The doctor will see you now: NHS starts outsourcing mobile video consultations

THe doctor will see you now The Times 6 November 2017

The Times has an interesting story today about how NHS clinics in London are outsourcing mobile video consulting service to an xcludarly stage startup called Babylon Health than has already received $85,000,000 in Venture Capital funding:

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The startup is putting the raised money into some big budget outdoor marketing campaign on the London Underground:

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…and on huge road-side electronic billboards:

Babylon indigestion advertbabylon-hangover-did you mean liver disease

The news seems to have really hit a nerve with the RCGP leadership and there’s already a press release on the RCGP website:

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GPs have been quick to point out that the NHS GP practices working with the ‘startup’ are going to be able to cherry pick the younger/healthy Patients of neighbouring practices and it’s going to make them increasingly unviable if they continue to only offer an office visit only service (which they don’t have to as there are plenty of proven ways they can safely innovate beyond this 2,000 year old model without having to outsource to a startup with huge VC debts):

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I think the RCGP is fighting the wrong fight here because there are plenty of things that are more fundamentally nonsensical that NHS funds are wasted on (eg. NHS England pays for free WiFi to be installed in Chip Shops in the hope that customers will use it to learn about how to live healthier lives!) and it’s clear this isn’t a sustainable business in the UK (even the ~$T Google couldn’t afford to sustain their free* doctor video call service and BabylonHealth pretty much acknowledge this in their T&Cs which practically exclude anyone who isn’t healthy (eg. those with health conditions and all sexually active women!) probably because the NHS GPs are only paying them <£50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them:

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The RCGP has obviously struggled to keep up with the breadth of opportunities that mHealth offers to their members (eg. their Video Consultation Skills Course wasn’t live streamed or even video recorded and was run by a medic who doesn’t offer his Patients video consults and their 2020 Vision for General Practice was outdated by the time it even went to print) but really in 2017 it’s futile to argue online with anyone that is trying to make accessing Doctor care more convenient (like it or not we live in a time when convenience is now a quality measure that is used by Patients) when most RCGP members tolerate a situation in which their services are already outsourced to daft non-evidence based political schemes like NHS Re-Direct/111 etc and for years Patients (some aged 93!) haven’t been able to understand why they can’t use the tools of our time with their NHS GP.

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I think the RCGP are in a losing position here because they’re arguing against this for the wrong reasons as there’s plenty of things that already make GP care access fragmented (eg. Patients who can/are able to line up outside a GP clinic to get an appointment in the morning get better access than those who can’t, Patients who are prepared to exaggerate symptoms will get to navigate the receptionist gatekeeper whereas those more honest will have their greater needs more easily dismissed, etc).

My advice to the RCGP would be to:

> Get your own house in order.

Develop and provide a mHealth for GPs course to all members, we can produce that for you with the Healthcare Informatics Society or watch some of the modules we’ve video recorded for organisations like the International Diabetes Federation and get inspired to make your own.

Make it mandatory for GPs to bring smartphones into their membership exam (currently the presence of a mobile would lead to an automatic fail) and test them on their use of it with Patients who have record access and understanding and have been able to use clinically validated tools that enable them to share their medical history prior to the consultation starting and get a written consult report at the end.

> The reality is Patients know, understand and trust their GP and while a sustainable financial model is fundamental to providing an invaluable ongoing GP service the RCGP must stop focusing on things that might harm the revenues of GPs and start making a big deal about the things that could potentially harm their Patients.

Instead of talking about the harm caused to the practices that will be made unsustainable if this service enables a neighbouring “BabylonHealth Partner” clinic to poach their healthiest/easiest to manage Patients, instead make recommendations to members about how they should be conducting themselves and to the NHS to reform the payment mechanisms (NHS GPs are mostly funded based on the number of Patients on their list rather than the quality of the work they do) and talk to Patients about the harm that the NHS is putting them in the way of by outsourcing consultations to symptom checkers that aren’t yet clinically validated and could clearly be very dangerous…

…and recorded video consultations that are run by private startups with complex T&Cs and Privacy Policies and huge venture capital debt that they need to recover (note: most VC backed companies fail and when they do the private personal data they have collected doing their business will be transferred to another company who may try and reuse it to recover their debts).

Related posts:

Can a quick phone call substitute for a Doctor visit? (December 2016)

Technology will never replace Doctors but they must embrace it(January, 2016)

Google is now giving away free Video Chats with Doctors to citizens searching for health info (October 2014)

Update 7 November 2017: 

Plenty of common-sense coming from GPs over at Pulse – I wonder if the RCGP will actually do anything?:

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Update 12 November 2017: 

Harry Longman of GPAccess has an interesting take on what’s happening in his regular newsletter/blog:

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As does Dr Phillip Hammond in his Private Eye article (from 24 October):

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Peter Blackburn in the BMA puts forward the argument that the ‘doctor leaders have said’ that this “smartphone GP service would divert patients away from doctors who know them – and could risk quality and continuity of care” which I don’t think is valid when you appreciate the access to a GP that knows them that young healthy Patients (the only ones eligible for the GPatHeand service) in a city like London have:

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Update 15 November 2017: 

Interesting to see the views of NHS GPs as they get a chance to read the small print, I wonder if they’ll share their concerns about how their colleagues are sharing video recordings of their consultations with the GMC? I wonder how big/successful a class action would be against the GPatHand Partners if the Patients who used the service became aware that their NHS GP had outsourced their private GP consults and the video recordings of these were now the property of a Liquidator? Perhaps that’s the business model (free consult for now and you only pay us if you want to stop someone else owning the video recording)?

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Update 16 November 2017: 

Dr Margaret McCartney has got a response to her “General practice can’t just exclude sick people” article in the BMJ from Dr Mobasher Butt, Partner at GP at Hand, and I think it pretty much proves that you’re trying to split hairs if the big issue you see here is that a few NHS GPs are doing something that excludes large groups of Patients as it’s reasonable to say ‘yes in an ideal world we would offer this to all Patients but NHS GPs aren’t implementing the available proven technology that some of their colleagues are already using and Patients expect convenience so we have to start somewhere’. Yes it’s clearly unfair to offer citizens with iPhones better access than those who don’t have one but the reality is there are probably bigger disparities in the NHS and this is pretty much insignificant when you weigh up the reality that this service is not actually going to make or lose a few NHS GPs in London a lot of money and the additional costs are in all likelihood just going to be paid for out of the £85Million that venture investors have already sunk into this startup (this is a common ‘land grab’ technique with VC debt funded mobile apps eg. look at the impact Uber has had on the Taxi business in cities like London and appreciate that although revenues have grown to $20B in 2016 it lost $2.6B but new investors are still clamouring to get in on the next $10B round!).

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I think Dr Margaret McCartney would’ve made a much more powerful argument against the unacceptable design of this new service if her discussion had focused on what happens if/when the GPatHand/Babylon Health company runs out of money or decides it can’t make money from the NHS and ceases to offer the service. Do the Patients all have to move back to their old GP? Do the old GP clinics have to accept them back? What happens to the video recordings of private Doctor consultations that the private company now claims to ‘own’ because a NHS Patient who wanted convenient access to a NHS GP has accepted T&Cs presented by a private company that was using the NHS logo/branding? What might be the long term negative repercussions of a company that owes £85Million to Venture Capital investors and claims to ‘own’ information relating to NHS Patients? What rights do NHS Patients have to access and own their own copy of this information if the NHS partnership ceases to exist? Does the existence of this new NHS service mean that the gates are open for NHS GPs to now start making £billions by misusing the Electronic Patient Records they have to market/sell private services to Patients or even sell Patients information onto third party organisations without having to do anything more than having Patients agree to some detailed T&Cs before they’re allowed to access NHS services?

Surely these are the bigger issues for Patients and GPs?

Perhaps it’s the use of eye catching adverts and terms like ‘digital health’ and “AI” (artificial intelligence) that has the NHS GPs bamboozled by the major challenges that this new approach presents after all the RCGP vision for the 2022 struggles to see beyond booking clinic appointments online. Perhaps it’s the naming of the service “GPatHand” and “Babylon”?

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…and the way the one company seems to be offering a NHS branded service that is planning to market and sell it’s private sector services to the NHS Patients that move clinic and download the app:

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Take away all the complexity and the proposition being offered to NHS Patients here seems a bit ridiculous eg. can you imagine if a NHS GP received a request from a Patient to move to the ‘GPatHand’ practice and the GP simply messaged the Patient explaining that they’d recently borrowed tens of millions from a venture capital investor and that they now have their NHS GP’s personal mobile number, Facetime ID and email address and from now on they can message them at anytime requesting a Facetime call back with the little caveat that before the Patient is able to have this new service they have to agree to T&Cs similar to the ones that GPatHand are using which enable the existing NHS GP to sell their medical record information and video recordings of any consults they have to third parties?

Update 9 March 2018:

In a bizarre initiative the London CCG that is paying for the GP at Hand service has put out a 250,000 offer for someone to evaluate the service:

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So far there are 11 comments by GMC Registered Doctors on the Pulse article and all of them very critical of the service and the evaluation process:

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About David Doherty
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