• Ipsos Mori review of Babylon GP at Hand published 
  • One in four patients left practice since July 2017 
  • Patients “most commonly” leaving after two weeks
  • Report finds that, on average, GP at Hand patients attended A&E less

The long-awaited evaluation of digital primary care provider GP at Hand has uncovered a high level of the patient churn, raised questions about the model’s sustainability, but also revealed contented users and doctors, as well as a positive impact on A&E attendance.

According to the Ipsos Mori evaluation, published on Thursday, one in four patients have left the digital first practice since July 2017, compared to an average of one in six across London during the same time.

Reasons patients gave for leaving included: dissatisfaction with care quality, wanting to book face-to-face appointment without having a digital appointment first and changing health needs. However, the report said it is not clear why some patients left so quickly after registering.

There are also “differing” views between doctors and patients over how well digital and face-to-face services have been integrated.

However, the evaluation also found that, on average, patients who switch to GP at Hand reduced their trips to accident and emergency. Over a six month period, GP at Hand patients had 38 fewer visits to A&E per 1,000 of the population, compared to the control group.

The report stated: “Overall, users are satisfied with the service. Although there are some areas of dissatisfaction, patients appear to ‘weigh up’ the advantages and disadvantages of the service to make an informed and considered choice about using it.

“Satisfaction appears to be driven primarily by the convenience of the service for its users and the ease with which they can book appointments.

“However, satisfaction was lower in relation to face-to-face appointments, especially in regard to the number of clinic locations, waiting times to book an appointment, and the amount of distance travelled.”

It added “high satisfaction scores should be contexualised with high drop out rate”, while “not enough is known about de-registering and it remains a key gap”.

The report was commissioned by NHS England and Hammersmith and Fulham Clinical Commissioning Group last year amid concerns over patients’ access to screening and related services, and the possible impact of other parts of the health system.

GP at Hand is effectively digital health company Babylon Healthcare’s NHS primary care service. It has used free video consultation and heavy advertising to grow its patients list more than 10-fold over the past 18 months. The service has been highly controversial, with some GPs accusing it of disrupting primary care and cherry picking health patients.

While “the majority of patients” preferred GP at Hand to their previous practice, some felt quality of care suffered due to “administrative issues and lack of continuity”.

The evaluation also found that, although patients understood “most” elements of the service, there was confusion over how face-to-face appointments worked.

The report stated there is a high work satisfaction rate among GPs working for Babylon, who appreciate the flexibility the company offers.

They felt “connected” to their colleagues, despite working remotely, and praised the system’s approach to monitoring their performance with weekly quality assurance meetings and regular feedback.

The evaluation failed to establish whether the GP at Hand model “is affordable and sustainable”, however it is thought it may inform the delivery of the long-term plan “to ensure all patients are able to access digital-first services”.

Medical director at Babylon, Matt Noble, said he was “delighted” the review found the GP at Hand model reduced the number of trips to A&E.

He added: “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 way of encouraging GPs to stay in the profession and to help recruit more doctors into general practice.

Howevr, Richard Vautrey, BMA GP committee chair, said: “This long overdue report reflects, and provides clear evidence backing, many of the concerns we have been raising for some time about GP at Hand.

“We have consistently expressed genuine reservations about a system that has been rushed-out with little regard for how it impacts patients, practices and the wider healthcare landscape.

“As this report makes clear, this is a service used by predominantly young, healthy and affluent individuals, who appear to be looking for rapid answers to health questions and issues, and are using this service as they would NHS 111, choosing convenience over longer-term quality and continuity of care. Indeed the rapidity with which large numbers of patients deregister and only to re-register with their previous practice provides evidence for this. 

“We are glad that the report has noted the risk that GP at Hand poses to [continuity], while highlighting the frustration experienced by patients when they wish to see a doctor face-to-face or they require more long-term care.

“The reports finding that telephone appointments are more popular than video consultations brings in to question whether the real issue is one of instant access to GPs, rather than radical changes to technology. Nearly all GP practices already offer these, but they lack the workforce and resource to offer them on-demand 24 hours a day. To sustain this pattern of demand the report concludes the service would need far more GPs than are currently working – something that would be unaffordable without the significant extra backing this service receives.”