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David Oliver: Lessons from the Babylon Health saga

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2387 (Published 05 June 2019) Cite this as: BMJ 2019;365:l2387

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What the evidence says - response to David Oliver: Lessons from the Babylon Health saga

Dr David Oliver’s article, ‘Lessons from the Babylon Health saga’, raises some interesting questions but appears to have confused a number of issues.

First, despite Dr Oliver’s assertion, Babylon GP at Hand does provide the full GMS services, just as conventional general practices do. If his concern is that patients living beyond practice boundaries are not contractually eligible to receive home-visits, GP at Hand offers them anyway.

The big and obvious difference between Babylon GP at Hand and the vast majority of other practices is that our service is provided 24/7 every day of the year and not the standard 8.00am-6.30pm Monday to Friday (plus extended hours where separately commissioned).

The overwhelming majority of our users joined our practice because they couldn’t access a GP at their previous practice. With us, appointments are usually available within two hours, patients can replay consultations, see their medical notes and have a lot more control over their health - and all at no extra cost to the NHS. Patient satisfaction matters, so when the independent Ipsos Mori report showed 85% of our users rated us as good or better, [1] that’s worth listening to.

Second, GP at Hand is funded just like any other NHS practice - through the Carr-Hill formula which allows for variations in patient age, gender and health. That’s why we are paid on average £91 per patient, which is 40% below the national average of £150. And as the evaluation by Ipsos Mori showed, despite our patients being higher users of services before joining us, within 6 months A&E visits had dropped by 3.8% in comparison to new patients at other practices. We have over 51,000 patients so we would expect nearly 2,000 saved A&E visits, and with each visit costing £160 that equates to over £300,000 (over £6 per patient) saved by the NHS in six months alone.

There has been a funding issue, though this is entirely about money flows between commissioners. It is very positive news that this is being resolved between the CCG and NHS England. Administrative systems clearly shouldn’t stand in the way of patient care, nor prevent people exercising their right to receive high quality NHS care from the providers they choose. After all, patient choice is embedded in the constitution of the NHS. [2]

It’s also important to note that the Ipsos Mori report said “patients were previously registered at a large number of CCGs and other practices. This indicates the impact on any singular practice or CCG would be minimal if the patients now registered with BGPaH were indeed subsidising patient care through the Global Sum Allocation Formula in their old practices.”

We support independent review and, as well as the Ipsos report, we were recently assessed by the health regulator the CQC which rated our services as Good, with 39% of patients able to book an online appointment with a GP within 30 minutes and 89% within six hours. [3]

In terms of GP stress, the Ipsos report says we have a “highly satisfied workforce who gave “overwhelmingly positive feedback” and “could have a positive impact on the recruitment and retention of a group of GPs who may not remain in or enter into general practice otherwise.”

Provocative articles are useful for ensuring debate, and lessons can be learned, but rather than a one-sided view, they should include the facts if a commentator is seeking to educate and inform.

No one is in doubt that NHS staff face formidable challenges from an ageing population and the changing expectations of patients. Inflexible infrastructure and funding systems shouldn’t compromise patient care by limiting innovation and change. Babylon GP at Hand is helping to make NHS money go further and achieve more for patients.

1 Ipsos MORI. Evaluation of Babylon GP at Hand: final evaluation report. May 2019.https://www.hammersmithfulhamccg.nhs.uk/media/156123/Evaluation-of-Babyl....
2 NHS Constitution. https://www.gov.uk/government/publications/the-nhs-constitution-for-engl...
3 CQC report 21 May 2019. https://www.cqc.org.uk/sites/default/files/new_reports/AAAJ1557.pdf.

Competing interests: All authors work for Babylon. Dr Keith Grimes: "I run VR Doctors, which is an online forum for people interested in clinical VR (unpaid), am a digital champion for Lantum (unpaid), NHS locum GP (self employed) and very infrequently offer paid digital health consultancy (none ongoing)"

07 June 2019
Dr Mobasher Butt
Chief Medical Officer for Babylon and a GP in West London
Dr Kultar Garcha (Clinical Lead for Babylon GP at Hand and a GP in West London), Dr Keith Grimes (Clinical AI and Innovation Director for Babylon and an NHS locum GP), Dr Matthew Noble (UK Medical Director for Babylon GP at Hand and a GP at an inner-city practice)
Babylon
60 Sloane Avenue, London, SW3 3DD