Update from WE OWN IT on fight against Centene's takeover of GP surgeries

 

Last week you took action to pressure North West London local health authorities to kick Centene, the profit-greedy US multinational, out of our GPs.  There's no two ways about it, the decision NW London local health leaders ended up making was a mixed bag. They decided to renew Centene’s contract - BUT with a BIG catch. Instead of renewing it for 5 years, as originally suggested by local health officers, they decided to renew it for JUST 2 years.  And they are placing Centene under much stricter patient feedback conditions. So if after the two years patients say that Centene has done a bad job, local leaders will have no excuse to keep them on. This result represents slow but good progress in the fight against private corporations in our GP practices. And this outcome was down to the incredible work you did writing to local health leaders, joining protests, taking action on social media, etc. It is not exactly the win you were going for. But we could never have got this if you had not taken action. You wanted Centene kicked out completely and things are now headed in that direction.  It is time to double down and push harder since it's clear that the pressure you’re applying is being felt. Just to recap some of the amazing work you've been part of, which made this result possible: Thousands of people across the country took action or joined protests on the 22nd of April in our “Get Centene Out” day of action. 24,896 emails were sent to local health leaders to show them the depth of public opposition to Centene. Over 700 people from across the country sent short personal messages to health leaders in North West London in less than 24hrs.  55,721 people have signed the online petition against Centene and many more have signed physical petitions at protests. Almost 200 London councillors from all main parties (including a few Conservatives) have signed our local leaders open letter against Centene. 15,540 people emailed and asked their MP to oppose Centene. 76 MPs from right across the country and from all parties except the Conservatives have now supported the motion in parliament. We are helping Labour’s frontbench primary care team brief MPs about the dangers of companies like Centene running our GP practices.   These and many more actions have forced health authorities to look more critically at Centene. But you need to keep going.   You are already forcing them to take your voice into account in their decisions. This is not the time to let them off the hook. We are planning actions to be announced soon. Local health leaders in areas with Centene GPs need to continue to feel the pressure.  In the meantime, please sign the petition and share it if you have already signed. Thank you so much for the great work that you have done and are still doing. The progress we’ve made would not be possible without you. Cat, Pascale, alice, Chris, Zana and Johnbosco - the We Own it team

AT Medics re Operose and Centene takeover: 'We can't see how we can get this wrong'

 

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.

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

 

 

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.