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Sale of GP surgeries: a slippery slope to corporate-run NHS
NHS bosses must look again at the controversial awarding of doctors’ surgeries contracts to private US firms, says John Lipetz
I WELCOME the prominence the New Journal has given in recent editions to the takeover of the three GP practices at the Brunswick Centre, King’s Cross and Camden Road by United Health and am delighted at the legal action against this move being undertaken by Barbara Saunders.
This is the start of the slippery slope to corporate takeovers of general practices across England and is being replicated elsewhere, including in Derbyshire, Leicester and Tower Hamlets.
I do not know whether PCTs are required by the Department of Health to take this action or simply encouraged to do so. Whatever the circumstances, the PCT’s approach reflects a total lack of concern for the needs of patients and a docile response to the DoH by senior managers and, particularly, non-executive members.
There is a huge difference between GPs working as independent contractors under a well-defined NHS contract and being subject to the requirements of a private company, particularly a large corporation. GPs are concerned with the priorities of their practice population; they understand the local needs of their patients and deal with them as individuals with specific needs. As the corporation’s employee they will have to comply with company policies determined by a chief executive and board of directors whose business strategy may well be drawn up at their headquarters which could be anywhere, probably abroad (in a tax haven?). It will be the companies, not the doctors, who will decide on the priorities for the services to be provided.
Whatever they may say, companies have to prioritise the interests of their shareholders. The care given will be shaped by pressure to boost profit margins and short-term concern for share value. Healthcare is not a commodity in which the market sets the price and quality, nor should it ever become so. We must not allow healthcare to be compromised and distorted in this way.
As a result of this takeover, clinical decision making will be shaped by commercial managers and shareholder interest. Most critically, the GPs’ professional integrity and autonomy, so essential to the doctor-patient relationship, will be put at risk. What we must maintain is the ability of doctors to use their professional judgment freely in taking decisions in consultation with their patients to best reflect their healthcare needs.
Patients can expect less access to the GP. The company is likely to reduce the skill mix of practice staff so they may require patients to receive care from less qualified staff at all levels.
The range of services on offer may well be more limited. Health companies typically drive down staffing costs by employing fewer and cheaper staff. They will negotiate the pay and conditions of employees. Retaining NHS terms and conditions, including membership of the NHS pension scheme, has not been guaranteed.
It’s all about the profit motive.
The public and patient involvement in the PCT’s decision has been minimal at most. For transparency, the public should have been able to see the detailed bids of those seeking to run these practices. The argument of commercial confidentiality will be rolled out but this simply reflects the opaqueness of the whole process. We are therefore unlikely to know what standards of care to expect because these will be “negotiated” within the “secret” contract. I doubt that NHS monitoring of the contract will be other than cursory.
United Health is by no means the only corporation seeking to take over general practice. Richard Branson’s Virgin, Care UK and others are also in the fray. Large corporations are not involved for charitable or altruistic reasons. Their values are not ours or those of the NHS. The profit motive attracts. NHS budgets worth billions are in their sights. It is quite likely that they have put in cheap bids as loss leaders in order to establish a base in a lucrative market.
They will fragment primary care in the same way as Independent Treatment Centres are doing to secondary care.
People should know one specific fact about United Health: this US-based corporation has faced numerous charges of fraud across the United States and has paid out millions of dollars in fines and out-of-court settlements. Currently it faces $1.3 billion fines from the state of California and is being investigated by the New York State Attorney. Given these facts, why has the DoH not carried out a thorough assessment of the company’s probity?
The information in this article stems from my membership of the steering committee of Keep Our NHS Public (KONP). We have been concerned for some time about the privatisation and marketisation of significant parts of the NHS.
This latest development is, in our judgment, very serious for the doctor-patient relationship.
I would expect Camden’s health scrutiny committee to carry out a careful assessment of the PCT’s decision, including a thorough examination of the case and costings put forward by each bidder and then make public its detailed report. If it is not prepared to do so it should at least provide a detailed justification of its action and allow public debate.
The longer-term approach to establish local democratic accountability and to ensure patients and public have proper involvement in NHS decisions, PCTs and local trusts should be brought under local authority control.
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