NHS Hammersmith and Fulham Clinical Commissioning Group (CCG) has published this week the independent evaluation of the Babylon GP at Hand service, undertaken by Ipsos Mori and the York Health Economics Consortium to understand the impact of the digital-first model on patients and staff, as well as the wider system.

It follows the release of the Care Quality Commission’s report that saw GP at Hand be rated as “good” overall, but requiring improvement for effectiveness. And only this morning, the Guardian reported that University Hospitals Birmingham NHS Foundation Trust was exploring the potential of using Babylon’s services to help reduce pressure on A&E and outpatient appointments.

KEY TAKEOUTS FROM THE EVALUATION

Findings indicate that convenience and ease of access are the two main reasons for patients signing up for the GP at Hand service. “Access to a GP was regarded as more important than all other considerations, and in most cases, this was a result of perceived poor access at their previous practice,” the authors wrote.

Digital consultations are the features most commonly used “by far”, although more than half of patients have used the online symptom checker offered by the app, and a large number are choosing telephone over video appointments. Last month, MobiHealthNews reported that data collected by askmyGP in the first quarter of 2019 from 21 practices — with a combined list of around 213,000 patients — showed that a video consultation was requested in 0.1% of cases.

The evaluation also indicates that, compared to national data, the rate of consultations per year is higher for GP at Hand patients. The authors noted that they might be using the service “more than would be expected given their age" — 94% are under 45 years — and health needs: “However, it is difficult to form any firm conclusions on whether the apparent relatively high use of BGPaH (Babylon GP at Hand) results from the accessibility of the service, and whether this is linked to unmet need or supply-induced demand."

The authors said that, given the profile of the majority of patients using the service — younger, healthier, “potentially more affluent” than at the average practice — it could be “inferred” that the service was not being used by a greater number of older people or people with complex needs. Those without a smartphone or those less “comfortable” using one were also seen as "less likely" to sign up for it. "This clearly limits the number and type of patients that are likely to use the service, with potential implications for health inequalities," they wrote.

Meanwhile, 28% of patients deregistered from GP at Hand since July 2017, the equivalent of one in four, compared to the London average of one in six during the same time. NHS England data show that they returned to their previous practice, citing a “dissatisfaction” with the quality of the care provided, not being able to book a face to face appointment without having to have a video/ telephone consultation first, as well as a “change in their health needs”. The authors noted that “the evaluation has not been able to answer the question as to why so many patients leave so quickly after joining the practice”.

WORKFORCE IMPLICATIONS

But GPs interviewed said they were "highly satisfied working for Babylon" due to the flexibility and independence the work offered — services are mainly delivered by a "large, flexible workforce, the majority of whom work part-time at home". They said they were attracted to the job because it was perceived as offering a "better work-life balance" compared to practices not operating a digital-first model.

According to the evaluators, evidence suggests that a model such as the one provided by GP at Hand could positively impact the recruitment and retention of GPs that “may not remain in or enter into general practice otherwise”. But, if it is rolled out more broadly, stakeholders also cautioned that it might make recruiting staff in so-called ‘traditional’ practices "more challenging".

ON THE RECORD

Trish Longdon, Hammersmith and Fulham Primary Care Commissioning Committee chair, said they would be releasing a response on behalf of the CCG “in due course once there has been an opportunity to review it in full”.

Dr Matthew Noble, Babylon medical director, UK Clinical Service, said: “This independent report shows that GP at Hand is loved by all types of patients as they can now access a GP when they need to. I’m particularly pleased that the report has shown how our GPs enjoy their work, aren’t becoming burned out and how our digital-first approach may even be a two-way of encouraging GPs to stay in the profession and to help recruit more doctors into General Practice.

“The findings show Babylon GP at Hand isn’t just of great benefit to patients and GPs, it is also saving the NHS time and money. When you consider that the average A&E visit costs £1602 and the average outpatient appointment £1252 then you can see how quickly Babylon GP at Hand and digital-first services can have a positive impact for the NHS.”