‘Destabilising’

Doctors in Unite (DiU) has called on health secretary Jeremy Hunt to pull the plug on GP at Hand, an online video GP consultation service that critics have said is defunding already overstretched surgeries.

Since November when the app was launched in London, nearly 30,000 people have signed up to the service, which requires you to deregister from your current GP.

The loss of tens of thousands of patients – the vast majority of whom are between 20 and 39 years old and so tend to be healthy – has sparked fears of a substantial loss in registration fees, since it is younger, healthier patients who in effect subsidise the older and less healthy population.

In a letter sent to Hunt, Doctors in Unite noted that “practices have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand.

“There is, no doubt, that GP at Hand will destabilise other practices, robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients,” the letter, which was signed by 130 health professionals, many of them current GPs,  went on to read.

“Losing registration fees for younger, fitter patients who join GP at Hand threatens the model of general practice relied on by so many patients.

“The scheme is hoovering up the younger, healthier patient and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems.”

“Continuity of care is threatened because you may never see the same GP again when consulting GP at Hand,” Doctors in Unite wrote.

“In practice, 70 per cent of all patients are reasonably well. Their funding helps surgeries care for the 30 per cent who are sick. It’s a system that works, because it’s fair. We all eventually end up in the 30 per cent.”

Lurking beneath GP at Hand’s ostensible purpose to help people access GP services are powerful business interests bent on privatising the NHS. GP at Hand, for example, is run by Babylon Healthcare Services Limited, a firm headed by CEO Ali Parsa, an ex-Goldman Sachs banker and founder of Circle – the same company involved in running Hichingbrooke Hospital.

It was the first NHS hospital to be entirely privately run and after only a few short years Circle pulled out of its contract in 2015 amid heavy criticism. In the end, patients paid the price with care that was rated “inadequate” and taxpayers footed the bill of Circle terminating its contract.

‘Havoc’

DiU deputy chair and London GP Jackie Applebee said GP at Hand has had a palpable effect in the area of London where she works.

“In Tower Hamlets alone, we’ve lost about 1,500 patients since GP at Hand launched,” she explained. “The service operates five sites in Tower Hamlets and one of them is located within an NHS GP surgery – the surgery had empty rooms to let – which has caused havoc and confusion for patients. There have been many complaints.”

Applebee says that it isn’t the technology itself that she finds troubling.

“I have no problem with evidence-based technology. But there’s no evidence that something like GP at Hand is beneficial for patients; in fact, it’s very much the opposite,” she explained.

She pointed out that only 4 in 10 health apps rated by the Care Quality Commission have been deemed safe and that the GP at Hand app, called Babylon, has had substantial problems with its ‘chatbots’ – the artificial intelligence used to check patients’ symptoms.

“An NHS consultant who tweets under the name @DrMurphy11 signed up to the Babylon app and input symptoms suggesting a heart attack that were dismissed by the app as nothing serious,” Applebee noted. “He input symptoms indicating possible meningitis and again, the app said to go to a pharmacist.”

Cherry-picking patients

Applebee argued that the app is inherently discriminatory because those who are elderly, who don’t speak English or who have complex health needs are not likely to sign up. GP at Hand’s own website lists a number of different types of patients for which it said their services would “be less appropriate.”

These include , the website states, “women who are pregnant or likely to be pregnant; people with complex mental health conditions; adults with a safeguarding needs; people living with complex mental health conditions; people with complex physical, psychological and social needs; people living with dementia; older people with conditions related to frailty; people requiring end of life care; parents of children who are on the ‘Child at risk’ protection register; people with learning difficulties; people with drug dependence.”

“It is truly outrageous how they cherry-pick the healthiest people in the population and discourage others to apply. They’re essentially exploiting an entire sub-section of the population and in the process destabilising general practice.”

DiU chair and GP Dr David Wrigley agreed.

“An increasing number of GPs are in open revolt at this online service that is seriously eroding the vital personal relationship between GP and patient, as envisaged when the NHS was set up in 1948,” he said. “The model of care used by GP at Hand should be scrapped immediately.”