The eagerly awaited official evaluation of Babylon GP at Hand has been published. According to Babylon the review shows the service saves NHS time and money – but GPs argue the findings highlight long-held concerns.
The independent report, commissioned by Hammersmith and Fulham CCG, was conducted by Ipsos Mori after it won the £250k bid in March last year to assess the outcomes and risks of the digital-first provider.
There were high hopes for the review – with critics of GP at Hand calling for its expansion to cities outside of London to be put on hold until it came out.
Published yesterday, it seems parts of the report will not disappoint those critics. However, it also found a lot of positives – such as high patient and GP satisfaction and low prescribing rates of antibiotics.
“This is a service used by predominantly young, healthy and affluent individuals, choosing convenience over quality”
Dr Richard Vautrey
But GP leaders have focused on the more negative elements of the review. They point out that the review found GP at Hand poses a number of problems, including luring away GPs from traditional general practice during a recruitment crisis. It points out ‘administrative issues and lack of continuity’ meant patients felt the quality of service was reduced.
And it also finds GP at Hand ‘experiences higher de-registration rates than the London average, with patients most commonly de-registering after two weeks’.
The BMA says the report ‘provides clear evidence backing many of the concerns we have been raising for some time about GP at Hand’.
Dr Richard Vautrey, BMA GP Committee chair says: ‘As this report makes clear, this is a service used by predominantly young, healthy and affluent individuals, who appear to be looking for rapid answers to health questions and issues, and are using this service as they would NHS 111, choosing convenience over longer-term quality and continuity of care.
‘Indeed the rapidity with which large numbers of patients deregister and only to re-register with their previous practice provides evidence for this.’
GP at Hand’s model, based on serving patients primarily through digital services across wide geographical areas, may also be a problem for new primary care networks, according to the evaluation.
“The independent evaluation notes the GP at Hand model ‘presents a challenge for primary care networks”
Dr Michelle Drage
The digital service has registered to become a network – though Hammersmith and City CCG recently said it has reservations.
As Londonwide LMC chief executive Dr Michelle Drage says: ‘The independent evaluation notes that the GP at Hand model “presents a challenge for primary care networks if they are defined geographically”. We hope this point is taken onboard by those making decision on the future of PCNs in London.’
Despite the challenges raised in the evaluation, the report praises some elements of GP at Hand.
It states the NHS could learn from the service’s recruitment model – and what features are attracting GPs to it, stopping them from leaving the profession.
Meanwhile, it finds the ‘majority of patients were positive about their overall experience’ of the service – with 85% rating their overall experience as ‘good’.
But it also suggest the global sum is not fit for purpose if a wider roll-out were to go ahead – and that a different funding model would be required.
The report states: ‘The current funding formula is based on a number of factors including population demographic and illness profiles, but it does not take into account demand for services.
‘The evaluation has shown that GP at Hand patients have better health than comparable patients using traditional primary care but that they are higher users of primary care.’
It warns that further research would be required ‘to understand whether the higher use of primary care services was a product of specific health concerns or simply due to better accessibility’.
“The findings show Babylon GP at Hand is saving the NHS time and money”
Dr Matthew Noble
The issue of whether the NHS can cope with extra demand – which may be created by the service itself – is of concern to Dr Vautrey: ‘That GP at Hand’s patients are using the practice far more than the average patient would visit their own practice, begs the question of whether a wider rollout in an already overstretched NHS, would be able to cope with additional demand.’
Babylon itself is not fazed by the report findings. It claims the review has shown ‘how our GPs enjoy their work, aren’t becoming burned out and how our digital-first approach may even be a way of encouraging GPs to stay in the profession’.
Dr Matthew Noble, Babylon’s medical director for its UK clinical service, says: ’The findings show Babylon GP at Hand isn’t just of great benefit to patients and GPs, it is also saving the NHS time and money.’
But GPs say just because GPs are attracted to work in the service, that doesn’t mean the model would be appropriate for all of general practice.
Family Doctor Association chair Dr Peter Swinyard says: ‘If you’re attracting qualified doctors to do relatively less demanding work and paying them reasonably well then of course there’s going to be less incentive to go and graft away in a practice.’
But he warns: ‘The GP at Hand model may be an easy option for some people but the risk of making big mistakes is really quite significant.’
What the independent evaluation of GP at Hand says
Babylon GPs tend to be younger: ‘Overall, BGPaH [Babylon GP at Hand] GPs tend to be younger, and therefore may be less experienced than the general GP workforce. Evidence would be needed to explore whether this has any impact on the quality of care provided and/or the training and development needs for models with this profile of workforce.’
Patient satisfaction: ‘Overall, users are satisfied with the service….Some patients felt administrative issues and lack of continuity decreased their satisfaction with the quality of care.
‘Around one in ten patients felt the quality of care at BGPaH was worse than their previous GP practice (11%). Some patients mentioned the quality of care was lower when it came to referrals, tests or prescriptions, due to administrative issues; for example, not being able to provide urine samples easily following a digital appointment, chasing up prescriptions with pharmacies, referrals not being processed or sent to the correct hospitals.’
GP satisfaction: ‘While overwhelmingly positive, some participants listed some downsides and identified areas for improvement. Some GPs thought that their relationship with their patients had suffered due to the loss of rapport and continuity of care. They also felt disconnected from the patient population they were treating because they were not living in that community.’
GP at Hand patients using urgent care: ‘Comparing BGPaH patients’ use of NHS 111 and A&E against average London rates (rather than a population of newly registered patients) highlights that rates increase just before registering with the practice. This suggests BGPaH registrations are, at least in part, prompted by a health need. This spike in health service activity is not unique to BGPaH as increases are also seen for patients registering with other London GP practices.’