenly spread in terms of 'complexity', and there must be many surgeries in areas with an elderly population currently having this issue.

I believe that technology will ultimately improve our healthcare service, but the technology is still very early stage. AI just isn't ready yet to diagnose, and even building a video consultation system is still technically complex. I don't believe the NHS are the right people to invest in building/deploying unproven technology, as it takes such a huge amount of time and money to create.

Big fat no.

I'm shocked Mumsnet are thinking of partnering with Babylon for all the reasons stated above.

That link is really useful, Tribpot. In practice, do you know how many GP surgeries do agree to take people from outside their boundaries? And do only crap practices accept people from outside the boundaries? I have checked a few surgeries in the past and they won't take out-of-area patients.

As an aside, it would help a lot if there were much greater transparency about how GP surgeries were funded. Can anyone link to any useful explanations? I can deal with complicated.

"Patients have been able to register with a GP near work rather than home (or indeed near anywhere else they want to) <a class="break-all" href="http://go.mumsnet.com/?xs=1&id=470X1554755&url=www.nhs.uk/using-the-nhs/nhs-services/gps/patient-choice-of-gp-practices/" target="_blank">since 2015." In theory - try actually doing this!

ARude - maybe start here. GP funding is very complicated, and does include measures like QOF (PDF link) which is about good management of some key conditions, and payments for Enhanced Services like immunisation.

In terms of out of area patients, this is a Pulse article quoting NHS England stats that take-up is low - from the comments it would appear GPs have been deterred from offering the option because if they refuse to provide home visits (which is an exemption the patient has to sign up to in order to register out of area) they are then penalised by the same people who created the policy in the first place.

Thanks, Tribpot, very useful. Am still reading.

@MichaelMumsnet, how about having a webchat with someone very senior in the NHS about how MNers, their dc and their elderly relatives can access adequate primary healthcare in this country? Clearly those who work at the coal face of the NHS feel that nothing should change, but patients definitely need it to - urgently.

There is a thread here which is highly relevant.

Please take a look at it.

No one’s mentioned Push Doctor.
I use them, they’re fab. You don’t have to deregister with your GP, and you can get appointments within half an hour. They email prescriptions through to a pharmacy of your choice... obviously you have to pay but I think they’re fab.

@arudeterribleperson

It seems an overstatement to say that those who work within the NHS don't believe anything should change. There are a huge number of changes which would benefit the NHS, not least ceasing to become a political football.

All those who work for the NHS are at some point or another patients too along with our family and friends. It's not that we don't see problems, or want to fix them, more that we understand more than a casual observer about how complex the issues are.

Just to add to my last post (then I'll shut up), one of the main issues within primary care is the lack of GPs. Lots of complex reasons why but a longer term view must be taken and one of the main areas they could address easily is by making university and post grad training free for doctors and nurses as long as they accept 5 years (for example) post qualification work must be within the NHS. It's crazy that nurses are expected to fund their own nursing studies when they are in such short supply. We financially compensate teachers for the same reasons, the government need to look at this area and quickly...

Thanks to all who have contributed thoughts and feedback so far. We really appreciate it.

We sent your questions and concerns to Babylon and asked them to comment. I’ll post the answers below. We’re afraid that this isn’t a live Q&A - but there were a few requests for updates so we asked Babylon and here are their responses...

Please don’t.

Thank you for all of your feedback, we've read each and every response on this post. We'd like to respond to some of the comments and also provide you with some reassurance about what we do.

Babylon offers two different services. One of them is GP at hand, a free service where we work in partnership with the NHS to provide GP care. The other is our private digital-only service that requires a subscription.

To register for GP at hand, you need to de-register from your current GP practice. This is because NHS England only allow you to be registered to one GP practice at a time to ensure patient safety.

GP at hand is available to everyone, regardless of their circumstance or medical history. If you have a complicated or long-term illness, you won't be turned down if you want to register with us. 24/7 video appointments are a key benefit of the GP at hand service but you can still access the full range of care you'd expect from any GP practice in England, including face-to-face appointments when you need them.

We encourage people to choose the best place for them to receive care based on their needs. That's why we check if patients who are are frail, elderly, pregnant or have complex mental health issues might prefer to stay with their current GP as it may be more convenient for them.

Concerns about potential misdiagnosis via the AI symptom checker

Babylon's symptom checker is constantly being updated to improve safety and accuracy, and is subject to extensive pre- and post-market testing. We have published our techniques (here) for scrutiny and comment, and welcome all feedback.

Safety is our highest priority, which is why we take such care over informing users about the abilities of the app, as well as ensuring that everyone takes care to contact a medical professional if further care is required. We feel that the triage function of our application is helpful to understand when you should seek that help, and how quickly.

Our app does not provide a diagnosis, but instead offers information tailored to the responses given by the user, which improves on the accuracy and appropriateness of medical information which can be used by the informed patient to better manage their health and illnesses. It also reduces the pressure on attending emergency departments by providing this information immediately, at any time of day or night.

All of the information provided in the application come from validated sources such as NHS Choices, and are carefully curated by experienced doctors (including practicing NHS GPs) and research scientists.

Babylon’s services and technology have been tested and approved for use by the Care Quality Commission, NHS England, NHS Digital, the Medicines & Healthcare Products Regulatory Agency and local NHS Clinical Commissioning Groups. We regularly audit and manage the clinical practice of all our doctors in order to deliver consistently high-quality care. This additional level of safety is possible because all Babylon consultations are recorded, an uncommon practice with most traditional GP practices.

Worries about appointments over video (prescription focus).

Babylon enables patients and parents to seek advice from a doctor quickly, at any time of day or night. Video consultations form and important part of the service that Babylon makes to its patients, but it is important to understand that it is not the only offering. Like all NHS GP surgeries, you can have voice consultations and, if needed, face-to-face examination.

Not all presentations to a doctor can be handled by video consultation. This is why all of our doctors receive specialised training and careful audit to ensure they provide the very highest quality of care using this medium. The real strength of video consultations comes from the fact that many of the reasons a person visits a doctor do NOT require physical examination. As a result, video and audio consultations offer significant benefits, including the ability to be recorded and available, securely, to you for review at the time of your choosing. By being able to handle a large proportion of your healthcare needs without the need to travel physically to your doctor, 24 hours a day, 7 days a week, 365 days a year, we feel that we offer a service that is not available to many on the NHS.

“In addition it is also threatening the security of other GP surgeries who are left with complex or elderly patients (anyone who is basically not a young healthy person) with far less money.”

By appealing/advertising to healthy/young patients (those more likely to use the service), Babylon is removing funding from local GPs and leaving only the more costly (long term illness etc.) patients with local GPs.

Both Babylon and GP at hand are committed to serving everyone who chooses our services. The GP at hand service is designed to provide high-quality NHS primary medical services for all members of society and their conditions, even those with complex medical needs. We have a dedicated complex care team, which means we can offer the right level of care right across the spectrum.

Babylon is not permitted, under the General Medical Services (GMS) contract, to accept only 'easy' patients. As our GP at Hand model is new, we have been required by NHS England to help those with more complex or specific needs to discuss whether our service is right for them before they register. As the service matures this restriction will be removed, bringing the full benefit of our product to all.

Funding of General Practice in the NHS is complex, and broadly operates to a 'capitation' model. This pays practices a sum per patient, weighted as to their age. This figure varies six-fold between the younger and older age groups, meaning practices get paid substantially more for their older patients. Additional, item of service payments, money for meeting care targets, local specialist services, and private and non-GMS services make up the rest. Our model of care makes significant efficiencies in the cost of providing high quality care by making the best use of the available staff through advanced technologies like video consultations, preventative health checks, and artificial intelligence. This, in turn, means we can offer this care 24/7, 365, with a response time that meets the needs of the modern patient.

Babylon believes in serving all patients, regardless of age or health status. Our technology is simple to use, and is based on familiar smartphone platforms that nearly 90% of the UK population now use. The fastest growing sector of the population to use this technology is the over-65s, who stand to benefit even more from the rapid response, extended access, and choice offered by our service.

The GMS contract already pays significantly higher fees for the care of older patients than younger patients, compensating GPs for the predicted increased work needed for these groups, but using our technology we feel that we can help the NHS make the very best use of tight resources.

This one was answered above - but here it is as a separate post

Does Babylon vet patients for (GP at hand and Babylon) and if so does it allow them onto the service? Is it able to provide the level of care which some patients would require?

GP at hand accepts all patients, regardless of their circumstances or medical history. You won't be turned down if you have a complex or long-term illness but we recommend checking that our clinic locations are convenient for you before registering.

With 24/7 video appointments available, it means you'll be able to see a GP within 2 hours but usually it's much quicker than that. Of course, we also offer the full range of care you'd expect at any NHS GP practice in England, including in-person appointments.

GP at Hand is London-centric and only the paid version of Babylon is available to the most of the UK.

Babylon has launched our service in partnership with GP at Hand in London, but we are responding to the high demand to roll the service out much more widely. We are looking forward to expanding across the UK soon. Babylon’s private service is available nationwide. If you are travelling abroad, you can also access the Babylon service. Prescriptions may not be available, depending on where you are travelling. Please check the website for further details.

Deeply disappointed that MN considers this appropriate let alone something they wish to be promoting in light of the articles posted above.
Very poor judgment.