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October 24, 2017

Private Eye Medicine Balls 1455 October 6, 2017
Filed under: Private Eye — Dr. Phil @ 2:04 pm

Babylon or Bust

Perhaps the biggest crisis facing the NHS is the shortage of GPs. In 2016, 92 practices closed (including 34 mergers), and many patients now have to wait three weeks for a routine appointment. Health Secretary Jeremy Hunt promised 5000 more GPs by 2020, but in the 3 months to December 2016, there was a drop in full time GP numbers of 445. Numbers of GPs in training were up by just 147 in 2016. NHS England is now desperately trying to import GPs from countries that need them even more than we do, and train 1000 physician associates – who are currently unregulated – to take on GP work. Hunt’s other big hope is to use technology to take the pressure off GP practices.

Telephone triage, where all patients are screened on the phone by GPs to determine if they need a face to face consultation should – according to NHS England –  result in 20 per cent less A&E usage and cost savings of £100,000 per practice. However, when the scheme was tested in a proper trial published in the BMJ, it found that almost half of the patients who had a phone conversation still had to be seen in person, there was only a 2% drop in A&E attendances and this was dwarfed by rising costs from extra numbers being admitted to hospital (around £12,000 extra per 10,000 patients). Phone consultations worked well for simple problems but many patients had highly complex needs.

Undeterred, Hunt has announced ‘a decade of patient power’ by launching an NHS app which will (by the end of 2018) allow everyone in England to read their medical records 24 hours a day (some sadly will), book a GP appointment, order repeat prescriptions, check symptoms, encourage self-treatment or be ‘signposted’ to the best place to go for help. Quite how an App will succeed in cutting workload and costs when GP telephone triage and the NHS 111 phone triage has failed remains to be seen. The bottom line is that all new technology has to be rigorously tested not shamelessly promoted.

 

NHS 111 in North London has a contract with Babylon to use its Artificial Intelligence software in an App which doubtless it hopes will take the pressure of its call handlers and the rest of the NHS. Hunt even promoted it in a recent speech. Babylon was founded by Ali Parsa (who resigned as CEO of Circle after it withdrew its contract to run Hinchingbrooke hospital) and provides private GP services by video link and has corporate contracts with Bupa, Sky, and Boots. Earlier this year the Advertising Standards Authority told Babylon to stop saying on its website that it had the “world’s best doctors” and the “world’s most advanced AI [artificial intelligence]” after a complaint from GP Dr Margaret McCartney. Today, it just claims to use ‘the best doctors’ with no supporting evidence.

The website also claims that “An independent study tested the app’s symptom checker against nurses and junior doctors. It found that the app gave safe advice 100% of the time, whereas doctors gave safe advice 98% of the time, and nurses gave safe advice 97% of the time. It also found that the app is more accurate than doctors or nurses, sending patients to the most appropriate place for their treatment more often than either doctors or nurses. This means that the app not only gives safe advice, but also saves patients from spending time in Accident and Emergency or at their GP’s surgery when this isn’t necessary.” But as McCartney observed in the BMJ: ‘This study was not “independent”: it had six authors; five are current or past Babylon employees while the sixth is Parsa. The study is not indexed in PubMed and was not a real-life trial of how humans use the app but a simulation using actors and invented scenarios. I would not regard it as a trial. It omits essential details about the clinical scenarios tested.’ And it hasn’t been properly peer reviewed.

Babylon claims that its partnership with NHS 111 is an independent pilot programme set up to evaluate the technology, but McCartney has been asking since March for details of the pilot study, how they would assess any harms from the scheme and what proof they have that it is ‘100% safe’.

Parsa, meanwhile, has asked “Why couldn’t Babylon be a patient’s NHS GP?” His medical director (and GP) Mobasher Butt wrote in the BMJ. ‘Our AI app has reduced same day GP consultations by 40% by appropriately providing reliable healthcare information, self-management advice and pharmacy support. As a result, we have been able to keep waiting times for our list of hundreds of thousands of patients in the UK at a matter of hours rather than days or weeks. And 93% of users give four or five star ratings.’ Alas Dr Butt gave no references. Patient satisfaction is no substitute for proper scientific evaluation. Before Babylon replaces NHS GPs, we need robust proof that it works. Babylon’s claim to be 100% safe and have the world’s best doctors and AI are unsubstantiated drivel.