Cost-effectiveness of GP at Hand 'challenging' to assess, interim report warns

The cost-effectiveness of the Babylon GP at Hand service will be difficult to determine because of its predominantly young, healthy population, an interim report on the service warns.

Cost-effectiveness (Photo: iStock.com/Alphotographic)
Cost-effectiveness (Photo: iStock.com/Alphotographic)

An interim report from a £250,000 review of the impact of the controversial video consultation service warns that infrequent use of healthcare by most patients who have signed up for GP at Hand will make it difficult to assess.

Market research firm Ipsos Mori was appointed earlier this year to evaluate how the rollout of the service had affected other GP practices, and its potential long-term impact on the overall sustainability of general practice.

The interim report warns: ‘Evaluating the cost-effectiveness of the service for users is more challenging because the Babylon GP at Hand cohort are most likely to be episodic users of primary care and may not have any underlying health conditions.'

Cost-effectiveness

It adds tha cost-utility analysis - a form of financial analysis used to guide procurement decisions - will ‘not be possible’.

Instead, the market research firm will use ‘proxy metrics’ from other services such as A&E and 111 to understand the patterns of usage between the cohort using GP at Hand and a ‘comparator group’.

Of the 31,519 new patients who have signed up with GP at Hand over the past 12 months, 87% are aged between 20 and 39 years old - leading to accusations of ‘cherry picking’.

Researchers have also had some difficulty assessing the system-level cost of GP at Hand as negotiations over access to ‘necessary datasets’ are ongoing, the interim report reveals.

Impact of GP at Hand

‘An evaluation with limited access to data and covering a short time period will not be able to provide definitive conclusions on whether Babylon GP at Hand is cost-effective or provides value for money but it will be able to provide information for decision makers to help them understand the impact of Babylon GP at Hand,’ the authors write.

‘The quality of that information will depend upon the granularity of the data available for analysis.’

In addition to cost-effectiveness, the interim report also sets out plans to assess the impact of GP at Hand on:

  • Registered patients, including ‘the impacts on experience; cost and efficiency; equity; and as far as possible, safety and effectiveness’.

  • The primary care workforce, considering the ‘potential effects’ of GP at Hand on staff, including ‘job satisfaction; pay; training, retention/recruitment/working patterns; workload; the patient/doctor interaction; and the wider primary care workforce’.

  • The wider healthcare system, including ‘the impacts on other practices and their patients; CCG finances [and] referral pathways; overall demand and costs; productivity, efficiency and value’.

Ipsos Mori will use case studies and surveys to feed into a final report due to be published in March 2019. These will cover ‘key aspects of the Babylon GP at Hand model', with surveys to include questions designed to 'allow a comparison to wider primary care'.

Patient satisfaction

Patients will be asked about the registration process, appointment process, overall experience, future intentions, smartphone usage and demographics.

The interim report also highlights numbers of patients deregistering from the service. ‘Given the rate at which patients are de-registering from Babylon GP at Hand, it is anticipated that a number of patients invited to take part in the patient experience survey may have deregistered or stopped using the babylon GP at Hand service by the time they complete the survey.

'The survey is, therefore, the preferred approach for identifying and recruiting deregistered patients for the evaluation and has been designed with this in mind,’ the report says.

The interim report is due to be discussed at Hammersmith and Fulham CCG's primary care commissioning committee meeting on Tuesday.

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