Margaret McCartney: General practice can't just exclude sick people.

GP at Hand, an NHS general practice in west London, is offering to register patients for virtual consultations. It may also permanently destabilise English general practice. One partner of GP at Hand is Mobasher Butt, medical director of the health IT company Babylon, and the practice uses the Babylon symptom checker app. This app, the practice says, gives patients “useful medical information and accurate triage advice.” Interesting, because it also says that “The GP at Hand practice shall not be responsible for the artificial intelligence symptom checker which is a separate service provided by Babylon via the App.” The results of a pilot study of this app in north London do not yet seem to be published. Babylon has claimed to have independent evidence of safety, but I’ve yet to see it. Babylon says that the app “enables your purchase of healthcare and other products sold by our third party product partners.” GP at Hand provides video call consultations for patients. If necessary, patients can arrange to be seen in person at one of several participating general practices. Its website says that the doctor may ask the patient to “perform simple checks, like feeling the glands on your neck.” Who is it for? GP at Hand says, “We deliver all the core NHS primary care services”—but it then qualifies this by saying that “the NHS has suggested that the service may however be less appropriate” for people with learning difficulties, dementia, “complex physical, psychological, and social needs,” “complex mental health conditions,” drug dependence, or terminal illness, as well as for pregnant women and frail older people. It’s very odd for the NHS to allow a contract that enacts exclusion of people with these conditions by design. In fact, the NHS’s general medical services contract specifies that refusing people registration on the basis of illness or pregnancy is not allowed. So why this exception? GPs are paid in a stupid way, such that we receive a flat rate of around £150 per patient per year. No matter how many home visits you have, no matter how many drugs are prescribed to you, the rate is about the same. The Quality and Outcomes Framework (now gone in Scotland) attempted to pay for specific disease management, and other fees and services are tangled in there, but that’s the essence.