This article was written by Keep Our NHS Public member Dr Jackie Applebee, and was originally published in Tribune magazine. We are reproducing it with permission.
The latest move by US health insurance giant Centene to buy GP services across London proves one thing – the argument that our NHS is not being sold off to corporate interests is a lie.
What’s the Background?
General Practice surgeries that AT Medics ran were mainly under the auspices of Alternative Providers of Medical Services (APMS) contracts. These were introduced in 2004 and, as the name suggests, allowed Alternative Providers, other than GPs, to be the contract holders.
APMS contracts are negotiated locally with the Clinical Commissioning Groups (CCGs) and are time-limited, often for between ten and fifteen years. The more traditional General Medical Services (GMS) contracts are held by GP partners, are not time limited, and the terms and conditions are negotiated nationally and collectively by the General Practitioners Committee (GPC) which is made of up elected members of the profession.
Initially APMS contracts tended to be awarded to groups of GPs, although in Tower Hamlets a contract was awarded to ATOS in 2007. Predictably, they failed to provide the services they had promised and their contract was terminated in 2010.
The Health and Social Care Act enshrined competition in the NHS. From 2013 onwards, once an APMS contract came to an end, it had to be put out to competitive tender. AT Medics bid successfully for many of these contracts across London. A look at the Companies House website will reveal that AT Medics managed to make a profit of over £7 million in 2019-20. Most GPs will wonder how this is possible.
But Aren’t GPs Private Businesses Anyway?
It’s often argued by supporters of commercial organisations that run General Practices that all GPs are private. Funding of General Practice is complex, but in essence, GP partners receive a fixed budget from the government, depending on the services that they are contracted to provide. This money is used to employ staff, equip premises, and provide GP services. GP partners effectively pay themselves a salary from this funding.
The reality is that traditional GPs, due to a historical aberration, are subcontracted to the NHS. The surgeries are run by GP partners and do not have shareholders. Commercial organisations generally do have shareholders who expect dividends to be paid. To generate dividends, the organisation needs to make a profit. The only way to make a profit out of General Practice is to cut costs; GPs cannot put their prices up to make more money out of their NHS provision.
Private company Centene, however, is listed on the New York Stock Exchange and its full-year revenue in 2019 was $74.6 billion. It is not unreasonable to expect that the GP surgeries now managed by Operose/Centene will seek to cut costs by cutting staff and services, as has happened with this company in the past.
NHS Privatisation Must be Opposed
Privatisation has been going on under the radar for over two decades. It needs to be stopped and reversed now, before it’s too late. The NHS is much beloved by the public, and many do not understand what is being done to it, as it’s so complex. The government are therefore getting away with it.
The most recent survey (in 2018) shows that the NHS was the second most loved institution by the British public, after the Fire Brigade who had acted so bravely during the awful Grenfell Fire in June 2017. Politicians (perhaps unsurprisingly) came bottom of the pile. We must use this. We must shout from the rooftops and tell people the truth.
GP surgeries are embedded in the community. Most people will be able to relate to the threats to services that the change of ownership brings. Many APMS contracts are coming to an end, and are therefore at risk of being awarded to the likes of Centene/Operose.
What Can I Do?
Everyone needs to join their local health campaign, and if there isn’t one, advice can be provided on how to start one. Keep Our NHS Public, We Own It, and the umbrella organisation Health Campaigns Together are very good places to start. We must find out whether there are APMS GP contracts coming to an end soon in our CCG areas, and campaign to keep them in the public domain.
We must write to our MPs, our local councillors, and our health scrutiny committees to ensure that our local politicians are aware of the threat. Even previous Tory leaders have been known to join campaigns to save their local health services, as they know that this means votes.
We must protest outside the threatened surgeries in a Covid-safe way, or take selfies with placards and post them on social media. The opening sentence of the NHS Constitution says: ‘The NHS belongs to the people.’ Increasingly, though, it belongs to commercial organisations.
The leaked White Paper for the NHS poses a further threat. The proposals are to remove competition, but far from getting rid of privatisation as promised, it is likely to be accelerated as contracts can be awarded to commercial providers without competitive tendering.
The chumocracy evident during the pandemic and the ability of Matt Hancock to shrug off the courts finding that he has acted illegally should act as a warning to us all. NHS founder Aneurin Bevan said that there will only be an NHS while there are folk with the faith to fight for it: we need those folk and that fight now more than ever.
Image shows Keep Our NHS Public executive committee member Carol Ackroyd outside Trowbridge Surgery in Hackney which was taken over by Operose in February.