Outraged patients are demanding that local NHS leaders reject a “Trojan horse” takeover of their GP surgeries by Operose Health, and start the public procurement process to find a new provider. Brent CCG’s Primary Care Commissioning Committee is meeting on 17th March to discuss a regional NHS recommendation to approve the Operose takeover of AT Medics Ltd that previously ran the NHS contract for two GP surgeries, Burnley Medical Practice located in the Willesden Centre for Health and Care and The Wembley Practice based in the Wembley Centre for Health and Care.
Operose is a heavily loss-making subsidiary propped up by US based health insurer, Centene Corporation which is registered in Delaware, and has paid no UK tax. Centene could pull the plug on Operose at any time forcing the the shut-down of a large number of GP practices. Centene’s shareholders have accused it of financial cover-up and insider share dealing.
Operose Health’s publicity states openly that its market strategy is to exit NHS contracts that do not make a profit. In one instance an Operose associate company pulled out of running Camden Road Surgery giving patients only 4 weeks to register elsewhere, to the fury of Camden councillors.
Patients argue that an open procurement process will guarantee patient safety and provide sustainable and transparent GP services, as opposed to Brent CCG rubber stamping a takeover where assurances by AT Medics have already been broken and Operose comes with a dubious financial future.
Nan Tewari, a patient of The Wembley Practice, accuses the NHS North West London region of wilfully misusing the pandemic as cover to bounce other local CCGs into rushing through approvals of the Centene/ Operose takeover bid. Former Brent NHS non-executive director, Ms Tewari explained:
It didn’t take much for our own basic internet research of Companies House records to uncover how Operose Health and MH Services are controlled and bankrolled by Centene to the tune of £tens of millions. Then there is the little matter of Operose’s CEO and a director being former senior NHS executives. Is it cronyism and corruption, or serial incompetence by greasy pole climbers, that led NHS NWL to withhold this vital information from the local CCGs?
On the one hand you have NHS region insisting Brent CCG has no choice but to agree the Operose takeover and on the other, it is advising that ultimate responsibility lies with Brent CCG as the legal decision-maker of the Brent GP surgeries’ future. The breathtaking cynicism in this dishonourable ploy lies in NWL region knowing perfectly well that with Brent CCG soon to be abolished under national plans, patients will have no come-back if Centene decides to pull the financial plug on Operose and the surgeries close down. Then, NHS region will shamelessly lament the late Brent CCG’s poor judgement and lack of prudence. I’ve seen a similar scenario played out here in previous years.
NHS NWL says it’s satisfied by unenforceable ‘assurances’ that former GP surgery contract holders, AT Medics, would remain in control of the surgeries, yet in the space of a few short weeks since the Operose takeover, all the AT Medics directors have resigned or been sacked It’s deplorable how NHS region gets away with continually palming off its sub-standard services and empty promises onto Brent patients.
Not that long ago, 3 reputable, UK tax-paying surgeries in Queens Park had wanted to merge and they were made to jump through a load of hoops and be grilled at length by Brent CCG’s Primary Care Commissioning Committee. The double standard of NHS North West London practically instructing the CCG to push through the Centene/ Operose takeover under secrecy of ‘Chair’s Action’ and without any similar questioning, is a public scandal.
As with the Queens Park surgeries’ merger, the CCG must now fulfil its legal duty and moral obligation to Brent patients, and commission a reliable company through open public procurement rules, to run the two surgeries.
BRENT PATIENT VOICE RAISES KEY ISSUES OVER AVAILABILITY OF INFORMATION, SCRUTINY, DUE DILIGENCE AND FINANCIAL STANDING
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As a patient registered at Burnley practice, please keep up your fight. We deserve good, safe and dependable GP provision.
Thank you for your support, Sophia Mac.
Peter Latham who chairs the Burnley Medical Practice PPG (patient participation group) is putting Herculean efforts into this, as is Brent Patient Voice.
I fully support Nan and other Brent residents in this fight, but as an individual who is not registered at either of these G.P. practices, I'm not sure how much say I can have.
Someone who may be more help is a relevant senior Brent Councillor, Ketan Sheth, and I have just sent him this email message:
'Dear Councillor Sheth,
You are probably already aware of this issue:
As the Chair of the relevant Scrutiny Committee, is there anything you can do to assist local residents in this matter, please?'
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.
Interesting that neither NHS North West London nor its legal advisers managed to pick up on the information that Philip Grant has unearthed - or did they in fact, conceal the information?
As ever, many thanks. Philip Grant, for your support and your superb, forensic analysis of the Operose Centene financial relationship.
In response to my email this morning, Cllr. Sheth confirmed that he is very much aware of this issue, and that his Scrutiny Committee is keeping a "watching brief".
He also sent me a "link" to the agenda and papers for the CCG meeting on Wednesday (17 March). Anyone interested can find it at:
The agenda shows just 20 minutes allocated to consideration of this item. The report includes this recommendation:
'Officers recommend that the PCCC:-
Note the granting of consent for the proposed change in control without conditions based on the due diligence evidence set out above.'
In effect, simply noting the decision already made under "Chair's Action" to grant consent for the change!
At least one of the supporting documents carries the message:'This paper is a redacted/abridged version of a paper considered by the Committee in private in advance of the meeting in public.'
This is not how important decisions, affecting the provision of health services for local residents, should be dealt with! They should be dealt with in an open and transparent way.
Thank you Martin and Philip for shedding more light on this disgraceful and sharp practice. I'm not registered at either of these surgeries but if this company should be successful in gaining a toe hold no surgery will be safe from their attentions.
Thanks for your comment Nan (at 17:08). It's fairly easy if you have the internet, and the time.
Anyone can get lots of useful information on any company operating in England and Wales, free of charge, by going to the beta.companieshouse.gov.uk website.
For the US companies, I just searched their names on Google.
Centene appears to be a huge US corporation, specialising in healthcare insurance and healthcare facilities (and benefitting hugely from "Obamacare"). If I read the figures properly, its 2020 turnover was $111billion, although its profit margin on this was a tiny percentage.
Because of its scale, it can borrow money quite cheaply, so its investment in buying-up UK companies that have been allowed by the NHS to takeover groups of G.P. practices is "peanuts" in comparison to its overall operations.
But it wouldn't be doing so if it didn't see good profits coming its way further down the line - and those profits will be made at our expense, if it (and other, mainly U.S., healthcare businesses) are allowed to buy up our NHS.
Good luck to you, Robin and BPV in your fight on our behalf!
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