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Babylon’s Health App Puts Patients At Risk

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Roy Trevelion
BHIVA Reps
Posts: 332
Babylon’s Health App Puts Patients At Risk
Posted on: October 24 2018, 10:06 am

This post can be found at this site with links: http://classonline.org.uk/blog/item/babylons-health-app-puts-patients-at-risk.

Does anyone have more information on this please?

Quote
“I think doctors have roundly rubbished @babylonhealth from the start because they are scared of the future. And the future it is. Patients like ease & speed & convenience & in this 24/7 world its what they expect from healthcare (rightly or wrongly),” tweets Dr Renee Hoenderkamp, resident GP at BBC Radio London. 

Launched in November 2017, ‘GP at Hand’ is a new NHS app by private digital provider Babylon Health. It promises the ability to “book an appointment in seconds” using your smartphone. Video consultations “are available 24/7 and you can usually be seen within 2 hours.” Those requiring face-to-face appointments may be seen within 48 hours at one of five GP clinic locations across London.

Contrary to Dr Hoenderkamp’s view, as both a doctor and a patient, I find the prospect of technological advancements that provide improvements in healthcare exciting. However, there are certain things about this new provider of NHS care that patients may be interested in knowing before considering signing-up.

The most pressing concern is regarding patient safety. Babylon’s AI chatbot screening tool has not undergone robust, independent trials, and has failed to identify red flag symptoms for potentially life-threatening conditions including heart attack, stroke, deep vein thrombosis, cancer and meningitis.

Complaints have been made to the Care Quality Commission (CQC), with one doctor stating, “These flaws were so fundamental that I felt the clinical validity of the entire system should be questioned.” Babylon later responded to a critical inspection report by the CQC - which questioned the service’s safety and effectiveness - with the threat of legal action (subsequently dropped).

GP at Hand exploits the controversial 2015 GP Choice Scheme, which allows general practices to register new patients who live outside their practice area, without the responsibility for providing home visits.  Patients that register with GP at Hand have to de-register from their own surgery, withdrawing precious funding from community general practice in the process.

It provides a selective service that may be less appropriate for pregnant women, people with complex physical, social, and psychological needs, and adults with a safeguarding need… the list goes on. And it disadvantages those without access to or the ability to utilise the technology, e.g. the elderly, those with learning disabilities, and those with poor English language proficiency.

Babylon Healthcare Services Limited can be traced back to a holding company in Jersey, the offshore tax haven. And Babylon’s founder and CEO, Ali Parsa is a former Goldman Sachs investment banker, who was also the co-founder and CEO of Circle Health Limited - the company at the heart of the failed experiment to privatise the management of Hinchingbrooke Hospital in 2012, which resulted in compromised patient care and squandered taxpayers’ money.   

The blurring of lines between public and private sectors in the NHS, and the development of a two-tier healthcare model are also evident in the enhanced service Babylon offer - private appointments with GPs, specialists and therapists to those willing and able to make one-off payments or subscriptions. 

Developments in information technology and artificial intelligence have the potential to improve healthcare for all, and there is a role for private digital companies in designing systems for the NHS. But any new policies must be based on sound independent evidence, be shown to be cost-effective, and have undergone health equality impact assessments. 

Though it is reasonable that patient preference for “ease & speed & convenience” be taken into consideration in policy-making, it is also the responsibility of NHS England and the Department of Health & Social Care to prioritise the needs of patients over their choices as consumers.

What the introduction of GP at Hand teaches us more than anything else is that we urgently need to modernise our institutions and make them fit for the 21st century, because NHS England is getting out of hand.

Dr Ameen Kamlana is a GP in east London. For more follow him on Twitter @ameenkam
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Paul Clift
Member
Posts: 467
Re: Babylon’s Health App Puts Patients At Risk
Reply #1 on: October 24 2018, 10:44 am

Interesting post! And yes, it would be great to know more.
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Roy Trevelion
BHIVA Reps
Posts: 332
Re: Babylon’s Health App Puts Patients At Risk
Reply #2 on: October 24 2018, 11:33 am

Thanks Paul,

Yes, I agree. In fact there was a Radio 4 Today Programme interview with Ali Parsa, CEO of Babylon, that was very enlightening. So later that day I listened again and logged the conversation.  Any mistakes are mine but I believe this is an accurate transcript. On the problem about the App and clinical safety, Mr Parsa seems to answer a different question in this interview.
Here it is, below:

R4 Today programme 13 September at 6 mins to 9:00 am

(Int) Interviewer
AP (Ali Parsa, CEO Babylon – parent company that runs GP at Hand)
RV (Dr Richard Vautrey, Chair GP Committee, British Medical Association)

SoS = Secretary of State


(Int): So Ali Parsa just explain to us how your App works.

(AP): So, we have a very simple service. So, what it does is allow patients to check their symptoms whenever they want. To make an appointment with a doctor within seconds, to be able to see a doctor within minutes. In fact, I was just checking my App and it says that if I want to see a doctor I can see one at 9 o’clock today, in the next few minutes.

(Int): You mean ‘see’ over the phone?

(AP): Over the phone. And if you want to see somebody physically then, you can go see them that very same day. It is open 24hrs a day, 365 days of the year. And it is available for the same price the National Health Service pays any other GP. What we have done is to solve the problem of accessibility and the continuity of healthcare – using technology and what the SoS and the NHS is doing today is celebrating that and promising it for the whole country.

(Int): And Richard Vautrey, this is something which patients complain about again and again, isn’t it, access to their GP, so is this kind of App the solution?

(RV): We have real concerns, as well as patients do, about the inability of many practices to be able to offer enough appointments and that’s simply because we haven’t had the funding over the last decade to support the expansion of the health service to be able to meet the growing needs of our patients. What General Practices are doing right now is seeing thousands and thousands – if not a million – patients today offering, you know, face-to-face consultations and seeing them in their surgeries, so that’s when patients approach them today. So that’s happening right now. What we haven’t got is the resources to be able to offer some of the IT technologies in every single practice. And the SoS’s commitment to IT is welcome, but we need to see that commitment translated into resources provided to enable every practice to offer this type of consultation.

(Int): But could this kind of technological approach actually help some of the pressure on GPs because people would consult a doctor over the phone rather than going to the surgery.

(AP): Well many practices, if not most practices, already offer telephone consultations. What they haven’t got is the IT kit to be able to offer smart phone consultations, or Skype-phone computer consultations, any many would like to be able to do that, if the technology was provided to them. But the other big difference is that every Practice that is open today will see any and every patient who lives within their area, and we have concerns about the model of which GP Hand has been built, which is primarily about looking at some of the relatively mobile healthy patients and not accepting every single patient who lives within their area.

(AP): I’m afraid Richard that is simply factually not true. We will ask when patients started the service, to ask patients to seek advice if they want to change their GP Practice to our Practice, if they have any clinical issues. Most patients seek advice and join us ¬– we look after them, young, old, sick, healthy, our patients are across the border, and we don’t do that just in Britain, remember we look after one third of the population in Rwanda, and we do so in the United States, we do this in Canada. . .

(Int): But specifically, on this idea of whether you cherry pick patients, it’s likely that patients who don’t have very serious health problems, and maybe younger, are more likely to want to use an App on their mobile.

(AP) . . . but, why is that? If the patient is not very mobile, if the patient is very old, if the patient can’t wait a few weeks to see their GP, they’re significantly more likely to use a service that is continuously available. Many of our patients have mental health issues – they can’t wait for a few days or a few weeks to see their GP. That’s why they switch to us. A thousand patients today will choose to apply to GP at Hand, and then switch their GP Practice – one every three minutes.

(Int): Richard Vautrey, some GP Practices are worried about the fact that if their patients sign up to GP at Hand they then lose that funding, don’t they?

(RV): That’s exactly right. And the way that General Practice is funded at the moment is a balanced mechanism, so those patients who use the service less, and there are many patients that use the service more, and that overall, that compensates one for another. What we have concerns about is that this would effectively replace a personal service with an anonymous call centre and patients don’t want that.

(Int): And finally, Ali Parsa, this was something that commissioning groups in Birmingham were worried about and that was clinical safety – isn’t it better to see a doctor the next day.

(AP): No, it wasn’t clinical safety, you do see a doctor, not a call centre, face-to-face on your mobile and then see one in one of our surgeries. We will open up across the country physical surgeries, their issue was not that. It was an IT hitch that doesn’t allow its screening to be done with your local hospital and that IT hitch has been fixed. This is the future, and I encourage more and more patients to join it.

(Int): Okay thank you both, we’ll leave it there, let us know what your think via twitter.

All the best,
Roy
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Roy Trevelion
BHIVA Reps
Posts: 332
Re: Babylon’s Health App Puts Patients At Risk
Reply #3 on: October 25 2018, 07:47 am

Hi All,

Keep our NHS Public (KONP) has a very helpful description of GP At Hand on their website at https://keepournhspublic.com/wp-content/uploads/2018/03/GP-at-Hand-KONP-national-EMAIL-version.pdf   

It would be good if we could circulate. Anybody working hard in HIV prevention should be aware of this.
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