Doctor App Babylon Health Offers Quick Appointments, But Grapples With Follow-Up Care For Mental Health

On a winter day in February 2018, a British woman with a history of depression had one of her first ever video chats with a doctor. At first the call was a revelation. She couldn’t afford private healthcare and was used to waiting weeks to see a doctor through Britain’s free National Health Service (NHS). Now she could see an NHS doctor within hours. Since November 2017 the NHS has paid Babylon Health to replace local doctor visits for patients in London with video consultations through its app GP At Hand. Hailed as an example of how technology can widen access to healthcare and slash costs, the $200 million digital-health startup attracted 41,000 patients, most of whom de-registered with their local NHS physician to use GP At Hand as their sole primary care provider.

On that call, Lauren, who asked to be identified by a pseudonym because she didn’t want to worry those close to her, told one of Babylon’s general practitioners that she’d been experiencing depression for around 15 years and that she wanted to explore options for treatment. Over the video call, the doctor promised to refer her to a psychiatrist for counseling. Two months went by with no word on a counsellor, and Lauren’s depression returned. She says she made the decision to commit suicide and ordered the tools she planned to use. Just before they arrived, she changed her mind and scheduled a phone call with a Babylon GP, she says, where she revealed she had been suicidal. The doctor promised to “urgently” refer her to see a psychiatrist through the NHS and said she would hear from a hospital within a week.

She never did. Lauren should have been connected to a local psychiatrist within 24 hours, according to a spokesperson for Mind, a mental health charity. But almost a year after that consultation, Lauren says she has yet to see a psychiatrist through Babylon’s GP At Hand. She’s caught in an administrative bottleneck that two people who worked at the company say is tripping up many mental health patients who made Babylon their main doctor. Confirming that assessment to Forbes, a Babylon spokesman says that a third of London’s mental health providers are rejecting treatment referrals from its patients. That could affect hundreds of people, including those needing immediate care like Lauren.

“We cannot comment on an individual case,” a Babylon spokesman says of Lauren’s experience. “However, if a psychiatric referral was made rather than a crisis team referral, then the GP must have assessed this as appropriate at the time.” Babylon says if a patient is deemed high risk, he or she will be referred to a crisis team on the same day. Lauren says her local NHS counseling service had rejected her psychiatric referral from Babylon because of an administrative quirk: She, like 95% of GP At Hand patients, was registered elsewhere.

While Babylon’s GP At Hand is technically registered as a medical practice in the London borough of Hammersmith, its thousands of patients are spread across dozens of boroughs that pay for their follow-up care, an unusual model stemming from the NHS’s own structure. Former Babylon staffers tell Forbes that many patients have been left in limbo as a result, with treatment requests bouncing back and forth across the NHS referral system far more than is normal for established clinics. An article in Wired this week detailed how the setup had disrupted the NHS’s funding flows and that a quarter of Babylon’s NHS patients had quit to return to their original doctors. According to the Health Service Journal, care providers were already turning away Babylon’s mental health patients in June 2018.

Babylon blames vested interests in the NHS: “Some senior individuals in a few London clinical commissioning groups and providers continue to put their narrow business interests or ideology ahead of patient care,” says a spokesman, who says that a third of London’s mental-healthcare providers are not following rules about treating patients from other boroughs. The startup has spent the past year trying to fix its referral delays through a series of meetings with NHS representatives, the spokesman says. NHS England did not respond to questions seeking comment.

Founded in 2013 by Ali Parsa, a former banker, Babylon Health has two contracts with the NHS to serve patients through its telemedicine apps. It has expanded to 1,000 employees and has rapidly picked up software licensing deals with Samsung, Prudential Asia and Canada’s Telus Health to bolster its revenues.

The GP At Hand doctor video-calling service—the only Babylon app that refers people for medical treatment in addition to offering advice—acts as one of Britain’s biggest primary care clinics. U.K. health minister Matt Hancock has called the service a model for transforming healthcare with technology, even claiming to use GP At Hand himself. In November 2018, the NHS gave Babylon permission to care for the elderly and people with complex illnesses, and the company is now hiring doctors in Canada for an expansion there.

Late last year, however, insiders at Babylon raised concerns that the company had rushed to release a diagnostic chatbot that gave inaccurate advice, and that it had fostered a Silicon Valley-style startup culture that grated against more cautious approaches to healthcare among its clinical staff. Babylon said then that it had a “safety-first culture” and that “no clinical probability analysis can be right all of the time.” Lauren’s difficulties getting urgent psychiatric treatment now also point to Babylon Health’s broader struggles to provide follow-up care to patients, three former staffers tell Forbes.

Local NHS Model Contributes To Delays

On average, NHS doctors can refer people with depression and anxiety issues for treatment relatively quickly. Last year, 90% of the 1.4 million people who were referred for state-backed counseling started treatment within six weeks, according to NHS data. The delays experienced by Babylon’s mental health patients stem from its decision to staple its service onto the NHS’s highly fragmented referral system. British doctor clinics normally see and refer patients within the borough that pays for their treatment, but Babylon’s patients are spread across as many as 32 boroughs in London.

When Babylon’s GP At Hand was set up in November 2017, it was registered to the borough of Hammersmith and Fulham, even though it would turn out that as of today, only around 5% of Babylon’s 41,000 NHS patients are living there. Such a setup was possible because the NHS had recently begun to allow Brits to register with a doctor far from home. That move wasn’t designed for telemedicine companies, but Babylon has been able to use it to grow its patient base. One former Babylon doctor recalls dealing with a patient in Sheffield, a four-hour drive north of London.

Tower Hamlets, Walthamstow, Camden, Islington and Lambeth are among the London boroughs that have been rejecting therapy referrals on the basis of location, according to a former Babylon employee. Patients getting referred to Hammersmith itself face a long wait. Responding to a U.K. Freedom of Information Act request, a local counseling provider there called Back On Track said that its waiting list for GP At Hand patients had more than tripled in 2018. Babylon says this is because its patient list size “increased greatly in 2018.”

While a stodgy, 70-year-old healthcare system is part of the problem, so are some of Babylon’s administrative processes, former employees say, citing administrative staff who lack appropriate training. In Britain, a primary care physician will usually write a letter referring a patient to a local hospital or direct a medical secretary to do so. The letter will include some background on the patient along with the patient’s symptoms and a possible diagnosis, as well as suggestions for how a specialist might help. A confusing letter can derail the process. Babylon’s GPs don’t write such letters themselves but rather alert administrative staff to do the job, and some are untrained for this job, according to two former staffers. Babylon denies this. “A trained team of administrators transcribe the clinical notes and referral letters,” a spokesman says, “but every word is checked by a senior GP before being sent to the provider.”

Babylon Health, which receives approximately £80 (about $100) annually per patient from taxpayer funds, acknowledges that in some cases patients with complex needs— who will probably need regular referrals for treatment—should not be registered with GP At Hand and that it would “arrange this in a careful way with full handover to [a] new GP.”

But for NHS users like Lauren, the allure of easy access can still outweigh the problems of getting care. Today she is still registered with Babylon’s GP At Hand because of the speed of seeing a doctor. “The remote appointments are very convenient when they work,” she says. “I’m holding out hope that this year might be worth it on balance.”

[“source=forbes”]