For years patients and General Practitioners (GPs) have lamented the pressures of too many patients fighting over finite appointments with rising waiting times and possible missed opportunities for an individuals’ health needs to be met.
Into this mess enter Babylon Health with their ‘GP at Hand’ mobile service application. Allowing patients to have appointments without leaving the comfort of their own home. Decreasing pressure on GP services and giving patients what they want, when they want it. So why are GPs so against what seems like a win-win situation?
Who are Babylon Health?
A health innovation company using mobile apps to allow patients to have access to a GP 24 hours a day, 7 days a week. These consultations occur over a video platform so patients do not have to attend in person. The app also has a ‘symptoms checker’ which can be used to help direct patients based upon the information they input into the app. It is important to state GPs are a 24 hours a day, 7 days a week service and has been for many years but this point seems to be lost on the general public and one of the selling points of Babylon.
How has Babylon Health changed the NHS landscape?
Their initial business model involved charging patients for each appointment as any private provider would. However, in 2018 the group entered into a partnership with Fulham and Hammersmith Clinical Commissioning Group (CCG) allowing patients from all over London to register with the provider using a small surgery as its ‘base’ of operations. These patients would be registered with the company as any patient registering with an NHS GP. This small branch of some 2000+ patients suddenly grew in size with up to 400 patients registering every day. At last count they had registered over 50,000 from all over London. There were certain caveats such as patients with complex needs not being able to register. They also advertised that patients could be seen by a clinician immediately but neglected to mention that it could take take six weeks to become registered.
Why Do GPs fear this change if this reduces their burden of patients?
A large component of GP funding stems from something called ‘capitation per patient’. This is a set lump-sum payment made on an annual basis to a practice from NHS England and is based on the number of patients registered with the practice. This fee provides some, if not all, of the care provided by a practice. A key cornerstone of this payment is that the payment is independent of the amount of care provided. This means that patients who register with a practice but rarely attend are effectively supplementing the needs of those who are complex conditions and need regular attention. In 2017/18, this payment amounted to£152.04 per registered patient. Thus, if patients get drawn away from practices, so does this funding.
So what? Who cares? Aren’t they paid too much anyway?
You may be one of those who think that GPs, or doctors in general, are grossly overpaid. However, a reduction in funding would have many varying consequences, not least for the salaries of doctors. The funds provided to a practice are used to fund all manner of services, from nursing staff to additional services such as baby immunisations, to rent and maintenance for surgeries. If the pot at their disposal is smaller, practices will be less equipped financially to fund these services. Not to mention there will be even less money for them to procure clinicians for their patient population as their rates of pay would not be competitive.
How can this impact on GP services within your location?
One of the major problems is that a lack of funding may lead to a collapse of GP services altogether. Practices which rely on their core contract funding and procure salaries for staff and allied healthcare services would no longer be able to sustain their list sizes. This would mean as practices close, patients would be redistributed to neighbouring services who again may be unable to cope with numbers. Gone would be the days of seeing your local GP. In addition, the model Babylon propose is fine for those who are tech-savvy and without co-morbidities which preclude a video-based assessment. But what of the most vulnerable groups within our population?
What about Babylon health?
If they are managing the demand for now this may not necessarily be the case in the future. This could leave NHS England in a difficult spot should the app provider suddenly be unable to cope as has been seen with many private providers down the years. For them, it is a contract. For patients and GPs, it is their health and their livelihood. Can Babylon health help supplement the pressured NHS system without leading to all-out war with practices? Or will this change become a major turning point in the contracting of health services within the UK, forcing GPs to work in tandem with the app?
It is important to point out this situation is not the making of Babylon health. They have merely found a gap in the market and used current technological advances to carve out a niche. The real question is whether their model is sustainable.
What does irritate me as a clinician, a patient and a taxpayer is why a similar model has not been set up by NHSX. Why has the much anticipated ‘NHS App’ gone from all singing all dancing to barely fit for purpose?
As the NHS seems unwilling to support GPs, Federations are having to fill the void by proposing and funding their own apps. The Birmingham and Solihull CCG have recently launched their own app which now rivals much of the functionality of Babylon.
If all the NHS are using Babylon for is a much-needed stimulus to drive innovation within the NHS, Babylon may inadvertently end up saving the current GP model unbeknown to itself. I guess only time will tell.