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Report shows benefits of GP at Hand digital service, but concerns too

High levels of user satisfaction, but 'cherry picking' concerns remain

babylon

A new independent report of Babylon’s GP at Hand ‘digital first’ doctor service has produced plenty of positives for the company, with most patients reporting a higher level of satisfaction than their previous service.

Patients with breathing problems, such as asthma and COPD, were particularly satisfied with the service, why some signs it could also cut visits to A&E.

However the in-depth study by Ipsos MORI and York Health Economics Consortium also confirmed some existing concerns about the service’s introduction to the NHS, showing the service has attracted younger, more affluent and healthier patients.

This backs up fears that the service is ‘cherry picking’ the healthiest patients from existing GP lists, thereby leaving behind the patients with the most complex needs.

The report suggests this raises the risk of inequalities among patients, while critics of the service say it undermines traditional GP practices.

Since its launch as an NHS service in London in November 2017, Babylon GP at Hand (BGPaH) has been controversial with existing NHS providers, but has proved popular with patients seeking a more convenient telephone or video consultation in place of a visit to their GP.

The service now has more than 50,000 registered patients, and since February this year has been expanding beyond London, choosing to focus on another major urban area, Birmingham.

Some key findings from the report:

  • Many patients may be prompted to join GP at Hand by a specific health need, where speed of access is particularly attractive for them. NHS England analysis shows a peak in use of NHS 111 and A&E in the months immediately before registering.
  • The data suggests patients may be using the service more than would be expected given their age and health status. However, the researchers say it isn’t clear whether this is linked to unmet need or ‘supply-induced demand’.
  • Patients were more likely to state they had a ‘good’ overall experience compared with traditional GP patients (an 11% difference), and less likely to state they had a ‘poor’ overall experience (a 3% difference)
  • Over 6 months BGPaH patients had 38 fewer visits to A&E per 1,000 population compared to the control group
  • The service is not used by large numbers of older people, or those with more complex health needs. People with no access or not comfortable using a smartphone are less likely to use it. The authors say this limits the number and type of patients likely to use the service, with potential implications for health inequalities
  • GPs working for BGPaH were also found to be “highly satisfied” working for the company, and compared it favourably to working elsewhere. The role’s autonomy, flexibility and compatibility with family life, plus potential for development and career progression, were some of the main factors mentioned by doctors
  • Some doctors mentioned downsides, such as a disconnection from the patient population, and some technical issues with video-conferencing

Babylon says it is delighted with the report’s findings.

“Dr Matthew Noble, Medical Director (UK Clinical Service), Babylon, said: “This independent report shows that GP at Hand is loved by all types of patients as they can now access a GP when they need to. I’m particularly pleased that the report 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 and to help recruit more doctors into General Practice."

Dr Noble said the report also showed that the service was saving the NHS money.

“When you consider that the average A&E visit costs £1,602 and the average outpatient appointment £1,252 then you can see how quickly Babylon GP at Hand and digital-first services can have a positive impact for the NHS.”

However the BMA has interpreted the report very differently, in line with its long-running opposition to the service.

Dr Richard Vautrey, BMA GP committee chair, said:

“This long overdue report reflects, and provides clear evidence backing, many of the concerns we have been raising for some time about GP at Hand.

“GPs have been at the forefront of digital developments but these are always done with the benefits of all patients in mind, not just a select few. That is why we have consistently expressed genuine reservations about a system that has been rushed-out with little regard for how it impacts patients, practices and the wider healthcare landscape.

“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."

Dr Vautrey blamed long-term under investment in primary care for the demand among some patients for a faster, more convenient consultation, and also expressed concerns about Babylon not having attracted older patients with more complex conditions.

“While helpful, the report’s authors themselves admit that far more analysis needs to be done to assess this provider – both on clinical safety and effectiveness, and its impact on the way general practice operates and is funded.

“Ultimately, the NHS must decide what it wants to prioritise, quick access or continuity and quality of care, because one is likely to come at the price of the other.”

The lack of any serious clinical or patient safety concerns, and the many positive signs, suggests Babylon will be allowed to continue its expansion in England - this is especially the case because health secretary Matt Hancock is also a vocal supporter of digital doctor services.

This week also saw the Royal College of General Practitioners (RCGP) launch its vision for primary in 2030, which includes longer consultation times, development of ‘data dashboard’ to aid clinical decision-making, and ‘micro-teams’ to provide joined up care.

Read the full report: Evaluation of Babylon GP at hand

Article by
Andrew McConaghie

24th May 2019

From: Healthcare

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