A UK subsidiary of a multi-billion dollar US healthcare firm is in the running to take over an ‘outstanding’ Nottingham GP practice which looks after thousands of the most vulnerable patients in the city.
Operose Health, the UK arm of one of America’s largest healthcare companies Centene, has bid for the contract in a controversial procurement process which has been criticised by political leaders and raised a multitude of concerns among local doctors and health experts.
NHS Nottingham and Nottinghamshire CCG (clinical commissioning group) is looking for a new provider to run the GP services offered by NEMS Community Benefit Services at the Platform One GP practice, rated outstanding by the CQC (Care Quality Commission).
If this practice was run by a bigger, more corporate provider, it would ultimately not be as good as it is nowDr Tumurugoti
It is on the site of Nottingham train station in the heart of the city, and provides care for nearly 11,000 patients, including the homeless, asylum seekers and people with multiple mental health or substance misuse problems.
The news comes despite NEMS wishing to continue running the service with its current model.
A source told The Doctor that Operose Health, a subsidiary of Centene, which posted revenues of nearly $112bn in 2020, was bidding for the contract and the firm confirmed the news.
BMA East Midlands regional council deputy chair and Nottinghamshire GP Kalindi Tumurugoti described the revelations as ‘concerning’ and local GPs, including from the practice itself, have raised concerns about the company’s ability to provide an equal level of service while looking to deliver profit – all with reduced funding.
The Doctor sent a list of questions to Operose Health – including asking why the company had decided to bid for the contract, if it could replicate previous ‘outstanding’ care, whether it has premises for the service lined up and what sort of model the firm intended to run at the practice.
A spokesperson for the Operose Health said: ‘As we are in the middle of a confidential, public sector procurement process where no decisions have been made by the local clinical commissioning group, we are unable to comment on any of the queries.’
Operose Health, the subsidiary of Centene, has a growing presence in the Nottinghamshire health landscape. According to its own website, the firm now runs 21 GP practices across the country – five of those in Nottingham.
It runs practices in Balderton, Kirkby, Bestwood, Bulwell and Strelley.
In 2017 the BMA revealed that the county’s integrated care system, then called a sustainability and transformation partnership, had joined up with Centene’s UK arm, then simply called Centene UK, as part of a deal worth around £3m, which brought outsourcing firm Capita and Centene UK together to assist with ‘systems and pathways’ and ‘the logistics of developing new shared service models and information management and technology’.
Dr Tumurugoti said: ‘Doctors have raised concerns locally about contracts being handed to Operose Health and thus the role of Centene in the NHS. It is a worry that there is an increasing corporate Americanisation of the NHS happening in Nottingham without much coverage or transparency.
'The personal relationships between doctors and patients are diminishing across the city – it can be detrimental to having a patient-centred approach and that crucial rapport with patients.
He added: ‘We have concerns that if this practice was run by a bigger, more corporate provider, it would ultimately not be as good as it is now. And they can’t provide the same quality services with this lower funding – there will surely have to be cuts of staff and services.’
Irfan Malik, senior GP partner at the Elmswood surgery in the Sherwood area of the city said: ‘It feels like privatisation of the NHS. I would be against privatisation of aspects of the NHS especially when we have an excellent provider already whose practice has been outstanding, as rated by the CQC.’
The timing is wrong and the process could have been much betterDr Tumurugoti
And one Nottingham GP, who asked not to be named, told The Doctor there was a feeling among colleagues that single-handed GPs and smaller groups were being pushed out of providing care and that all contracts were likely to be handed to Operose Health or, if not, to the Nottingham GP Alliance, a GP federation led by local GPs, which includes 45 practices across the city.
An investigation by the BMA’s The Doctor magazine, published on 17 November, revealed the CCG had reduced funding on offer in the contract to a base of £110 per patient.
NHS digital stats suggest the practice currently receives core GMS funding of £160 to £173 per patient, rising to a total of around £195-£211 per patient, depending on weighting. NEMS’ deputy CEO said the organisation, which has been running the practice for 11 years, would lose around £400,000 a year or would have to make 40 per cent of staff redundant under the new terms.
She said: ‘We cannot provide that care under the current framework of the financial offering that has been offered.’
Call for pause
Just days after the investigation by The Doctor was published CCG staff were questioned by Nottingham City Council’s health scrutiny committee – with councillors raising significant concerns around the financial cuts involved in the process as well as repeatedly criticising the lack of engagement or consultation with vulnerable patients and local healthcare providers and professionals.
Concerns were raised by patient representatives Healthwatch, a GP who treats homeless patients and leads the city council on substance misuse and alcohol and a public health consultant, all called to speak at the meeting. The CCG was also heavily criticised for failing to provide a copy of an equality impact assessment carried out as part of its process.
Following the meeting, the chair of the committee, councillor Georgia Power, wrote to the CCG stating that the committee had ‘significant concerns’ about the CCG’s decision. The letter asked the CCG to pause the procurement process and look to extend the contract with NEMS while a review of the process is carried out.
The letter said: ‘As you know, the committee raised significant concerns as to whether the CCG’s current trajectory is based on adequate evidence and understanding of patient need of a particularly complex cohort of service users, and how best to meet those needs.
'Naturally, the committee expressed particular concern around the potential impact this may have for service users – present and future – and their outcomes.
'But the committee was also concerned about the knock-on effect the potential absence of a comprehensive, and long-term wrap around, support package may have on other NHS and partner services should the proposed changes go ahead.’
In a statement Councillor Power said: ‘In our line of work, even with the best of intentions, it can be too easy to fall into the trap of thinking we know best. We don’t, we have a duty to listen to people with lived experience, past or present, their loved ones and those on the front line day in, day out.’
Dr Tumurugoti said: ‘The timing is wrong and the process could have been much better. And there is no doubt engagement could have been much more comprehensive – from all perspectives.
'These are complex patients who need proper, comprehensive care. We also need to be sure that this won’t increase pressure for doctors in other parts of the health system – staff across Nottinghamshire are already facing huge workloads and increasing pressure.’
Dr Malik said: ‘It was clear from the health scrutiny committee meeting that this is a very deprived and very needy patient list with multi-morbidities and a lot of other issues. It would be very difficult for an outside company to come in and seamlessly pick up that work. There’s a huge potential impact on patients.’
During the scrutiny committee meeting the CCG’s chief commissioning officer, Lucy Dadge, repeatedly emphasised that the process was considering bids from ‘local providers’ and that while a decision had not yet been made she was confident the CCG had already found a provider which could meet the needs of patients.
Operose Health’s UK registered address is at a business park in Little Chalfont, Buckinghamshire, some 105 miles away from the Platform One practice by road. Its parent company, Centene Corporation, is headquartered in St Louis, Missouri in the Midwestern USA.
Funding should be secured for NEMS to continue their excellent work at the surgeryDr Malik
The CCG has attempted to procure a new provider for this service three times in the last four years – with each attempt failing due, according to a senior manager, to reduced funding on offer and a new provider having to find premises within 0.5 miles of the city’s Old Market Square centre.
These constraints remain as part of the current process, which now looks set to be delayed as a result of the concerns of the committee.
A GP at the Platform One practice, who asked not to be named, said: ‘At the health scrutiny meeting the CCG appeared to be stating that they wanted local providers to bid for this service and implied that they had interest. This service has been out for procurement on several occasions in the past with no success.’
They added: ‘NEMS is a very efficient organisation which has been running Platform One Practice for the last 12 years. They have also grown other successful services locally over the years. With all their experience and expertise, they do not feel they can provide the same high standard of care for the reduced funding so how can another provider do so?’
Dr Malik added: ‘Funding should be secured for NEMS to continue their excellent work at the surgery. The proposed re-tendering and partial list dispersal of 3000 patients across the city is poorly planned.
'Certainly, the timing during the current pandemic couldn’t be any worse. Our main concern should be for the vulnerable patients, who often don’t have a voice. For the CCG, £400,000 is not a lot of money to keep this excellent service going.’
Nottingham South Labour MP Lilian Greenwood said: ‘The health scrutiny committee clearly has serious concerns about the CCG’s plans for service users currently served by the Platform One practice, particularly those facing multiple disadvantages.
‘I hope the CCG respond promptly to these concerns. It’s vitally important that meeting the health needs of our city’s most vulnerable citizens is a top priority in this process and I will be seeking assurances from the CCG that any new contract will do so.’
A spokesperson for the CCG said: ‘Following the meeting with local stakeholders last week on Platform One Practice, the CCG has now received an official letter from the City council health scrutiny committee in regards to the current expression of interest process and will carefully consider all options and recommendations before making a decision.’