Wednesday 17 March 2021

AT Medic and Operose to be called in for 'grilling' by Brent Primary Care Commissioning Committee

 Following concerns raised by individuals, Brent Patient Voice and posts on this blog the Brent CCG's Primary Care Commissioning Committee decided this afternoon to call in AT Medics and parent company Operose for what the chair termed  a 'grilling' by the Committee. AT Medics is due to take over the Burnley Practice (Willesden) and Wembley Practice in Brent.

It was  unclear whether the results of that session could make any difference to the 'conditional' decision made in December - today's discussion was the first 'in public' airing of the issues and contained information that had not been available in December and included chanegs in control and  the down-grading of people who had been listed as directors.

Research by Brent Patient Voice, Nan Tewari and other individuals had unearthed financial and strategy issues concerning the companies involved AT Medics, Operose and tabove them the wholly American company Centene.

Gaynor Lloyd expressed astonishment at the lack of due diligence. Operose had made a loss in every year of its creation in 2016 and relied on a £9m funding from Centane.  She was surpised that no conditions had been put on the contract and asked if the CCG had complied with the procurement process. Nan Tewari said it had actively purused takeovers of loss making entities in the UK.

CCG officers said that services taken over by the contractor had received 'Good' and 'Oustanding' ratings.

Peter Latham, Chair of Burnley Medical Practice (one f those affected) and Vice Chair of Brent Patient Voice said that AT Medics had told staff not to inform patients of the takeover as it didn't affect them. They did not disclose that they were an off-shoot of Centene Corporation. 

Another aspect he raised was that the small print of the Privacy Policy on the practice website, required to access its facilities, that gave permission to share data with third parties for marketing purposes. The Chair of the meeting confessed that would worry her but officers said that all practices would be guided by GDPR.

Assurances had been given that AT Medics would make no changes in current personnel and that Patient Participation Groups would continue. GPs and other staff could of course decide to leave the practice.

The practices would be monitored for progress against Key Performance Indicators and Action Plans put in place if necessary.

Thr meeting was told that there would be an article about the issue in the Brent and Kilburn Times by Barry Gardiner, but unfortunately this had not been published at the time of the meeting so not available for consideration.

The Committee made the following decisions:

1. Undertake to gather more of the assurance documents involved and make them available.

2. Convene a meeting where directors of AT Medic and Operone could answer a range of questions in the spirit of GMS merger scrutiny sessions.

3. Provide answers to the list of detailed questions asked in a 12 page letter submitted by Brent Patient Voice

 A further question had been asked in the meeting for which no immediate answer could be given over whether if there was a financial failing in the practices that had been taken over, would action have to be taken in the US courts. Perhaps that could be added to the list.

Nan Tewari posed the question in 'Chat' at the end of the discussion as to whether the PCCC was acting lawfully in this case and added this comment after the meeting:

Notably, the only Brent Councillor who held the CCG's Primary Care Commissioning Committee to account was Gaynor Lloyd (Barnhill Ward).

One of the areas she floored the PCCC on, was whether they has followed the public procurement regulations in relation to the contract transfer.  

She had to insist three times before they finally admitted that they had not.

As expected, the PCCC gutlessly ratified the Operose takeover. Presumably their own thinking faculties just go into suspense when orders are handed down to them from on high (NHS North West London).

The question now is whether the outgoing CCG decision makers acted lawfully?

 I republish below a 'Comment' made on the earlier blog post abut Nan Tewari's concerns that I think is of relevance to the above.

I had not read Robin Sharp's excellently formulated letter before making my earlier comment above. The letter was very well researched, and his reasoning as to why Brent's Clinical Commissioning Group should be very wary of a takeover of Brent G.P. surgeries by Operose was spot-on!

Having had a look at some of the company records involved, I agree that there is a lack of transparency, and some complicated structures - something which in my experience is often exploited to try and conceal things that a regulator, or Tax Inspector, might find of interest.

As at 31 December 2019, the holding company for the UK group which Operose Health Ltd is part of, MH Services International Holdings (UK) Ltd, had creditors falling due within one year of nearly £49m (£48,999k).

It owed Centene Corporation £37.8m at the end of 2019, and then notes that it received a further £13m in 2020. These debts are unsecured, but repayable on demand.

Its accounts (audited by KPMG) have been prepared on the basis that the UK group is a "going concern". This is because Centene has advised 'that it does not intend to seek repayment of the amounts due at the balance sheet date, for the period covered by the forecasts.' Those financial forecasts only go up to 31 December 2021, and the accounts note that there is a risk that those forecasts may not be met.

The Director who made all the statements in connection with the holding company accounts to 32 December 2019, and signed them off, is not one of the company's UK resident directors, but Tricia Dinkelman. Her address is given as Centene Plaza, 7700 Forsyth Blvd., St Louis, Missouri, MO-63105.

That is also the address of Centene Corporation, which is a US company registered on the New York Stock Exchange, reg. 42-1406317.

The Delaware connection, referred to in Robin Sharp's letter, is that the money which the UK group owes to Centene, has not come directly from Centene Corporation, but via its Delaware registered "affiliate", MHS Consulting International Inc.

I hope that this information will be of use to Brent Patient Voice, in their efforts to get the Clinical Commissioning Group to consider VERY carefully whether Operose is a suitable organisation to take over Brent G.P. practices.

Centene Corporation obviously appears to feel that large investments in UK NHS G.P. practices will pay dividends with profits (at the expense of UK taxpayers) in future.

It is clear from the business model policies set out in the accounts of the group holding company, MH Services International Holdings (UK) Ltd, that this will involve the closure of non-profitable parts of its business (i.e. G.P. practices that still don't make a profit after it has "rationalised" them to make them more efficient).

It also seems likely, from these policies, that G.P. practices will be charged for the consultancy services provided to help make them more efficient!

The "bottom line" is that, if this sort of "takeover" is allowed to go ahead, our NHS G.P. Services will be privatised, the Government (i.e. taxpayers) will pay more for a reduced service, and the profits will end up in the U.S.A.


Nan Tewari said...

I am appalled at any meeting of any public body being called purely as a public show.

In effect, three months after making its decision in secret to allow the Operose takeover, Brent CCG is letting the Brent Unwashed into the secret.

There is no up to date information on the CCG website as to who are the two Brent councillors that sit on the Primary Care Commissioning Committee. Whoever they are, why did they not raise the alarm when the report was coming up for secret discussion last December 2020?

Why precisely is Brent Council's Scrutiny Committee intending to scrutinise NEXT WEEK when it looks at this issue?

Brent CCG has hung us out to dry: Brent Council has done the same.

Tt seems We The Public Nuisances are singularly unworthy of the valuable time of either highly paid officials or of elected representatives (barring the honourable exceptions).

Philip Grant said...

Councillors who sit on committees, including as representatives of the Council on outside bodies, are appointed at the Annual Meeting of Brent's Full Council.

Because of Covid-19, the meeting for 2020/21 was not held until September 2020, rather than in May.

The appendix to item 10 on the agenda, which lists all of the appointments which the meeting was set to ratify, can be found here:

It does not appear to include any appointments for councillors to sit on the Primary Care Commissioning Committee.

Nan Tewari said...

Thank you Philip Grant (18 March 10.48 hrs) for unearthing the information that Brent Council does not appear to have appointed councillors to sit on the Primary Care Commissioning Committee of the NHS Brent CCG.

The appalling aspect of how the NHS is run, is that it is ruthless in not allowing dissenting voices, and only permits those whose utterances have been programmed in line with what it wants said, to be heard.

Back when I was an NHS-appointed, non-executive director of Brent Primary Care Trust (which is what we had prior to Brent Clinical Commissioning Group) I was the only NED that didn't have my term of office extended for a further three years, owing to my inclination to raise awkward issues.

Lkewise, I imagine the views of councillors are not taken into account, so perhaps they wonder why they bother to be there in the first place.

Yet, it is the function of councillors - who we elect - to speak on behalf of the local community.

One wonders how is it that councillors holding the health briefs from Barnet, Camden, Enfield, Haringey and Islington, spoke up on the issue at the North Central London CCG's meeting on 18 Feb 2021? Although their requests for the PCCC to revoke or reconsider the authorisations were rejected, at least their electors could feel they had demonstrated an active interest in a matter of such deep concern.