Agenda item

[To receive a report from, The Royal Wolverhampton NHS Trust on Digitally Enabled Primary Care]. 

The Deputy COO – Division 3 from the Royal Wolverhampton NHS Trust gave a presentation on digitally enabled Primary Care.  The presentation had a particular focus on Babylon, who the Trust had launched a partnership with on the 5 October 2021.  The Royal Wolverhampton NHS Trust covered 9 GP Practices, which were spread across the City and one just over the border in Staffordshire.  The registered population was just over 55,000 patients.  Babylon were a global digital health care company.  They were a large and well regarded organisation.  They were registered with the CQC (Care Quality Commission) and provided good quality care. 

The Deputy COO stated that the partnership with Babylon was within Primary Care.  Babylon’s cutting-edge AI powered technology combined with the local medical and clinical expertise to create an all-in-one healthcare digital offer from an electronic device such as a mobile, laptop or tablet.  It was important to note that all patients remained registered with their local practice.  Learning and experience from the partnership would be carried forward to help other organisations, as there was considerable national interest.  There were no up front costs to install the infrastructure for the project.  A multi-disciplinary project group had overseen the work and all information governance requirements had been met through the Partnership agreement.   

The Deputy COO said that patients using the Babylon service were seeing RWT staff, such as GPs, Physios and Pharmacists.  They were able to see a schedule of appointments and book in, without the need to call reception.  Appointments were via video or on the telephone.  The service also allowed access to digital self-care tools, this included a symptom checker, Healthcheck and monitor.  The app helped the patient choose the most appropriate clinician to have an appointment. 

The Deputy COO commented that one of the benefits of the App was the fact that it was ‘always open.’  It was not like a traditional surgery reception which you had to wait to open.  Patients could also book and reschedule appointments around their needs.  Patients had more choice over who they saw, such as the clinician type, gender or a specifically named person.  Patients could also leave feedback after every appointment which gave them more granular and real time information. 

The Deputy COO stated that to date nearly 2000 appointment had been delivered via the appointment system in the app.  82% of these appointments had been with a GP, 13% Pharmacy and 5% Physio. Over 2,500 people had also used the symptom checker.  Patient feedback had been really positive.  95% of ratings had scored 4 or 5 stars out of a maximum score of 5.  They were receiving a 44% response rate, which was favourable compared to the national survey response rate of 34%.  Over 100 comments had been received as part of the feedback.  67 had been positive, 26 suggested an improvement, 6 neutral and 2 negative. 

The Deputy COO remarked that the next steps were to explore additional Primary Care capacity by attracting new or more workforce who wanted to work digitally.  They wanted to explore the opportunities for the app in planned care and cited, as an example, the Annual Asthma Review.  They would continue to evaluate the impact on patients, staff and within the wider Wolverhampton system. 

A Panel Member made reference to people who were digitally excluded and how the Babylon Service would not work for them due to this fact.  She expressed a concern about the future of Primary Care relying on digital enabled care. 

A Panel Member asked how the Trust had chosen Babylon.  He was aware of some surgeries using other systems.  The Strategic Advisor to the Board responded that GPs had always used different computer systems, there had never been a single system.  The Trust had gone through a procurement process, a careful evaluation process, due diligence and Babylon was the company which offered capabilities which others didn’t.  He understood the concerns about the future of Primary Care.  Face to face human contact could not be beaten.  It was hoped that the Babylon App would free up clinicians to be able to offer more face-to-face appointments when needed.  The Deputy COO added that it was important to see Babylon as an additional service rather than, instead of traditional services.  They were mindful about equity of access and potential digital exclusion.  They were working with colleagues to try and understand who was using the app and who was not. 

A Panel Member commented that it was clear Babylon was a fantastic piece of software.  The issue he had was that it required a generational change.  It couldn’t just be rolled out over night as it would disproportionately effect people.   He asked for the average age of the people using the Babylon App in the Primary Care network and the consultation process.  The Deputy COO responded that she recognised it would need to be a slow and iterative process.  Four months into the partnership with Babylon, ten per cent of the practice’s population had registered to use the app.  She would provide the average age figure of users of the app after the meeting.  The Trust worked with the Patient Participation Group and the Trust’s engagement forum prior to the formal partnership with Babylon. 

A Penal Member asked if people within the RWT Primary Network who did not use the app, whether it would prejudice their ability to access vital appointments.  The Deputy COO responded that alongside the Babylon app project they had also been updating their phone systems.  It was a cloud based telephone system, 8 practices now had the system and there was one further practice left to install the system.  It allowed more call capacity.  They had also worked with the practices to identify all the different type of appointments available.  The app was accessible at any point during the day, but the cloud based telephone system would not be available 24 hours a day.

The Panel Member stated that people who did not have access to the Babylon App would be at a disadvantage as people who used the Babylon App could book appointments at any time, but you could not do this on the telephone.  The Strategic Advisor to the RWT Board commented that the Trust needed to find a way to make sure the allocation of appointments did not disadvantage people who did not want to access Babylon.  The Deputy COO agreed that more work needed to be done on the telephone system, including increasing capacity to answer phones.  They were working hard with their Public Health unit to mitigate or remove the risks in relation to digital exclusion. 

A Panel Member stated that technology was the way forward.  They were mindful that Babylon had just been introduced and needed time to develop.  They spoke positively about how it could free up capacity and in particular reduce demand on the telephone service.  She endorsed the approach taken. 

The Chair remarked that you had to opt out receiving information about Babylon rather than opting in.  She was concerned about the use of Babylon in Primary Care.  She wanted to speak to local clinicians rather than clinicians across the country.  She feared that the local approach may disappear in the future.  The Strategic Advisor to the RWT Board commented that they had been cautious and the Trust did share some of the concerns raised.  Babylon had millions of pounds invested, rather than a smaller local system. 

The Deputy COO commented that the need for some people to be seen face to face was integral to the Primary Care Offer.  Currently all clinicians taking appointments on the app, within the Trust’s Primary Care Network, were Wolverhampton clinicians.  The app gave them the option in the future to hire people not within the area should the Trust wish.  This was another tool to help with recruitment, which was a challenge within the NHS more generally.  It was true that people had to opt out of the service, those that had opted out were listed within the EMIS computer system as having opted out and no information was shared with Babylon.  Those that did not opt out had the option to register for Babylon, it was not an automatic registration.  Registration was currently at 10%.  Just under 5,000 people had opted out of the service, this was also at about 10% of the population covered by the RWT led practices.

A Panel Member remarked that whilst people were written to saying they had to contact the Trust if they wanted to opt out, those that had chosen to opt out were not given confirmation that an opt out had taken place.  She suggested that a confirmation would have been beneficial, as she believed that some people who opted out were still receiving information about the Babylon service.  The Deputy COO commented that she took on board the learning point and accepted the feedback.  She was happy to have the details of any people that were receiving information about Babylon that did not wish to do so.  All this information came direct from the Trust and not Babylon. 

A Panel Member expressed concern about a private company being used by the NHS, she feared that the NHS was going down a future privatisation path. She did not endorse the Babylon approach. 

The Chair stated her main concern was about equality of access.   Access was particularly important in a City of high deprivation.  She thought the process of introducing Babylon was going too fast.  The Chair suggested that the CCG should monitor how well Babylon was working compared to other digital systems being used by other Primary Care Networks within the City.  This was a point which she would ask the CCG to report on in the future.  The Strategic Advisor to the RWT Trust Board, took on board the Chair’s comments.  He recognised that not everyone had access to a digital device.  He didn’t want people to feel forced down a path that they were not comfortable with. 

The Chair on behalf of Panel Members thanked the representatives from the Royal Wolverhampton NHS Trust for bringing the report before the Panel. 

The Chair stated she wanted the first meeting in the Municipal year to be a special meeting on Primary Care access as a whole, following the meeting that had been held in December 2021.  The Panel agreed to the proposal.  She thanked the people involved in arranging for some Members of the Panel to visit GP practices recently within the City. 

RESOLVED:

a)    That the Health Scrutiny Panel do not endorse the current approach of the use of Babylon within, the Royal Wolverhampton NHS Trust, Primary Network of surgeries.

b)    That the first meeting of the next Municipal year be a special meeting on Primary Care access as a whole. 

The meeting closed at 4pm.