US takeover of GP surgeries could lead to cuts, says expert

A coalition of doctors and NHS campaigners are considering a legal challenge to the takeover by an American health insurance giant of 37 GP practices across London, including seven in Croydon.

NHS GP services are being privatised by stealth

US insurer Centene, through Operose Health, its UK subsidiary, recently acquired AT Medics, a primary care provider responsible for 49 GP surgeries and more than 370,000 patients in the Greater London area.

Centene is one of the United States’ highest-earning Fortune 500 companies, with revenues of $74.6billion in 2019 (the latest figures available).

Now, it is making profits from the NHS, as part of the creeping privatisation by stealth of the UK’s health provision.

Private Eye this week reports that AT Medics managed to make £35million profit from the NHS from its GP practices in London in the five years before the Centene takeover.

The likes of Doctors for the NHS, Keep Our NHS Public and NHS Support Federation have written to health secretary Matt Hancock asking for an investigation into the Centene takeover, alleging a lack of transparency, breaches of procedure and misrepresentation.

The AT Medics practices in Croydon which are subject of the latest Centene takeover are:

  • Fieldway Medical Centre, 15a Danebury, CR0 9EU
  • GP Hub Central Croydon, Brickwood Road, Croydon CR0 6UL
  • AT Medics at Parkway Health Centre, Parkway, New Addington, CR0 0JA
  • GP Hub Purley War Memorial Hospital, 856 Brighton Road, CR8 2YL
  • Headley Drive Surgery, 117a Headley Drive, CR0 0QL
  • Thornton Road Surgery, 299 Thornton Road, CR0 3EW
  • Valley Park Surgery, Healthy Living Centre, Franklin Way, CR0 4YD

The left-wing magazine Tribune has said, “This giant US health insurer is now providing general practice services in England, and is yet another example of the NHS being parcelled up and sold off. Despite what politicians would have us believe, our health service is in grave peril.”

Profit-motive: Centene is one of the US’s biggest corporations

The GP surgeries that AT Medics ran were mainly under the auspices of Alternative Providers of Medical Services, or APMS, contracts. These were introduced in 2004 and allowed “alternative providers”, other than GPs, to be the contract-holders.

Six GPs set-up AT Medics 17 years ago to take advantage of the APMS system. By the time of their takeover last month, they had practices in Croydon and 18 other London boroughs.

When the Centene/Operose takeover was nodded through, in a virtual meeting at which the public were excluded, it was stated that the six directors of AT Medica would remain unchanged. All six directors – including one based in Streatham and another from Thornton Heath – resigned en masse last month, to be replaced by three Operose directors.

APMS contracts are negotiated locally with CCGs, clinical commissioning groups, and tend to run for 10 to 15 years. The more traditional General Medical Services contracts are held by GP partners, are not time-limited, with terms and conditions negotiated nationally by the General Practitioners Committee, made of up elected members of the profession.

Funding of General Practice is complex, not least because of the way the profession was organised when the National Health Service was established in the years after the Second World War, and doctors insisted on being treated as self-employed sub-contractors of the new NHS.

Tory health secretary Matt Hancock: privatising the NHS, bit by bit

Now, GPs receive a fixed budget from the government, and the money is used to employ staff, equip premises and provide GP services. GP partners effectively pay themselves a salary from this funding.

The surgeries are run by GP partners and do not have shareholders. There is rarely any pressure for these medical practices to be run at a profit.

As Tribune observes, that’s not the case with big American corporations. “Commercial organisations generally do have shareholders who expect dividends to be paid. To generate dividends, the organisation needs to make a profit. The only way to make a profit out of General Practice is to cut costs; GPs cannot put their prices up to make more money out of their NHS provision.”

Private Eye quotes Allyson Pollock, clinical professor of public health at Newcastle University and the author of NHS plc, who says, “These deals are bad news for patients.”

Prof Pollock and other campaigners claim that Hancock’s Health and Care White Paper risks enshrining profit-driven corporations into the NHS’s commissioning system, and that this is being pushed through now under the cloak of covid.

“The shareholders want a return on investment,” the professor said.

“If the US experience is anything to go by, they pave the way for the closure of surgeries, fewer GPs, lower staffing levels, reduced access to services and erosion in quality of care and coverage.”

To find out more, and to sign WeOwnIt’s petition against the takeover of NHS surgeries, click here.


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14 Responses to US takeover of GP surgeries could lead to cuts, says expert

  1. moyagordon says:

    I don’t mind who runs the NHS as long as quality is not compromised and care continues to be free at the point of need and funded through taxes.

    • Michael Hembest says:

      The problem is so few people take an interest in the quality that is provided. I fear that we could be given a much reduced service and most of us would be happy with it.

    • The article says:-”The surgeries are run by GP partners and do not have shareholders. There is rarely any pressure for these medical practices to be run at a profit.
      As Tribune observes, that’s not the case with big American corporations. “Commercial organisations generally do have shareholders who expect dividends to be paid. To generate dividends, the organisation needs to make a profit. The only way to make a profit out of General Practice is to cut costs; GPs cannot put their prices up to make more money out of their NHS provision.”

      Clearly, the introduction of profit-taking from a fixed standard budget can ONLY result in a reduced and poorer quality service. Any attempt to suggest that will be achieved by ”efficiencies” means exactly those reductions in quality and service, including staffing, some thing I have seen in many decades of increasing private provision while employed in the NHS.

      • moyagordon says:

        I’m not convinced private provision will result in lower standards, to be honest the standards I’ve experienced in the current NHS haven’t always been great but equally they have been great on many occasions. We need innovation and a willingness to try new ways of delivering healthcare and social care and maybe smaller more nimble providers could come up with improvements in provision. Standards should be the highest priority and I’m sure people wouldn’t accept lower standards.

        • Ian Kierans says:

          Private provision of Health services to the NHS have repeatedly led to a significant cut back of the service to a bare bones functional service. So for example you have multiple damage to say three parts of an arm – two muscular and one break – instead of seeing one doctor and one consultant at Croydon you will now see three. This lengthens the time for treatment as the Gp refers you for it all but the Consultant treats say your fingers and sends you back to begin the process again for the other two parts. – I have had this twice situation four times so far as have many people. GP hubs cannot refer you to a consultant – so when say East Croydon Medical Center has no appointments you call 111 who send you to the GP Hub (at East Croydon medical center who cannot refer you but then due to impact on other illness sends you by ambulance to C.U.H who after triage send you back by ambulance to the GP at East Croydon Medical Center for the appointment they did not have that morning. Soas you can see the cost reality and patient impact of this kind of cost cutting is quite a lot and endemic – these are not isolated incidents. The costs affect everyone in the end – many of the services you feel have not been great is due to having to accommodate privately supplied services that do bare bones and then the NHS being told it no longer needs the resources to do the whole task and are redeployed. But the remaining medical tasks now fall on A+E or just do not get done leading to PALs complaints etc and Doctors at Hospitals taking the can for something they are not actually employed to do.
          So whether you are convinced or not the factual reality will still happen and as you experience. Think on this Who consulted at the CCCG change when they made Hubs in the first place?

          • moyagordon says:

            If you look at the performance figures for different healthcare systems the UK is behind many European countries like France, Spain, Portugal, Italy, Norway so there is room for improvement in the UK. Maybe we should look at different countries’ systems and be open to whatever system gives the best standards of care and outcomes.

          • Perhaps you should look at the American no-care system, Moya. Because this is where this is really leading.

        • Michael Hembest says:

          Lower standards

          The medical improvements are happening so fast it would quite easy to give you a 3rd class service and you would not even realise it.

  2. Hans Mien says:

    I think people were clapping goodbye to the NHS. The future will be for those that can afford it and get a better quality of service. At the point of need will be decided and determined by corporations and not the people. It’s just a matter of time. Check it out! NHS IS NEXT! Wake up people.

  3. This is a nightmare waiting to happen. Who will you call when you want to complain?
    Selling England by the £ is fast becoming normal.

  4. Ian Kierans says:

    . Profits will be made but costs to the taxpayers for health services will also increase. The areas of additional money making from the NHS like jabs and general screening done by these surgeries will be industrialised to ensure maximum gain – and not for patient need. There will be no benefit to those surgeries at all in having costs that produce no cost saving or profit and therefore no process put in to do so – what is there will be removed as un-productive. This is not a bias just sound business practice. It will highlight the NHS inefficiencies and the fudges that have been made for good or bad. There are so many wrongs with this and nothing right.

    Not everyone gets good GP service due to the way it is set up and the pressure on GPs. GPs are human and make mistakes also they are not infallible and may take a couple of times to get to the bottom of what is wrong. (I am sure a GP can put this better than I can) But many people, the majority of the time get good treatment from their GP service. And GPs do go above and beyond for EVERY patient when it is required in their medical opinion, although we as patients may not feel that way at times especially if it went wrong for us.
    This is a service and a practice. GPs can deliver medical advice and services within the general constraints of what the CCG and NHS England etc allows and pays for. and the little bit of cash profits are usually used to cover cuts made by CCG, additional service or a bonus for the GP/ partners for their hard work in recognition of the long additional hours they do. With a profit taking concern that will not happen.

    GPs will do the contractual hours, and in time will have little to no patient GP relationship and will rarely have time to effectively deal with long ongoing chronic conditions in a ten minute consultation when it takes 20 minutes just to read and understand the background. This can lead to more people ending up in hospital and the treatment instead of being prevented will become emergency and will be more costly. It will also lead to excess deaths before time that could have been prevented. This higher cost will not be paid by those areas privately owned as there is no ”One NHS” there. In actuality the cost for this will diminish at the GP point and those ‘savings’ go to them as profits. The hospital and emergency treatment is a transferred cost paid by the Hospital/Ambulance services (and the families of the patient) which is back to our taxes. As the cost is now overall higher the Government then makes more cuts to save money and so on. Sadly we are used to this cycle of more money for less service by Croydon Council.

    Of less immediate issue but a factor to consider especially with the IT used by the NHS is Data – your data Whether you go to the GP or not they hold your records. But now a Health insurer also holds your records. At present you have to give permission and external companies and employers have to request access. They cannot be used for bulk commercial purpose unless for agreed medical research. 10 surgeries data can mean a million records. This is quite a significant amount of data. it may not be attached to you as a person but that data used to extrapolate risk in geographical areas can (and is used by others) give commercial advantage to a Company (has the Monopolies commission looked at this?) affect insurance premiums (has the insurance regulator looked at this?) can infringe your data rights (has the ICO looked at this) but also where is the legislation and or process to protect both people and data.

    One has to ask – Has this been allowed due to a loophole or oversight in legislation – or has this been intentionally allowed? Perhaps our three MPs can ascertain the answer to that? It is remarkable that all three GP hubs are taken over – was this the intent of the CCG when it set them up? If not what is their view? Clearly this was not part of the consultation by the CCG at that time – Is this an unintended consequence? Hard not to have not known about this risk when it was raised at the time of the consultation?
    We may not like how the NHS works or how it has evolved but we should fix it and make it better not break it up piecemeal – Is it not time we stopped clapping and started actually standing up and saying no more and really appreciating the work our medical profession does?

  5. Ian Kierans says:

    Regarding other countries health care systems in Europe that perform better than the NHS – Mostly this is due to them being funded better than the NHS, many are not universal care as the NHS is (just) many have health insurers and do not cover long term chronic conditions (nor report on them) and many have some additional contributory factor. Most definitely the NHS requires overhaul and effective measures put in to it and a better regulatory system that protects patients and staff equally. It should also lose most of the top heavy administration and have better process – the list can be quite long – But fundamentally this should be done in house independent of Politic’s and owned by the Public. Most privatisations if not all in this country have failed spectacularly (or will) in improving services and are not very good at saving money either. Interestingly many of the Make (internal public) as opposed to Buy (contracted from Private or wholly privatised) concerns have been successful and most of the Buy have failed – Always on essential services the Government has had to use taxpayer funds to bail them out in the end and its been very costly.

  6. Lewis White says:

    I am assuming that the newly-refurbished Purley Memorial Hospital still beongs to the NHS ???.

    Is this shortly to be followed by another case of selling off the family silver? As Harold Macmillan said, in respect of privatisiation, “The sale of assets is common with individuals and the state when they run into financial difficulties. First the Georgian silver goes, and then all the nice furniture that used to be in the saloon. Then the Canalettos go.”

    Thank you to those who are challenging this disgraceful transefr of UK NHS pactices –and no dobut, a huge amount of assets asociated with the practices and sites– to the US private sector.
    Also to Inside Croydon for publicising it.

    Anypone who thinks this is going to lead to good is sadly deeply deluded. Go to the US . Be unemployed…. you don’t even have to be poor to be bankrupted by the US health system.

  7. Ian Kierans says:

    Regarding other countries health care systems in Europe that perform better than the NHS – Mostly this is due to them being funded better than the NHS, many are not universal care as the NHS is (just) many have health insurers and do not cover long term chronic conditions (nor report on them) and many have some additional contributory factor. Most definitely the NHS requires overhaul and effective measures put in to it and a better regulatory system that protects patients and staff equally. It should also lose most of the top heavy administration and have better process – the list can be quite long – But fundamentally this should be done in house independent of Politic’s and owned by the Public. Most privatisations if not all in this country have failed spectacularly (or will) in improving services and are not very good at saving money either. Interestingly many of the Make (internal public) as opposed to Buy (contracted from Private or wholly privatised) concerns have been successful and most of the Buy have failed – Always on essential services the Government has had to use taxpayer funds to bail them out in the end and its been very costly.

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