Next year College intends to invite Lavrentiy Beria to address members on human rights issues.Those who think Babylon represents a good idea should consult their on-line psychiatrists and prepare for increased ACC levies.
Very poorly considered College...
Of course, there are risks. In the end, patients will decide, mistakes may be made, and some evaluation will result from many quarters. Things do evolve and improve, they are never perfect at the outset. Trying to fight technology or even AI will serve little purpose, Pilots can no longer avoid computer-assisted flying even if, as we have seen, things can fail. Decision support systems are certainly not new in medicine, they have existed for decades, and technology is now much more advanced. On-line advice is better than Google and will either succeed or fail on its utility or misadventures. Our patients may want this just like they use After Hours care. The benefit of that service can also be questioned but consumerism out-trumps arguments to the contrary. Not all patients need or want a GP they know or even a GP at all, and the 'now' answer does have some appeal, accepting that some personal responsibilities must be taken. I am not convinced that the College needs to veto such topics just because we don't like them but facilitate such debates and seek dialogue and clarification. Maybe one day this will part of every general practice rather than separate entities as Babylon. In my view, this is simply a more sophisticated extension of the 'Portal'.
I'd suggest you read UKPulse you GP opinion of Babylon in the UK. It is not what you think it is and it does not do what you think it does. It is a competitive provider that enrols patients and creams off the "easy" patients (and their funding) whilst leaving the rest of General Practice to cope with the complex patients, the high needs patients, and the mistakes all on reduced funding levels.This is not "technology" to embrace, this is poor care and increased risk - but "cheap" for Government. We do not want this in NZ.
Thaty should read "...for GP opinion...."
Babylon serves an unmet need for fit 20-40 years olds that are rarely seen in practices.
The best response to Babylon is for NZ practices to offer the same services to this demographic. This will be particularly the case in large metropolitan areas.
If NZ general practice, responds by introducing Babylon type services, then NZ general practice can control the message ie Online services from your own practice team as opposed to Babylon,which is service delivery by professionals you do not know.
In addition, if practice introduce these service, they must market them aggressively, to inform their patients and to minimise the impact of new entrants.
It is important to adapt to these changes and waste time and effort resisting them. Early adopters will survive and prosper.
I would not use the term "unmet need" to describe the situation. It is a convenience and not a need. It is convenient because of the nature of the NHS and the problems it faces with access. They are patients who are not seen often because for the most part they are in the healthiest period of their lives (even if they engage in unhealthy activity) and because they are "healthy" it is mostly "low risk". They are "media savvy" and want instant gratification/response. Babylon does not offer ongoing doctor-patient relationships, it does not offer personalized health care, it does not offer a "medical home", and it is fraught with patient risk and medico-legal liabilities. There is nothing in it that represents "good medicine" to me. It is convenient, that is all. And when it goes wrong - because it will - the rest of us will be expected to pick up the pieces and fix things. If you think that this represents technology improving healthcare you are seriously misguided.
Thank you, Bryan for your response. Many of the issues you bring up are valid, however, there is a role for episodic care that is reflected by patient choice using A&M's and going to practices near their work for casual consultations. At present, the 'Babylon' model is restricted, over time, it will offer more services and will have a physical presence as well ( as it does in London).
Uber, Amazon and AirBnB offered people good access and responsive choice. They transformed the market. Current medical practices need to be developing their practices to become more digital practices over the next 5-10 years.
We have to respond to our patient's changing needs by looking at how they respond to new service configurations. There is rapid change occurring in the sector.
My opinion is that general practice needs to change and adapt. It is only my opinion and time will tell if it is right or wrong.What happens if I am right?
Except many cities around the globe have banned Uber, its stock value has dropped and many of the drivers have found that they barely cover their costs. Competition has been spawned and the market place has become unregulated and potentially unsafe. Would you invest in Uber now? I wouldn't. The same can be said of AirBnB. Amazon is Amazon and whilst its original core business model is sound (after it survived the DotCom crash) there are a lot of things it has become involved in that are little less savoury. The on-line gaming industry for one thing and the promotion of microtransactions and loot boxes. Go and watch Jimquisition (Jim Stirling) about the predatory nature of many on-line games and then read about Amazon's involvement. This is technology in action and technology unregulated. Maybe you did not mean to choose such poor examples, or maybe you chose to be ironic.
I am very much in favour of the use of technology for the improvement in outcomes for patients and how it can facilitate communication. Please don't equate technology and early adoption as singularly good. This is naive. You need to consider what it offers, why it offers it and where it could all go horribly wrong. In the field of healthcare going wrong could cost lives. Please don't assume that this is a model to improve healthcare, it is a model to improve profit. Do you think the Sackler's and Purdue Pharma were that concerned about the well-being of patients when they pursued their strategy with Oxycontin? We all know there haven't been any casualties there...oh, wait, I think you are now more likely to die of an opioid overdose in the USA than in a motor vehicle accident. Nothing to see here....aside from a bit of profit.
The issue is that we as professionals are expected to put the needs of others before our own. We are expected to carefully consider risk versus benefit and perform due diligence. I am not against profit but when profit is the sole motive I am against it. I like to think that I have done due diligence when it comes to organizations or corporations such as Babylon (because I have been reading about it for some time and did some research). I am far from convinced.
I have visited Babylon in London was very impressed by their values and commitment to delivering high quality healthcare in both the developed World and the Third World.
They are continually investing in the development of AI to support health professionals and will be expanding services and distribution across the UK and other countries.
The new technologies to support clinical practice are all being developed in the private sector. Health system neither have the expertise nor the funding to create these IT solutions.
One must do due diligence on any new product, I suggest that Babylon fits a clear market sector and will expand over time.
New Zealand general practice runs a for-profit, with values model, there is not reason that other private organisations cannot do the same.
The NHS is very cognisant of clinical risk and Babylon has been assessed independently and by the UK CQC and was found to be 'good', like the majority of UK general practices.
NZ does not have a CQC that rates practices, the UK does and it has been applied to Babylon.
I understand you remain far from convinced. I am not naive in my viewpoint, I suspect you need to open the horizon of your imagination.
CQC assessed it as good. Wow what a ringing endorsement. Now ask any UK GP what they think of CQC. I don't think you will get a ringing endorsement from anybody who is not actually part of CQC. Funny that. Do we want to start a critique of CQC?
As far as adopting and adapting technology I think you will find I am far from a technophobe. Have you ever bothered to perform a statistically representative survey of your patients as to what they want both in terms of the use of technology and communication tools and what they wanted by way of "services"? We did. Turns out less that 10% of patients wanted anything other than to see their chosen provider face-to-face at a mutually convenient time. The most popular "tech" they wanted was "Txt to remind" about appointments, and considering the number of missed appointments we have (very few) the cost-benefit analysis was not particularly favourable.
Just look at what the advertisement for Babylon says and say this is not simply a convenience technology. Think what you like, but this is not a technology that will improve patient outcomes or actually improve patient satisfaction. It is much easier to provide some at best second-rate nebulous solution than actually look at what the issues are and how we deal with them. Technology may play a part in a solution - but I don't think that it is Babylon - no matter how good their sales pitch is or how they sell themselves. It is because I have opened the horizon of my imagination that I can see where this can all go horribly wrong.
The RNZCGP made a good choice inviting Dr Mobasher Butt, the CMO of Babylon as a keynote speaker. NZ GPs will have an opportunity to hear him talk and ask questions about nature and impact of Babylon. They will learn a lot, maybe you should and get some first hand knowledge of the services that Babylon offers?
I think one of the major concerns many of us have Jonathon is the current funding model for Primary Care is not fit for purpose. It will not support General Practice and a clawback of the low hanging fruit that will occur with the likes of Babylon. We also have a Government that clearly lacks the insight, motivation or the competence to address these and other critical issues facing the sector.
I could not agree with you more. New model of care need new ways to fund them and this is the critical issue. The whole of the primary care funding is no longer fit for purpose.
I would hope that the review committee will take action maybe this is naive!
Sorry Jonathan, highly naive! Without GP representation on the review committee we are dead in the water. Whe our representatives didn't scream about this beggars belief.
One of the Health Quality and Safety Commission 2018 funded projects for 2018 was for the Whanganui Gonville Health clinic set up in 2007 by the Whanganui PHO to take difficult patients , poor payers mental health difficult patients and over flow from established practices and see if they could reduce the time taken for new enrollments to be seen .At the start of the project the average time was 80 - 100 days . The demographic was low socioeconomic and started wih 6000 patients of whom 19 % were clients of the hospital secondary Community mental health teams . Over less than 18 months the practice enrolled 2600 patients . although mentioned on the HQSC website that some 1700 left the practice a " churn " of 20-30 % in the write up in the Whanganui District Health Board staff News for March 2019 the exit rate was not mentioned . This is just the group that continuity of care and wrap around services and stable GP/ Practice Nurse staffing are most helped by but not being provided by the set up established .
It was to be an exemplar of the practice for the future . Million dollar rooms paid for by community trusts , community rooms, integrated pharmacy , full time social worker , Clinical Pharmacist, community located and engaging Nurse practitioners , GP s and health care assistants .
The trust pays more than many self employed GPS earn, has effectively, free rooms has regular stop smoking practitioners from another trust extremely well funded by the PHO and the results and investment are difficult to justify. Had the PHO backed the practices that had spare room capacity and needed salary support while new GPs got established instead of their own ideologically based theories of how General practice could be run by a committee with managers on $ 150,000 -$200,000 salaries perhaps the current dysfunction in the Town's Primary care could have been different .
2600 patients enrolled should generate about a million dollars of income but with 1800 leaving in the same time there is a huge wastage of people resources , energy and money achieving little .
If one looks at the demographic with Meningitis turning up at after hours clinics and EDs with a story that not infrequently seems to go some thing like my sore head and neck must have been when I was lifting something, strained something etc and the HDC reports seen by lots of different practitioners . this piecemeal service doesn't provide the outcomes that stable continuity of service should be able to.
Low hanging fruit which enables places like Northland JUST financially viable. Take that away and we are left with the massive elderly load, many who individually cost us thousands per patient and weeks each to care for. Oh FFS.
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