GP at hand. General practice in very big trouble.

You cannot have failed to notice Babylon’s GP at hand service all over the media this week.  As a PR exercise, on the Today programme, You and Yours, TV, front page of the Times and an almost unheard of positive story in the Daily Wail, it was SIMPLY BRILLIANT.

What you may not have appreciated is the existential threat this makes to regular NHS GPs.  While presenting it as “the NHS has suggested that the service may however be less appropriate for…” the list of exclusions is in fact the engine of profit for Babylon.  Read the list.  It’s 90% of a normal GP workload.  It begins with women (twice the consult rate of men in middle years), who are or may be pregnant (more work.  And babies – lots of work).  All the usual suspects, the elderly, sick, frail, confused and multi-morbid are there.  They are work.  Babylon doesn’t want them.

Babylon has got something spot on:  patients are fed up with the often abysmal service from their current GP.  

They want the young, fit and healthy, especially men, who rarely need a GP but when they do, want help fast, and don’t want to bother with going to a surgery unless they have to.

All these patients carry the same capitation.  Think: what if you lost half your income and the easy half of your population?  But kept 90% of the work?  If it isn’t obvious yet, GPs will go under.  That may not be you, but your neighbouring practice, whose list will be dispersed… to you… and you know those dispersed will be high demand.  Nice.

They are in London so far, but Babylon’s ambition is limitless and I fear a multiplier effect from the mechanism above.  They have the law (practice boundaries abolished), the funding model, the technology, the demographics and clearly the PR on their side.   No doubt BMA is dreaming up legal challenges as I write, but they are no match for weasel words backed by £60m of VC money, while changing the law takes years, at best.

If it were simply about better GP services, I would be cheering.  But the inevitable consequence is to stoke the Inverse Care Law.  Those who most need help will find it most difficult to obtain.  General practice will be dramatically less profitable in the hardest areas, and will suffer even in the most privileged.  This undermines nothing less than the core principles of the NHS, universal, accessible and free at the point of use.

I will end on a note of hope, because this is not hopeless if we act fast.  I founded GP Access & askmyGP with the vision “to transform access to medical care” and some might say Babylon have achieved that.

But our vision is universal.  We have no exclusions. We understand the quality and safety from relationship continuity, to say nothing of the professional joy in work.

Although Babylon’s offer is getting the PR, it’s actually not that great.  2 hours for a video?  So slow.  48 hours to be seen?  So long.  Travel within zones 1 – 3?  So far to go.

You can beat it.  Faster, easier, closer, with the GP you know.

As @stevekellGP tweeted yesterday, “All patients contacting the surgery today for GP help have spoken to GP & been seen if needed. No DNAs, clean start tomorrow. No videos needed” – most of them spoken to within half an hour.

If you haven’t seen his 2 minute interview you really must.

Our vision is of a transformed general practice that you own and you run for the care of all your patients.  It is not a transformation done over you by the power of money.

I’ve been saying this for six years.  Now wake up GPs, before it’s too late.

 

Harry Longman