DAUK in GP Online: private GP companies like Bablyon should not be able ‘cherrypick’ patients at the expense of the NHS

“The company behind controversial video service GP at Hand has partnered with an NHS hospital trust that runs 10 GP practices – and plans to deliver the ‘world’s first integrated digital health system’ to 300,000 patients across the region. Under a 10-year deal with the Royal Wolverhampton NHS Trust, which has completed the takeover of 10 GP practices in recent years through a ‘vertical integration’ scheme, Babylon says it will help deliver joined-up care for 300,000 people in the city and surrounding areas. Patients will have access to video consultations with both GPs and hospital doctors along with real-time disease monitoring tools through an app, Babylon said, with the first services expected to go live later this year.

The move is the latest significant step into NHS provision from a company that has seen the number of patients registered with its GP at Hand service expand from less than 5,000 just over two years ago to more than 70,000 now. The GP at Hand service, which operates under a franchising arrangement with what was once a small west London GP practice, looks set to continue its rapid growth after being granted permission to expand its patient list in Birmingham and with a further expansion to Manchester expected this year.

The service has been accused of ‘cherry picking’ – which it denies – because more than 85% of patients registered with it are aged between 20 and 39 years old, and leaders have strongly criticised the government’s decision to allow its rapid expansion over concerns that the move is undermining existing GP services.

The Doctors’ Association UK GP lead Dr Yaso Browne said the Wolverhampton plans could destabilise existing general practice. She warned that NHS hospitals were already under unprecedented pressure, and said it was ‘extremely worrying’ to see changes that could threaten the GP gatekeeper role when the need for primary care to manage demand was greater than ever.

Excerpt from GP Online

Read Dr Yaso Browne’s full interview with GP Online

What are the implications for the GP-patient relationship?

This threatens traditional general practice where GPs see a range of age groups and complaints. Fitter and younger patients will likely prefer the convenience offered by online platforms such as Babylon. Those with chronic diseases or who are frail and elderly are actively excluded from registering with Babylon.

What are the implications for practices in the area that are not owned by the Trust?

GPs largely receive funding by numbers of patients registered. The Babylon model which exists in London and Birmingham, attracts fitter patients with a quoted 0.1% of those registered having chronic disease. Therefore practices not part of the network will have patients with higher needs. The way general practice is currently funded this would mean that despite the additional work generated by patients with more complex health needs the practices would not be sufficiently reimbursed doing this work. This may lead to financial ruin and GP practices closing unless the government changes how practices are funded.

Could we see the start of a two-tier system as patients look to join practices that are part of the setup?

Yes. We will continue to see private companies exploit the current GP funding scheme and profit by cherrypicking patients, putting traditional general practice, which is there to provide holistic care from birth to old age, at risk. The Doctor’s Association UK strongly believes that this is unethical. Does this then put pressure on practices to join the Trust/be taken over in order not to miss out? Yes if they are invited to join. Practices not already part of the scheme may find that the Trust will not see profitability in absorbing practices who have a higher proportion of patients with chronic diseases. Or we could see Trusts take over primary care services and introduce more corporate structures with less clinical autonomy including salaried GPs and the end to the very cost effective GP partnership model.

Does this represent a threat to the future of traditional general practice?

Yes. There is no need for the NHS to shamefully give room for private companies, such as Babylon, to profit from absorbing fitter patients, at the expense of both general practice and our vulnerable patients. This has the consequence of destabilising the crucial gate keeper role of GPs, which secondary care relies on to keep demand and wait times as low as possible. Our NHS key performance indicators are already some of the worst on record; it is hugely worrying that we are potentially threatening this further long term. Matt Hancock has endorsed Babylon as freeing up GP resources for those most at need but this would require a complete overhaul of how GP practices are currently funded to be true. If the NHS app which NHSx are developing was able to provide a similar digital platform this would give enough choice for patients to have online consultations as well as other options like telephone consultations, home visits and face to face consultations managed under one practice providing more joined up care and likely less risk adverse practice such as proper antibiotic stewardship. This set up risks cost effective and gold standard practice of care and could spell the end of general practice as we know it.