‘Inherently inequitable’

Doctors in Unite (DiU) has slammed health secretary Matt Hancock for uncritically endorsing the controversial GP at Hand app, which has drawn criticism from the medical community and beyond and is now undergoing a safety evaluation.

Speaking to the Telegraph last week, Hancock called the app “revolutionary.”

“It works brilliantly for so many patients and goes with the grain of how people access modern services,” he said. “I want to see GP at Hand available to all, not based on their postcode.”

Hancock went on to praise the app in a speech he gave last week at the headquarters of Babylon, the company behind the GP at Hand app.

The app is now only available to people living or working in certain areas in London. Its roll-out in Birmingham was blocked last week by NHS England after it upheld an earlier objection by clinical commissioners over concerns about patients accessing screening services.

Safety evaluation

GP at Hand’s roll-out in other areas will be further delayed while the app is undergoing a £250,000 NHS-funded evaluation carried out by IPSOS Mori and a research institute in York. The evaluation, which will test how the app impacts on patient safety and health funding is not expected to be completed until next spring.

Medical professionals and health experts have questioned why Hancock, who says he is a patient of GP at Hand, has glowingly endorsed the app before the evaluation has taken place.

Oxford University primary care professor Trisha Greenhalgh told the Times, “Yes — we should be exploring how new technologies can enhance and modernise the old-fashioned GP service.

“No, we should not be pushing models of care that are scientifically untested and explicitly geared away from the sick and vulnerable and towards the worried well,” she added.

Doctors in Unite (DiU) deputy chair and London GP Dr Jackie Applebee agreed.

“It beggars belief that Hancock is so uncritically supportive of the GP at Hand app before the evaluation is complete,” she said.  “He is also being utterly dismissive of concerns from the medical community which we have expressed loudly and very publicly.”

Applebee highlighted the main problems with the GP at Hand app, which requires patients to de-register from their current GP in order to sign up. About 30,000 people are now signed up to GP at Hand.

This loss of tens of thousands of patients from GP surgeries – 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.

“Why is Hancock endorsing an app that, rather than granting greater access to those who need health services most, is doing the exact opposite? By attracting only those who are technologically savvy and are younger and in general good health, the app is inherently inequitable,” Applebee noted.

Indeed, patients who have complex health problems are explicitly told on Babylon’s website that GP at Hand is not appropriate for their needs.

Serious flaws with the app’s ‘chat-bots’ – the Artificial Intelligence used to initially diagnose patients – have also been exposed. Applebee pointed to research that has found that the GP at Hand app is much more likely to give out unnecessary prescriptions for painkillers and antibiotics.

Applebee argued the GP at Hand model ultimately goes against the grain of what the NHS has been trying harder to achieve against a backdrop of limited resources.

“We don’t have a problem with the technology itself – when it’s evidence-based and used appropriately, it can improve patient outcomes and improve convenience. But the way GP at Hand works is actually very backward-looking. The future of the NHS is integrated healthcare and GP at Hand works against that integration we’ve been striving for.”

Babylon

Questions have also been raised about Babylon, the private company behind GP at Hand which was founded by a Goldman Sachs banker, Ali Parsa, who also founded Circle – the same company involved in running the disastrous private Hichingbrooke Hospital.

The Times highlighted that Hancock, when he served as culture secretary, appointed a Babylon investor, Demis Hassabis, as a government adviser on artificial intelligence.

And Applebee pointed out too that as part of the Evening Standard’s ‘Future London’ campaign, its health project is sponsored by Babylon. The company joins another controversial sponsor of the same Future London campaign – Uber.

“It certainly raises eyebrows that Babylon’s logo is emblazoned on a paper whose editor, former chancellor George Obsborne, once directly employed Hancock as an economic adviser,” she said.

“At a time when the NHS is under serious financial strain, that the health secretary is encouraging a model that further diverts resources from the health service is disturbing and highly in appropriate,” Applebee added. “We cannot prioritise the convenience of younger, healthier patients over the needs of older people with complex health needs. This undermines everything that the NHS stands for.”