Does GP at Hand risk destabilising care for patients with the greatest needs?

An expert fears that GP at Hand will fatally undermine traditional general practice

Expansion of the digital GP service, GP at Hand, risks destabilising care for patients with the greatest needs, argues an expert in The BMJ.

Martin Roland, Emeritus professor of health services research at the University of Cambridge, asks could – and should – smartphone consultations replace traditional approaches to accessing primary care, and will the new service make the NHS’s current crisis in primary care better or worse?

Babylon, which runs GP at Hand with a group of London GPs, provides remote consultations with doctors and health care professionals via text and video messaging through its mobile application.

Almost all initial contacts are through smartphone consultations, explains Roland. Only if the problem cannot be sorted out on the phone do patients travel to one of five clinics in London for a face-to-face consultation.

Yet some fear that the new service will fatally undermine traditional general practice, leaving GPs with sick and complex patients to look after as fit young patients move to GP at Hand, he writes.

Indeed, the new service has proven popular, with over 50,000 patients now enrolled.

A recent independent evaluation confirms that GP at Hand caters principally to a healthy, affluent, young and working population, says Roland.

However, he points out that a quarter of GP at Hand’s newly-registered patients move back to a conventional NHS practice, many within two weeks.

The health and care services regulator, Care Quality Commission, recently rated GP at Hand as ‘good’ in most areas but found it needed to improve its performance in cervical screening and childhood immunisation coverage.

“The service clearly meets the needs of some patients who value a fast convenient service, but it falls short of providing comprehensive proactive primary care,” says Roland.

He acknowledges that phone and video consultations have much to offer as an adjunct to conventional primary and secondary care, and notes that Babylon’s entry into the NHS is already stimulating other practices to widen the range of services they offer.

But could smartphone consultations replace traditional approaches to accessing primary care in developed countries, and will Babylon’s GP at Hand make the NHS’s current crisis in primary care better or worse, he asks?

There are fears that Babylon will make the shortage of GPs worse, he writes, although the evaluation found that GP at Hand enabled some GPs to increase their NHS work, finding it convenient to work part time from home alongside their work in conventional NHS practices.

However, he argues that the current NHS funding formula “does not adjust adequately for the costs of providing a comprehensive primary care service and the NHS needs urgently to review its arrangements that have allowed a private company to cream off fit young patients from existing NHS practices”.

If the GP at Hand model became widespread, “it would risk destabilising care for patients with the greatest needs and those who need regular proactive care,” he concludes.