Councillors have warned that “outrage is growing” over the change in ownership of a number of GP practices across London, including two in Islington, to the subsidiary of a US health insurance group.
Both Mitchison Road Surgery and Hanley Primary Care Centre are run by AT Medics, ownership of which has been transferred to Operose, a subsidiary of American giant Centene, an arrangement that went to the primary care committee in common (PCCC) for North Central London for agreement.
In a recent meeting with Islington councillors, Clare Henderson, director of integration at North Central London clinical commissioning group (CCG), said that there was “no legal or contractual basis” to reject the request for transfer of ownership.
Health chief Cllr Nurullah Turan revealed that he had been told that following legal advice from NHS England, the CCG would have faced a “very high risk of legal challenge” if they had done.
Both the CCG and Operose/Centene have stressed that there will be no change in service for patients, with the same staff remaining on site and contracts “essentially unchanged” at the two Islington surgeries, both of which hold a ‘Good’ rating from the Care Quality Commission.
Addressing Henderson at the meeting, Cllr Tricia Clarke said: “AT Medics has 370,000 patients across London. It is a big deal, and it is being called a stealth privatisation. I wrote to the CCG and to Matt Hancock, from whom I’ve had no reply, but had a reply from the CCG saying that the patients won’t notice any difference.
“I thought that was really patronising. There was no patient consultation, no public scutiny of this deal, and I can see why you did that, because the outrage is growing.
“It’s here in this meeting, it’s going to be at the joint health overview and scrutiny commission, all the local papers – there is an outrage about people having their medical records handed over to this huge American insurer.
“It is just not what people expect. [What people] are asking is for these contracts to be terminated and let’s have some consultation.”
Henderson, who pledged to take any points that she could not answer back to her organisation, said in return that she “absolutely accepted” Clarke’s points, while remaining “not sure [she could] particularly respond very well to that”.
Cllr Turan made clear that the administration at Islington consider the “main perpetrator” of the change not the CCG itself but the government for “paving the way for privatisation” through the Health & Social Care Act 2012, which allows corporate providers to “find their way from the US to here to take over our GP surgeries”.
Cllr Martin Klute quizzed Henderson on what level of local scrutiny and redress was possible should services begin to suffer, or if priorities were shifted at the two practices from Hanley or Mitchison to see more patients virtually rather than in person, given that the owners of the practices are outside UK borders.
Henderson responded: “If the services started to suffer, these contracts are still held, we still manage those contracts, and CQC continues to regulate these services.
“Similar to any other of our primary care contracts, we still have responsibility to monitor and manage those contracts, and we can take action where we see problems occurring. We still have that ability. If we did not see improvement, we could still put in breach notice or move to ending contracts should that happen.
“At the moment, we still have the same staff teams onsite, and talking to the local GPs there, there is still a commitment from them to provide good patient care to local people.”
Klute went on to press Henderson on what recourse lay available to local systems if the surgeries’ operators “frankly out of commercial interest” sought out a preference of dealing with younger, fitter, less medically vulnerable people, and if councillors began to notice that the practices’ patient profile “had mysteriously got younger”.
Henderson responded: “It is a challenge. Previously we used to have boundaries within which patient lists sat, and now because of patient choice, practices can register patients who are not from Islington, for example, so the Babylon-type service that was talked about a lot a couple of years ago in Hammersmith, which does offer a digital or a telephony service to younger people.
“For the CCG, we remain responsible for ensuring that all patients receive primary care that is accessible and of course we are very mindful that where we have more complexity for practices it is good to have that mix, because you want a mix of younger patients so you can manage your longer-term and complex patients as well.
“To be honest, there is not a huge amount we can do about that if practices do extend their list and register more patients from out of area for example. What we do is work very closely with practices to make sure lists are managed and kept up to date and that access for all patients is maintained.”
Hammersmith & Fulham CCG ran up an over-£20m deficit in May 2019 after tens of thousands of people signed up for Babylon’s GP at Hand app based out of the borough.
Klute branded Henderson’s response “not terribly encouraging”.
Cllr Turan, who said he is due to have meetings on the issue with Keep Our NHS Public and the Defend the Whittington Coalition, added: “This has led to [shadow health secretary] Jonathan Ashworth asking Matt Hancock a question asking him to block this deal. There is a lot of public anger.
“The main improvement is the CCG has agreed to communicate better with us and involve us much earlier so that we can scrutinise these documents together and warn against these almost scandals.
“Every member of the CCG is against this. They don’t want this to happen, but legally they think their hands are tied.”