Background General Practice is central to the NHS but remains difficult to access for the working well. It has resisted organisational change leaving it resistant to technology and vulnerable to competition. Privately funded Babylon GP at Hand (BGPaH) can disrupt through a value proposition (access) whilst undermining core funding.

Aim It is important to analyse the impact that Babylon has made in attracting London based patients. In 2017 Babylon created a joint venture with a London based practice resulting in list growth to the 5th largest in the UK. The study examines factors that make General Practice vulnerable to digital transformation.

Design and Setting Adopting a qualitative case-study approach we assessed GP awareness of technological disruption and their willingness to utilise scale-economics through organisational development. The setting of our research was London. Quantitatively, we investigated patient-flow within Hammersmith and Fulham CCG.

Method We utilised a mixed-methods approach utilising semi-structured interviews and analysis of public data. Six GPs and two senior health managers were interviewed (n = 8) and then analysed using thematic analysis. We also accessed the NHS Business Services Authority Database to compare numbers for each practice in Hammersmith and Fulham on November 2017 and July 2020.

Results Five broad themes were identified including GP Business Ideation, GP Organisational Development, Economies of Scale, COVID-19, and the NHS. The quantitative aspects of the study demonstrated a statistically significant increase in patient number by BGPaH.

Conclusion GPs exhibited an awareness of business threat from BGPaH but this did not translate to organic organisational change. Factors included the pandemic and the use of technology as well as the emergence of PCNs. There was evidence of successful use of economies of scale by a GP-owned Federation. We could not quantitatively prove that BGPaH had disrupted primary care.