GP At Hand

[Sue]

I (and I assume others in ED) received a leaflet through my door advertising an NHS service, GP at Hand.

I had never heard of this before, but it seems a great idea.

However it has mixed reviews online.

Just wondering if anybody has used or is currently using it, and if so what were their thoughts?

https://www.gpathand.nhs.uk/

[rendelharris]

There's an awful lot wrong with the GP at Hand model, starting with the fact that it's not an arm of the NHS as one would think from looking at their website but a private company contracted by the NHS (creeping privatisation), moving onto the fact that it strips resources from GP surgeries to the detriment of older patients who are less likely to be able to/want to sign up...this article sums up the worries about it pretty well.

https://www.digitalhealth.net/2018/03/gp-at-hand-protests-east-london/

When I first saw it I thought great, but just realising that it would mean permanently signing off from my (very good) GP surgery was enough to put me off.

[Sue]

Thanks Rendel.

It's certainly not at all clear from their website that it is not part of the NHS.

When I saw the leaflet I thought it wasn't, but when I went onto the website, I thought it was.

However, it does clearly say both on the leaflet and the website that you have to deregister from your current GP practice (but it would hardly work otherwise, would it?)

And it also says on the website that you can leave at any time and register with a "normal" GP, so I assume you could go back to your present GP (as going by some of the more negative reviews, some people have).

Are they actually vetting who they take on though, eg because of age or existing illnesses? That isn't at all clear.

[ianr]

Sue, I'm not quite sure of the strength of the nexus between Babylon Health's 'AI' diagnosis R&D and the day-to-day GP at Hand practice, but the link is worth being aware of. They were featured in Horizon last month: "Diagnosis on Demand? The Computer Will See You Now" https://www.bbc.co.uk/programmes/b0bqjq0q. It's viewable there for only one more day, but I do have a copy on disk. I don't remember atm how much it shows of actual patient consultations.

[Sue]

Thanks Ian, I'll try and watch that tonight!

[curlylocks]

More on the AI element on Radio 4's Inside Health https://www.bbc.co.uk/programmes/b08x9ckx

Including quite a "robust" discussion between babylons founder and the program's resident sceptic, GP Margaret McCartney.

[Sue]

That Horizon programme was riveting, thanks so much Ian.

Good luck I had just enough time to watch it before they took it off iPlayer!

Lots of issues raised obviously, but overall I thought the speed with which the AI is developing is extremely impressive, and to see what the company is doing in Rwanda was staggering really.

As somebody who has had potentially very serious misdiagnoses in the past (hospital consultant who told a load of students I had food poisoning when actually I had a ruptured ovarian cyst and peritonitis and could have died; A and E doctor who said I had an allergic reaction to eye make-up when actually I had an ulcer on my cornea and could have gone blind ... and other less serious mistakes.....) I don't find it terribly convincing to hear doctors say that because the AI wasn't 100% accurate that therefore it shouldn't be used.

Defensive or what?

And in one of the examples they showed, although the AI had come to a wrong diagnosis, it still said that the patient needed to see a GP, so the wrong conclusion presumably would have been picked up at that point.

Interested to listen to the Radio 4 programme now. Tomorrow!

[rendelharris]

Sue Wrote:

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> Are they actually vetting who they take on though,

> eg because of age or existing illnesses? That

> isn't at all clear.

Up until the middle of last month they were rejecting:

Women who are or may be pregnant;

Adults with a safeguarding need;

People living with complex mental health conditions;

People with complex physical, psychological and social needs;

People living with dementia;

Older people with conditions related to frailty;

People requiring end of life care;

Parents of children who are on the ?Child at risk? protection register;

People with learning difficulties;

People with drug dependence.

So in other words most of the patients who cost GP practices the most. Now they say they'll accept anyone "but we still may advise certain patients that our services do not suit them." Hmm. To an extent the list will be self-selecting anyway - over half the people I know aged 70+ don't own a smartphone, plus you have to be mobile enough to get to one of their clinics if an in-person consult is needed - the nearest one to ED is in Westminster. Thus far over 75% of their signups are from the 20-34 age group, knock out those who are pregnant, drug dependent or have mental health issues and you've got a pretty economical cohort, while standard GPs lose that funding for dealing with the care-intensive patients they have left. It also seems extremely dubious to me the way one is told one can easily return to one's GP practice; apart from the extra expense and hassle involved for GP practices having to deregister then reregister patients, one can easily imagine a scenario where one stays with GP at Hand until one's diagnosed with a serious condition when one would then be informed one would be better off with a local GP practice for more intensive supervision and care than GP at Hand can offer.

The virtual consultation model definitely has some merit (AI's a different matter, that also has great potential but I don't think Babylon (interesting name!) are planning on using it for GP at Hand at present, may be wrong), but as always with privatised services one has to question why this isn't trialled by the NHS, rather than contract it out to a private company who are paid per patient enrolled, like any other GP practice, and so clearly have a vested interest in keeping those who require the most care off their books. One wouldn't imagine the capital costs of establishing this sort of scheme are excessive.

[nxjen]

The Advertising Standards Authority banned their advertising for lack of clarity. See https://www.theguardian.com/society/2018/oct/03/advert-for-gp-access-smartphone-app-banned-by-watchdog?CMP=Share_iOSApp_Other

The Royal College of General Practitioners are quoted in the article as saying in a letter to Matt Hancock that GP at Hand ?could result in a ?two-tier? primary care service where healthier patient, with less complex medical conditions, can get an online appointment quickly and conveniently, while those with the greatest clinical need, such as those with frailty, multimorbidity or poor mental health, find it more difficult to access timely care when they need it.?

[Sue]

Given the potential real advantages of this to many people, I think it would be a pity if some solution wasn't found.

The "two tier" thing is a bit emotive. It is reasonable not to use this service for things it couldn't easily handle, surely?

I thought AI was already being used to give the GPs information before the phone consultation?

I know some older people who won't bank online and won't shop online. I personally won't use a banking app on my mobile. But that doesn't mean I don't think those services shouldn't be available to others.

I know it's not quite the same thing. But I'm a bit confused. Nobody is suggesting that people should pay for this service outside the NHS, are they?

I clearly need to find out more about the implications. I'll do some research!

[JohnL]

I signed up to "Patient Access" but haven't confirmed it (with my GP) yet.

Loads of emails :)

[rendelharris]

Sue Wrote:

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> Given the potential real advantages of this to

> many people, I think it would be a pity if some

> solution wasn't found.

>

> The "two tier" thing is a bit emotive. It is

> reasonable not to use this service for things it

> couldn't easily handle, surely?

The point is, Sue, that this service is aimed at taking away patients who generally cost little to a GP practice - the relatively young and healthy - and leaving those patients who take up the majority of resources. Thus in a simplistic model, a practice could lose 50% of its patients (and therefore 50% of its revenue) but be left with those patients who used 75% of its resources, resulting in a 25% shortfall. One way round this would be to provide payment per patient on a weighted basis, based on the statistical likelihood of them requiring care on the basis of age, socioeconomic status, gender etc. This would make the system fairer but it would certainly cut into GP at Hand's profits, in fact it might threaten their viability.

I don't think it's emotive to call it a two-tier system at all. As it stands, with the way GP at Hand have been recruiting patients, young, mobile, generally healthy patients will be able to access instant GP consultations while the elderly and those suffering serious chronic illness will be left with the old GP surgery model, only it'll be even more underresourced.

[alice]

There was a recent twitter teacup about tiny baby prescribed meds after video consultation. Dangerous

[uncleglen]

I expect Blair didn't bargain for the fact that loads of GPs would go part-time when he upped their pay a colossal amount!

[Sue]

alice Wrote:

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> There was a recent twitter teacup about tiny baby

> prescribed meds after video consultation.

> Dangerous

Well, yes, of course dangerous if the wrong meds or treatment were prescribed.

However, it could just as well have been human error after a non video consultation, couldn't it? Doctors are making mistakes every day - they're only human (no joke intended) - with in some cases devastating consequences.

I think it's easy to criticise a new way of doing things which is not necessarily worse, and may well be better overall, than the old way of doing things.

The issue about existing GP surgeries becoming under resourced is a separate one about funding, which surely could be sorted out.

ETA: Things change. Not always for the worse. Though it often seems like that these days.

[rendelharris]

Sue Wrote:

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> The issue about existing GP surgeries becoming

> under resourced is a separate one about funding,

> which surely could be sorted out.

Well yes, if the NHS could suddenly find an extra 25% to cover the loss of surgeries' most profitable (for want of a better word) demographic that would certainly make things much easier, but I haven't noticed the system being exactly awash with extra cash recently.

[Sue]

rendelharris Wrote:

-------------------------------------------------------

> Sue Wrote:

> --------------------------------------------------

> -----

>

> > The issue about existing GP surgeries becoming

> > under resourced is a separate one about

> funding,

> > which surely could be sorted out.

>

> Well yes, if the NHS could suddenly find an extra

> 25% to cover the loss of surgeries' most

> profitable (for want of a better word) demographic

> that would certainly make things much easier, but

> I haven't noticed the system being exactly awash

> with extra cash recently.

Let's hope for a general election then, eh?

[rendelharris]

Sue Wrote:

-------------------------------------------------------

> rendelharris Wrote:

> --------------------------------------------------

> -----

> > Sue Wrote:

> >

> --------------------------------------------------

>

> > -----

> >

> > > The issue about existing GP surgeries

> becoming

> > > under resourced is a separate one about

> > funding,

> > > which surely could be sorted out.

> >

> > Well yes, if the NHS could suddenly find an

> extra

> > 25% to cover the loss of surgeries' most

> > profitable (for want of a better word)

> demographic

> > that would certainly make things much easier,

> but

> > I haven't noticed the system being exactly

> awash

> > with extra cash recently.

>

>

> Let's hope for a general election then, eh?

Yep!

[nxjen]

I don?t have any complaint about the new means of delivering a service i.e. using AI but I am though uneasy about the social implications on the wider community. GP at Hand appear to practice discriminatory methods of accepting who they treat, if a ?traditional? GP practice were to set the same parameters, there would be an outcry. So yes, it could well lead to a two tier health service and I?m cynical that more funding would be forthcoming to compensate.

ETA (after seeing more recent posts)whoever wins any forthcoming general election

[civilservant]

rendelharris Wrote:

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> would be to provide payment per patient on a

> weighted basis, based on the statistical

> likelihood of them requiring care on the basis of

> age, socioeconomic status, gender etc.

this is actually how GP funding is currently allocated - on the basis of practice demographics