Private firm’s online doctors’ appointments could spell doom for GPs, top medics warn

8 January meeting of Health in Hackney Scrutiny Commission. Photograph: Ed Sheridan.

Medical top brass and councillors are warning of the potential threat posed to GP services in Hackney and elsewhere by online doctors’ appointments championed by private company Babylon Healthcare.

Babylon provides the technology for the “digital-first” primary care service GP At Hand, which, using symptom-analysing algorithms, provides free, round-the-clock “virtual consultations” to its members, with an in-person appointment provided “only where necessary”.

GPs in Hackney are anxious that Babylon’s business model could have a disruptive effect on their own services.

Laura Sharpe, chief executive officer of City & Hackney GP Confederation, stated that her organisation was fearful that the model currently being used by GP At Hand could “destroy general practice” as a result of a potential loss of younger patients.

Sharpe said: “What general practice will be left with is the complicated, complex patients with multiple needs who take a disproportionate amount of time and energy.

“Effectively the way the whole NHS works at the moment is as a public insurance system. The well subsidise the unwell.

“It’s that mix that allows practices to survive financially, and if a proportion of that is removed, what is left is probably not sustainable in that traditional way.”

Sharpe added that City & Hackney GPs are looking for ways to rise to the challenges of quick access to doctors which GP At Hand is designed to address, and that local medics would want to “learn from” Babylon whilst also providing continuity of care.

According to reporting in GP newspaper Pulse, Hackney has been selected by Babylon’s media agency PHD Media as one of the best boroughs in which to target 20- to 39-year-old patients.

In October 2017, when the company was launched in London, 1,523 Hackney residents were registered with GP At Hand’s Lillie Road practice in Hammersmith and Fulham.

The number of registered members in total on the company’s books has risen swiftly to over 35,000 by September 2018, including Secretary of State for Health & Social Care Matt Hancock.

Paul Bate, Director of NHS Services at Babylon Health, said: “We are a private organisation that exists to provide accessible, affordable healthcare to every person on the planet. That’s the stated goal.

“There are plenty of people who have much more complex conditions who are registered GP At Hand members. Our website explains we are available to everybody.

“We’re there to support people’s right to choose the service that works best for them. We hope that people choose us.”

GP At Hand members use an algorithmic symptom checker, which advises them on next steps, from managing the condition at home to calling 999, with online GP appointments taking place typically within 2 hours.

However, a number of “shortcomings” of GP At Hand are summarised in a draft report presented to an 8 January meeting of the Health in Hackney scrutiny commission, including the small number of locations for face-to-face consultations, a possibility of a resulting increase in referrals to A&E, and a lack of clarity for patients on the consequences of de-registering with their own GP when they register with the service.

The report states: “The advantages of the model to patients are that it offers near instant access, which routine GP practices struggle to offer. They also appeal to a younger demographic who are digitally minded, with little time, and they also argue that they relieve pressure on the NHS.”

Cllr Patrick Spence (Lab, Haggerston), said: “I really don’t see how what’s happening is not going to pull apart general practice very, very quickly.

“If I was a GP, I’d be very worried about it and I think there has to be a great deal of concern about this.

“We’re told it’s all about patient choice, but I think that’s not good enough. Our NHS requires a degree of planning to ensure that quality, equity and access are at its core, and it seems to me that this is cutting against that in a very dramatic and potentially very dangerous way.”