Demonstrate tomorrow against takeover of our GP practices by private US health company - Willesden Centre 2-3pm

 

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The GPs who had been on the board have resigned and been replaced by appintees from the insurance company.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 22^nd 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

 

 

Brent Scrutiny Task Group set up on GP services and accessibility

It is about 5 years since Scrutiny has looked at GP services in Brent and there have been many changes since then as well as current issues around accessibility during the Covid pandemic. A quick glance at locally based Facebook sites will demonstrate there are issues around accessiblity to face to face appointments, difficulties in making contact via the telephone and differences between surgeries regarding email contact and on-line consultations.

It is welcome then that a strong General Practioner and Primary Care Accessibility Group has been formed consisiting of  Cllr Mary Daly as Chair plus Cllr Abdi Aden, Cllr Tony Ethapemi,  Cllr Claudia Hector, Cllr Gaynor Lloyd and Cllr Ahmad Shahzad.

 

The scope of the Task Force will be discussed at 5pm on Monday at a meeting that is available to watch on Zoom. 

The Task 

i) To gather findings based on quantitative data and information about GP accessibility based on face-to-face appointments, physical and digital access, and qualitative information from patients’ experiences with particular reference to those who are older, have mental health needs or a disability, and who have long-term health conditions.

ii) To review the overall local offer of GP services, including the extended GP access hub service, and evaluate any variation in accessibility by practice and the underlying reasons for any variation with particular reference to clinical capacity and nursing.

iii) To evaluate the local demand to access primary care, changes in demand during the Covid 19 pandemic and changes in access to GP services during the pandemic with particular reference to digital accessibility and face-to-face appointments.

iv) To understand the role of primary care in addressing health inequalities by gathering findings on population health, deprivation and demographic trends in the borough with particular reference to Black and Minority Ethnic (BAME) patients.

v) To develop a report and recommendations for local NHS organisations and the local authority’s Cabinet based on the findings and evidence gathered during the review.

It is suggested that there are five evidence sessions for this task group. The proposed structure for the meetings will be meetings with representatives from NHS organisations and GPs for evidence session 1 and evidence session 2, meetings with Healthwatch Brent and patient advocacy groups for evidence session 3, and a meeting with the voluntary sector and other relevant community organisations for evidence session 4. There will be a meeting with community organisations for evidence session 5.

Key Lines of Enquiry

To structure the evidence sessions, the scrutiny task group will focus on particular key lines of enquiry to ensure there is accountability about local primary care services.

These will include, but not be limited to, the following suggested key lines of enquiry.

1. What is the local demand for GP services and what are the particular needs of Brent residents, including vulnerable patient groups, in relation to accessing GP care?

2. Is there sufficient provision of GP services in the London Borough of Brent based on local population health needs and the growing population in the borough and is there a difference in provision or accessibility between the north and south of Brent?

3. What has been the long-term trend in how GP services are accessed and what has been happening during the Covid 19 pandemic in terms of the balance between remote appointments using digital technology and face-to-face appointments?

4. Is there a danger of exclusion from primary care services for those patients who are not able to use the digital or online options and rely on face-to-face appointments?

5. What strategy is needed to address variation and ensure that there is fair and equitable access to GP services available to Brent residents across the borough?

6. What does benchmarking data show about primary care and GP performance in Brent compared with the other clinical commissioning groups in North West London?

7. What is the role of Patient Participation Groups in addressing accessibility issues? 

 MORE DETAILS

NHS Kill or Cure? STP knowns and unknowns - some key questions

So much creeps up on NHS 'reform'  and realisation of its true repercussions known only to a few who can penetrate the jargon, that I am pleased to publish this early warningby Robin Sharp and Peter Latham  taken from the website of Brent Patients Voice


 Sustainability & Transformation Plans (STPs) being prepared across the country on the orders of NHS chief Simon Stevens. There is a plausible view that they present the greatest threat to the NHS since the 1948 settlement. Although there is much that we don’t know, veils are removed almost every day.

This is a brief account of what we have so far gleaned. We don’t think we should delay further sharing it with our readers. What follows is based on a note we sent to Brent’s Chief Executive, Carolyn Downs, for a meeting she kindly offered us on 1st June about the process for preparing these plans. She is the local government lead for the 8 NW London boroughs.
Overall the national STP process as well as its local iteration appears to be radical and internally self-contradictory, but moving forward in semi-secrecy at an unacceptable speed. If it was clear that clinicians and other professionals who deliver care, as well as the wider public, were going to have a proper input before STPs were finalised and implemented we would be content to wait for our turn. However this does not seem to be the case.

By virtue of the NHSE National Planning Guidance for 2016/2017 NHS CCGs and Trusts are required to produce and submit STPs in outline (checkpoint) form by mid-April and in full by the end of June, with implementation beginning in October. Local authorities, though not subject to NHSE jurisdiction, are to be engaged in the process of production. Clinicians and patients are to be involved, presumably after the full STP has been submitted. STPs cover newly-created areas called “footprints”. In the case of our area the footprint consists of the 8 boroughs already grouped together for the purpose of 'Shaping a Healthier Future', 'Whole Systems Integrated Care' and 'Transforming Primary Care'.

The main purposes of STPs are 
to speed up implementation of the changes in ways of working between hospitals, GPs and community services outlined in The Five Year Forward View and;
to eliminate financial deficits, i.e. spending above budgets, in short order.

The Guidance makes no reference to current NHS shortcomings, pressures, staff shortages or population growth but strongly asserts that in the short term better services can be delivered with fewer resources. It has a list of questions to be answered which seem likely to provoke cynicism among front line staff.

The NHSE publication: General Practice: the Five Year Forward View issued on 21 April 2016 with Introduction by Simon Stevens describes a major transformation of NHS GP practices that Sarah McDonnell for Brent CCG recently described at the Brent Health and Wellbeing Board as a 'cottage industry', and Dr Sarah Basham characterised as 'getting more corporate'. This is set out in Chapter 5 at page 49.

The vehicle proposed for this transformation is the new 'Multispeciality Community Provider'(MCP) contract:

"Today the range of services funded within general practice owes much to history rather than optimal working arrangements for GPs or patients. The MCP model is about creating a new clinical model and a new business model for the integrated provision of primary and community services, based on the GP registered list, but fully integrating a wider range of services and including relevant specialists wherever that is the best thing to do, irrespective of current institutional arrangements. At the heart of the MCP model the provider ultimately holds a single whole population budget for the full breadth of services it provides, including primary medical and community services."

So-called Accountable Care Partnerships, including GP federations with patient lists averaging 170,000, would be formed to provide these services in place of the old model of care with the individual GP practice at the centre, going back to the 1948 origins of the NHS. These would still need to address the long-standing problem as to who pays when long-term residential care is needed for individuals who should not be in hospital but cannot care for themselves at home. The current shortfall in social care funding, even when supplemented by the Better Care Fund, only exacerbates this dilemma. These deep issues are not going to be solved by a series of hastily written and implemented STPs.

Moreover this is the point at which the STP process becomes self-contradictory. The major change in primary care, the “new model of care”, has not begun to be sold to GPs and the public, far less designed and accepted. It will need time and a good deal of money to be tested and to demonstrate its advantages. This is completely inconsistent with a requirement to eliminate NHS deficits in a couple of years or even less.

The trend in NHS Trust deficits is moving sharply downwards from a surplus 4 years ago to £800m in 2015 and £2.45bn this year (though experts say the true figure is closer to £3bn). Rising demand, higher costs of agency staff because permanent staff are not available and over-use of management consultants are factors. There is no evidence that this trend can be significantly reversed over the five-year planning period without reductions in the care delivered. Most key care outcome indicators are already on a downward trend.

Some questions and issues:

Is not a candid analysis of the current situation and immediate prospects the essential basis for realistic STP planning?

Can such planning be done without full involvement of medical and social care professionals?

Does not the recent dispute with junior hospital doctors just highlight the deterioration in relations between core staff and political leadership, whereas trust between these two elements in the system is essential for successful reform?

Why has the national political leadership made no effort to justify to Parliament and the public the major changes in GP/patient relationship envisaged by the Five Year Forward View proposals for transforming primary care?

Is not the structure of the footprints (and regional leaders above the footprints) where official representatives are meant to have delegated powers to commit their organisations an attempt to sidestep the legislation of the Health and Social Care Act 2012 with its devolved and GP-led commissioning by a centralised top-down planning system without any recourse to fresh legislation?

How can the secretive and rushed process for STPs ordained by Simon Stevens end up securing any measure of public consent? When is serious public and clinical engagement going to begin?

Is it not the case that projects to group GPs into federations working with other providers to deliver packages of care in the community or “out of hospital” will not deliver savings in the short term – even if GPs manage to understand and approve of them – with the consequence that closing acute hospital beds and A&E departments (in NW London 500 beds and two more A&E's) becomes once again the preferred method of acceding to HM Treasury demands?

Bearing in mind that outline STPs already submitted are not in the public domain and that local authorities are party to them, have elected Brent councillors seen and approved them or authorised officials to proceed without reference to them? Will the final STP submissions be considered in public before submission at the end of June?

Should we not recognise that the health and social care workforce is going flat out and that there are no more large “efficiency savings” to extract under the present financial settlement? Is not the underlying question here how much the UK taxpayer wishes to spend on health and social care as a proportion of GDP if the NHS 'free at the point of delivery model” is to be preserved? Or is the intention of this Government initiative to facilitate an extension of commercial provision of NHS medical and local authority social care?

Robin Sharp and Peter Latham
Brent Patient Voice
31st May 2016