|
|
From We Own IT
Centene’s contract to run Canberra Old Oak surgery in North West London is expiring on 25 July, 2021.
Local decision makers are meeting tomorrow, Thursday 27 May. They’ll be making a final decision about the contract at this meeting.
Please join our protest at the offices of North West London CCG:
Sign up for the protest on Facebook if you're on Facebook.
You can bring any homemade signs you have. But if you don't have one, don't worry. We will provide you with signs at the protest.
We know that their meeting will be held online, but we need to show them that the public really cares about this.
Hundreds of people joined protests across London on the 22nd of April to make their voices heard. We know local health leaders are feeling the pressure.
If you have not yet done so, please take 2 minutes to send this email to local health decision makers.
NHS North West London CCG: W2U3Z (former CCGs: NHS Brent CCG, NHS Central London (Westminster) CCG, NHS Ealing CCG, NHS Hammersmith and Fulham CCG, NHS Harrow CCG, NHS Hillingdon CCG, NHS Hounslow CCG and NHS West London CCG) last week so that patients groups, councillors and the public could ask about the recent takeover of Burnley and Wembley GP practices by Operose Health and Centene.
Much of the meeting was taken up by a slide show from Operose and AT Medics. The meeting was told that AT Medics had been started by 6 GPs who were all from a 'deprived background' and wished to 'give something back.' They had started with one practice but through 'process design' had grown to 47 practices across London. They run 6 vaccination sites across London which focus on hard to reach groups.
Answering questions from Brent Patient Voice they gave assurances that they did not share data for marketing purposes or without the permission of patients (caveats around care home patients and medical emergencies), They said that they could not extend Burnley Practice opening hours because they were limited by their contract with the NHS, addressed criticism of health questions being asked by non-medically qualified staff at triage, promised improvements in patient access via IT when the surgery is closed and the ordering of prescriptions via the surgery App.
Robin Sharp of got down to the nitty gritty to ask why AT Medics had approached Operose as a partner. He was told that the GPs were not business people and needed support for management and governance and access to resources. The model they had been working with was not sustainable at the scale they had reached. They needed the skills, leadership and resources that 'like-minded' Operose offered.
AT Medics said that it was early days of the new arrangement, a honeymoon period, and doubtless there would be bumps in the road, but they were getting on well.
Cllr Gaynor Lloyd wanted more information on the claimed advantages of Centene's international links and the dependence of Operose on Centene's income. Operose itself was loss-making and had AT Medics looked at Centene's exit from practices not making a profit?
Mohammed Tahir replying said that there were multiple aspects to the issue. They had engaged with Centene and found them very different: 'We believe in them. We are successful and we can't see how we can get this wrong. We just needed the organisational back-up. All contracts were won on a competitive basis. As long as we are the people concerned we will be part of the NHS culture.'
On consultation with patients, AT Medics said no formal consultation was required as there was no change in the service offered but there had been a dialogue. On services that had closed Camden Road building lease had expired and no replacement building was available and a Child & Adolescent Mental Health Service provision had been found to be unustainable.
AT Medics said that they were regulated by the Clinical Commissioning Group and like all NHS services were free at the point of delivery and were committed to increasing public access. They would always work with strategic NHS objectives and prioritised working with Primary Care Network.
Robin Sharp felt some of the answers had been inadequate and people were still interested in why the takeover had taken place and wanted to know what Centene's intentions were.
Cllr Lloyd wanted to know about Population Health Management and if Operose was a joint data operator with AT Medic - if so could data be sent to the US? AT Medics replied giving the example of data on diabetes checks where analysis was used to see how many patients had not had the 8 checks required and needed following up. They trained staff in how to use Population Health management as an approach.
Cllr Johnson asked AT Medics how many other providers they had approached but was told that the information was commercially sensitive and confidential.
From Brent Trades Union Council
25th May is the first anniversary of the murder of George Floyd and the start of the Black Lives Matter protests.
This year, the TUC and Stand Up To Racism started a week of action on May 17 to mark the anniversary of the murder of George Floyd with on-line meetings, 'Take the Knee' events and also requests for Town Halls and other public buildings to be lit on the 25th May.
TAKE THE KNEE AT WILLESDEN GREEN
Also, in line with many other places, we will be holding a socially distanced and covid secure event of 'Taking the Knee', outside WILLESDEN GREEN STATION on Tuesday, 25 May. AT 5.30pm.
We hope Black Lives Matter West London will support the event and deliver a short speech.
Other speakers welcome.
26 th May
Johnbosco Lwongo from We Own It and Jonathan Fluxman from Doctors in Unite will outline next steps in building a Brent Campaign. Your contribution to this discussion will be valued.
Join Zoom Meeting HERE
Rcent Brent demonstration against takeovers
The take over of GP's surgeries by US company Centene, including three in Brent, has been covered on Wembley Matters. LINK Now a legal challenge has been launched and I hope readers will contribute.
The Appeal
Help us to stop the takeover of GP Surgeries by the giant American corporation Centene!
Centene (through its UK company Operose Health Ltd) has taken over dozens of GP surgeries in London including eight contracts in Camden, Islington and Haringey. Hundreds of patients, councillors and members of the public have written letters, protested outside surgeries and have made their feelings clear. We do not want our GP practices taken over by large profit-seeking American corporations.
The decision to allow the takeover of the GP surgeries with over 375,000 NHS patients on their lists, was taken by the Clinical Commissioning Groups who are responsible for commissioning General Practice services for patients.
Following public outcry, a patient at one of the affected practices has decided to challenge the decision of her local CCG (North Central London) in court. Ms Anjna Khurana is a local councillor, representing Tollington Ward, and is a patient at Hanley Primary Care Centre in Islington.
Anjna said:
“I am so afraid that our NHS is being dismantled bit by bit, with the private sector playing a bigger and bigger part. The NHS belongs to all of us and it is wrong that it should be run to achieve private profit rather than for the good of everyone. I also worry that my personal NHS medical data will be used by Operose for purposes that I have not been informed about or agreed to.
I need to trust my doctor, and how can I do that if they work for a company like Centene? A company that has a record of fraud in the US. I am taking this court action not only for me but for all of us, because we all feel the same about the NHS. Please help me to make this happen.”
Anjna is right to be worried. It's clear that the Centene/Operose Health business model is built around profits not patient care.
This statement, from public accounts of the UK parent company behind Operose Healthcare, makes it very clear :
"Position at 31 December 2019 and future developments ... Rationalisation of our business activities… Has continued into 2020, as the business seeks to divest of activities that have not met profitability targets. As a result, on 31 March 2019, Operose Health Limited exited the Surrey Borders Partnership NHS Trust CAMHS contract, and on 1 July 2019, Operose Health (Group) UK Limited divested its complex care division, including the contracts and related assets."
From this statement it's also clear this is not just about London GP Surgeries. Operose Health Ltd have already taken over twenty other GP surgeries across England. The corporate takeover of NHS services can happen anywhere in the country.
This case affects all of us.
HOW YOU CAN HELP
Please help to raise £25,000 - £30,000 so that Anjna can bring the case to the Court. This target is on the assumption that the judge will award 'capped costs' because this is a case of vital public interest.
£25K is to cover the 'capped costs'. When the lawyers ask the Judge for permission to bring the Judicial Review, they will ask for this limit to the amount Anjna would have to pay to NCL CCG’s lawyers, if she were to lose the Judicial Review.
This is the only way Anjna can afford to bring the case to court.
The additional £5K is towards the costs of court fees, solicitors and barristers who are working hard already in presenting Anjna’s case for consideration.
We're sure you can see the public interest in this Judicial Review. Your support will be invaluable. Please contribute whatever you can and share this page now!
NOTE: Should it transpire that a judge says there are no grounds to proceed to Judicial Review, in accordance with CrowdJustice's Terms and Conditions, we will donate any unused funds to another similar legal challenge, via Crowd Justice or the Access to Justice Foundation.
THE DECISION SHOULD NEVER HAVE BEEN MADE
The hope is that the courts will judge that North Central London Clinical Commissioning Group acted unlawfully in making their decision and that the decision will be quashed. Certainly the process was carried out with little regard for public consultation and certainly no involvement of registered patients.
London GP, Louise Irvine, of Keep Our NHS Public (KONP) said: "The NHS Constitution demands transparency and people rightly expect transparency and accountability in NHS decision-making especially about such important matters as who runs our GP practices, and their suitability to be trusted with our health care and our personal health data."
Like Anjna, the public would hope and expect proper patient and public engagement about what kind of people or organisations should get the contracts to run our GP surgeries in the future. The public don't want to see good NHS GP surgeries taken over by companies who do not share a belief in the ethics of comprehensive healthcare for everyone regardless of wealth or status.
Cat Hobbs, CEO of We Own It agrees: "Our NHS belongs in public hands, working for patients not profit. People don't want health insurance giants like Centene taking over GP surgeries. We fully support Anjna and her incredibly important fight for our NHS."
This legal challenge is an important step in stopping more corporate takeovers of the NHS. It also demands transparency and accountability from Clinical Commissioners in the future.
Steven Carne of 999 Call for the NHS said: “What is most worrying is that the failure of the various CCGs to carry out proper scrutiny means they've allowed a multi-million dollar American corporation to hold a major position within the NHS infrastructure. And the people who will suffer are the patients who, of course, were told nothing."
THE PROCESS AHEAD
We are working with solicitors Leigh Day and barristers Adam Straw QC from Doughty St Chambers and Leon Glenister from Landmark Chambers.
Anjna's claim has to be submitted to the High Court and a judge will decide whether the case can continue to a full Judicial Review. We are asking for capped costs because this is the only way Anjna can bring this case. A case that is of huge public interest.
If the Courts grant approval and agree capped costs, we will then proceed to a full Judicial Review hearing.
Photo: Amanda Rose
Photo: Martin Francis
Photo: Amanda Rose
Photo: Martin Francis
There was a good turnout today outside the Burnley GP Practice in the Willesden Centre. The practice has recently been taken over by US private health conglomerate Centene along with two others in Brent and many in the rest of London.
The protesters were cross party and no party and included Cllr Janice Long an oustanding champion of the NHS. The protest was part of national action by campaign group WeOwnIt and organised as a local alternative for those who could not make it to Centene's national HQ in Central London.
PETITIONING IN GLADSTONE PARK
NHS Banner Photo: Anna Delazol
A demonstration and petitioning was also held in Gladstone Park for those unable to attend the event in Willesden. One of the organisers said:
In one hour we met around 60 people. Some wondered why so little or nothing is in the news about the takeovers of GP practices by Operose and Centene. Others promised to sign the petition on ‘We Own It’ website. Some signed up to offer help in campaigning in the future. People were worried about the Integrating Care Systems proposals by the Tory Government to restructure the NHS in England. We should all be worried.
The protestors were joined by Cllr Shafique Choudhary.
Cllr Choudhary Photo: Anna Delazol
Brent Trades Council organised a group to join the Central London demonstration outside Centene HQ.
Photo: Pete Firmin
Ken Livingstone added his name to the petition againstCentene takeovers of GP practices:
Local Demonstration - Willesden Centre, Robson Avenue tomorrow 2-3pm
49 GP practices in England have been taken over by a private health company based in the United States. The decision was made, very quickly and quietly, at a Brent Clinical Commissioning Group meeting in December.
The GPs who had been on the board have resigned and been replaced by appintees from the insurance company. Three of the GP practices are in Brent and one of them is in Willesden Green - The Burnley practice based at Willesden Centre for Health & Care in Robson Avenue.
There are London wide demonstration against the takeover planned for Thursday 22nd April. The local demonstration Outside Willesden Centre for Health & Care, Robson Avenue, NW10 3RY - where the Burnley GP practice is based. Time 2-3pm Stay for 5 minutes, stay for an hour. Wear a mask, keep socially distanced.
If it gets too crowded we may have to do a walking march / demo along Robson Avenue!
Bring a home made banner with you. Bring a friend. (You can go to Roundwood Park after the demo!) In Central London - there is a demonstration outside Centene headquarters, the details are: Address: Operose Health HQ, 77 New Cavendish St, W1 6XB Time 3-4pm
The Background
Green Left the eco-socialist group in the Green Party has issued the following statement in sypport of tomorrow's demonstrations:
Green Left urges Green Party members and supporters to join the campaign against the takeover of General Practice surgeries by Operose Health, owned by Centene, a US health company. The campaign includes a demonstration outside Operose Health HQ in Central London on Demonstration outside Centene headquarters on Thursday 22nd April 2021 3-4pm (Operose Health, 77 New Cavendish Street, W1 6XB) and in other areas of London as well as Nottingham and Leeds. Details here: https://keepournhspublic.com/event/stop-corporate-take-over-gp-surgeries/
Green Left notes that 70 GP practices in the UK, 49 of them in London, have been taken over by the Centene Corporation, a major US health insurer, through its UK subsidiary, Operose. These were approved by NHS Clinical Commissioning Groups (CCGs) without consulting the public or local councils and with minimal oversight of the effect on NHS staff and quality of service.
We demand that CCGs prohibit any further takeovers by Centene or other for-profit companies; and that all such existing for-profit contracts be terminated as soon as legally possible.
We believe that Centene has made its large investment in UK NHS GP practices, through Its UK subsidiary Operose, in the expectation that Operose will in future pay dividends to the parent company. Operose has contracts to digitalise the NHS, transferring various patient-physician interactions to online only, with serious implications for future quality of care. It is clear from the business model that dividends will involve the closure of non-profitable parts of its business. This could include closure of GP practices that remain unprofitable despite "rationalisation" through cuts in staff, wages and services to patients. Local GP practices in deprived communities, or with a large number of older patients, may be particularly vulnerable to closure and transfer of patients to large area GP hubs. This will create difficulty for patients with impaired mobility to reach a doctor.
We cannot trust the 'due diligence' of CCGs who permitted the sale of independent-provider contracts to a new corporate owner, while apparently ignoring that Centene is accused by the Attorney General of defrauding Ohio of millions of dollars of Medicaid payments.
Unless these profit-driven takeovers are stopped, our NHS GP Services will be commercialised and taxpayers will pay more for a reduced service, the profits ending up in the US.
More information is available here: https://weownit.org.uk/blog/3-reasons-centene-bad-your-local-gp-practice
The main agenda items tabled for Wednesday's meeting
This blog has reported the huge concerns of local councillors, Barry Gardiner MP, Brent Patient Voice and Patient Participation Groups over the takeover of two GP surgeries in Brent by a US company. The concerns have been echoed across London in a joint letter by London borough chiefs to Matt Hancock.
One of the main issues is the alleged lack of due diligence by Brent CCG in coming to the apparent decision to back that takeover and the fact that the decision (it it wasa decision) being made in a private session.
Surely then it is incomprehensible that the only vehicle that the Council has to holding the Brent CCG to account, the Community and Wellbeing Scrutiny Committee, does not have this as an item on its Agenda (above).
One can only hope that councillors will put such an item on the Agenda under Any Other Business in accordance with Standing Order 60.
Many questions were left unanswered or unsatisfactorily answered at Wednesday's meeting of the PPPG LINK this is a chance for Scrutiny to really do its job.
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.
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.
She added:
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
Click bottom right for full size document