New Zealand Doctor

Martin Hefford, CEO Tū Ora Compass Health is writing from a 12 week sabbatical in the UK, hosted by the Kings Fund in London and the Health Service Management Centre in Birmingham.

18 August 2019

Boris, Brexit, Brecon, and Babylon

if you have an interest in politics, it’s an intriguing time to be in the UK. Alexander Boris de Pfeffel Johnson is ensconced in number 10 and, with the Brexit Party eating the Conservatives from the inside, is undeterred by the prospect of a no-deal Brexit. I was visiting Brecon in the Welsh mountains on the day the Conservatives lost that seat in a byelection to the Lib Dems (who support remaining in the European Union) leaving Boris with a parliamentary majority of one. A snap election is looking likely.

Labour came fourth in Brecon, and seem to be in a poor state to fight a general election. But it may not matter anyway because, although a majority of MPs are against a no-deal Brexit, the executive (Boris) can apparently push ahead without parliamentary agreement, and there is now probably not enough time to have an election before the 31 October deadline. One timeline suggests that the earliest an election could occur would be on the day Brexit happens – making the results somewhat moot. Now there is talk of a grand coalition of parties to force Boris out and avoid Brexit. And I thought NZ coalition politics was tricky… It’s like watching a slow-motion train crash.

Babylon is the Brexit of medical politics in England. Babylon has introduced a controversial form of disruptive innovation with its “GP at Hand” service set up in direct competition with regular NHS GPs. They offer a digital-first service: an AI symptom checker, then a video or voice consultation with a GP, followed (if required after a virtual consult), by the option of an actual physical consultation. The big drawcard is that you can get a video GP consult within hours, whereas most GPs here have two week waiting times for routine appointments. A recent evaluation of the service indicated that users were younger, more affluent, and less complex than the average NHS patient, leading to a suspicion that the service is cream skimming the worried well. Interestingly the evaluation showed that many patients preferred voice over video consults.

I decided to be a mystery shopper and registered for the GP at Hand service in London. On registration, I was asked lots of questions by the Babylon AI chat bot as part of an intake assessment process. The results are shown graphically in my ‘’digital twin’’.

The assessment included a disproportionate interest in my thryoid functioning, probably because the fact that my mother had a goitre came up in the assessment, and Babylon AI hasn’t been told about the lack of iodine in NZ salt.

I also tried the Babylon AI symptom checker; I sprained my ankle sometime back and used my remembered symptoms to answer the very numerous Babylon questions. At the end the AI concluded there was a 90% likelihood that I had a broken or cracked ankle bone. A sprain didn’t seem to occur to it, so perhaps not quite ready for musculoskeletal medicine yet.

Fortuitously for this blog, I had an exacerbation of my asthma and used the GP at Hand Service for real. Same day video consult – script pick up from nearby pharmacy with a follow up physical consultation a few days later. My verdict? It’s a video front end to a fairly traditional model of care. In NZ the whole thing would have been dealt with by secure messaging between me and my GP through the patient portal (convenience plus continuity). I would have needed neither the video consult nor the physical visit. But Babylon GP at Hand doesn’t provide secure messaging to your GP. They do give good access to your notes – but so does my GP in Wellington. Though I expect the service offering will keep improving, Health Care Home practices in NZ having nothing to fear from Babylon in its current state.

Boris gets the last word on disruption: “My friends, as I have discovered myself, there are no disasters, only opportunities. And, indeed, opportunities for fresh disasters." Boris Johnson


                                                                                                                                                                                                                                                    Babylon GP at hand App

                                                                                                                                                                                                                                                    My Bablyon digital 'twin'