In a controversial move, the Shropshire, Telford and Wrekin Integrated Care Board (STWICB) has announced the termination of its contract with Shropdoc, a local not-for-profit organization run by GPs, for out-of-hours GP services. The contract will now be awarded to Medvivo, a for-profit subsidiary of the multinational Health Hero group, backed by the Eight Roads venture capital fund. STWICB leaders have publicly stated that this decision was not driven by cost-saving intentions, despite the shift to a profit-oriented provider.
Responding to questions about why the contract has been changed the ICB, grudgingly admitted that “the contact value … is lower than the current contract with Shropdoc,” while still claiming “this procurement was not a cost-cutting exercise,”
Details of the contract with Medvivo/Health Hero show the 5 year contract is valued at £32.5 million, an average of just £6.5m per year – over 18 percent lower than the £8m per year that has been paid to Shropdoc.
Shropdoc has highlighted the ICB’s “clear objective for financial efficiencies, evidenced by a reduced financial envelope for the service,” which “created an almost impossible competitive landscape.”
Responding to the decision to award the contract to HealthHero Shropdoc said:
“As a not-for-profit social enterprise, it became exceptionally challenging to compete against larger, profit and shareholder-driven private entities within a process predominantly driven by cost.”
Concern about cutting spending is not surprising, given the dire financial situation faced by the ICB, which is attempting to cut up to £260m from its spending over three years to break even, beginning with ‘efficiencies’ of £95.5m this year. It is also cutting £37.5m from urgent and emergency care.
Nevertheless, ICB bosses argue that the specification of the GP out-of-hours contract “has not been changed from what is currently provided by ShropDoc, the incumbent provider.” Moreover: “All elements of the contract have been retained within the service specification, and there is no difference to what is currently being delivered.”
How can this be achieved while incurring such a substantial cost reduction?
While the ICB chiefs remain silent, clues are evident from recent events in Wiltshire, Medvivo’s home territory. Publicly available information should have prompted them to think twice about the plan.
Warning signs
On June 11 GP magazine Pulse published a series of anguished complaints from GPs who had been working for Medvivo – and were looking for alternative work, finding the company’s performance targets “unsafe for patients.”
The targets they object to include requirements to triage four cases per hour, ensure 80% of consultations are dealt with by telephone, and closed ‘with no onward referral’ to a treatment centre or home visit, and make sure that less than 5% of cases are sent on to secondary care or the emergency department.
And while STW ICB has said it has guaranteed that the out of hours bases currently commissioned will remain, Medvivo has managed to slash its Wiltshire contract back from ten bases in 2019 to just four.
GPs in Wiltshire have also told Pulse they are worried about the company’s ‘significant’ shift over recent years towards a non-GP workforce: “an ‘almost exclusively GP workforce’ having been ‘gradually replaced’ with other allied health professionals.”
Carrying through similar changes in Shropshire, Telford and Wrekin would certainly be one way of cutting costs – at the expense of reducing the quality of patient care.
One GP who has worked in the Wiltshire Out Of Hours service for 16 years told Pulse he will not work for Health Hero any more, because the new targets leave “no room for going through cases more slowly, if the clinical circumstances require that.”
He added: “I’m not going to make a decision based on the imperative of the company. I’m going to act on the basis of what I feel is right.”
Campaigners Shropshire, Telford and Wrekin Defend Our NHS, who rapidly gathered over 13,000 signatures in a petition opposing the change back in February, warn that the contract will now change hands in October, at the start of the pressurised winter period.
Last month Medvivo officially changed its name to HealthHero Integrated Care, part of the HealthHero Group, “to align with its parent company’s brand.” But it is a long way from being able to deliver “integrated care” in Shropshire, Telford and Wrekin and over the border into Wales.
Shropdoc has over 200 GP members, comprising General Practitioners from Shropshire and Powys, with a smaller number from adjacent areas and around 250 members of staff working in a wide variety of roles including Management and Team Leading, Business Intelligence, Administration, Audit, Clinical, Reception, Driving and Call Handling.
For almost 30 years, Shropdoc has provided “joined-up care,” with clinical staff already engaged in local service delivery. Supporters believe Shropdoc is well-equipped to offer high-quality, community-based care.
In comparison, Medvivo, a profit-driven company lacking local staff and logistical knowledge, is not viewed as capable of providing the same level of care. It has none of the local assets of Shropdoc, and there is little indication of local GPs wanting to sign up to its very different, profit-driven clinical model. If they don’t the result could be an Out Of Hours services largely consisting of long-distance phone calls conducted by sessional GPs in Wiltshire.
Campaigners warn that if the company fails to deliver a service as good as Shropdoc, it will result not in savings but in increased costs to the NHS, if people who need prompt Out-of-Hours GP care are forced down “emergency ambulance/ A&E/ acute hospital admission routes instead.”
Another critic of the proposals, responding to the Pulse article reporting the decision, has pointed out that Shropdoc is one of only two GP led NHS OOH providers left in the West Midlands, out of an original 9 or 10 GP co-operatives.
Health Secretary Wes Streeting made a volley of speeches last year, promising Labour would “bring back the family doctor,” while Labour’s manifesto promised the “biggest wave of insourcing in a generation.” There is no sign of either policy being delivered.
Instead he has ignored local campaigners and local Labour politicians, and sat back and allowed STW ICB unleashes quite the opposite process, the worst of all worlds, a private company financed by venture capital – and based over 100 miles away.
A Shropdoc statement conceding defeat sums up: “Crucially, we … want to acknowledge and thank our exceptionally talented and dedicated employees and GP Members. For 30 years, they have embodied the very best of urgent primary care, delivering compassionate and high-quality services day and night. We are immensely proud of their professionalism and commitment.”
Campaigners will wish this effort and achievement had been recognised by the ICB, and will fear what future cutbacks are likely to follow as the quest to cut spending intensifies from now till 2028.
The “Independent” Panel comes to the expected conclusion
Shropshire, Telford and Wrekin ICB, fending off well-founded criticism from campaigners and the concerns of local MPs and councillors, has been able to count on a rubber stamp of approval from a body few people will have been aware existed: NHS England’s Independent Patient Choice and Procurement Panel.
It was set up under the Tory government back in January 2024, but seems to have taken over the role – and some of the personnel – of New Labour’s notorious so-called “Cooperation and Competition Panel,” which one-sidedly championed the cause of competition from 2009 until it was merged with the regulator Monitor in 2013.
The members of the current panel are united in their close working links with the private sector, and lack of any obvious sympathy with front line NHS services and staff.
Its chair Andrew Taylor previously helped establish the NHS Cooperation and Competition Panel (CCP) an independent advisory panel, from 2008 to 2011, and worked briefly for McKesson Europe, a healthcare technology business, before establishing Aldwych Partners, which advises NHS trusts on merger reviews and procurement related matters.
Other panel members are:
Carole Begent, a solicitor with over 30 years’ experience of competition and regulatory issues who has held senior positions at the Competition and Markets Authority;
Albert Sanchez-Graells, a professor of economic law specialising in competition law, public procurement and digital regulation who has advised the Cabinet Office;
Alison Tonge, an Executive Director of Arden & GEM Commissioning Support Unit (which claims that its customers “include more than 60 Integrated Care Boards” – despite the fact there are only 42 of them). She has held “senior leadership roles within NHS England, provider Trusts, Canadian integrated care system and the private sector.” Alison is “currently supporting innovation across NHS organisations and with commercial partners.”
Daria Prigioni, an economist specialising in competition economics: she previously worked at the NHS Cooperation and Competition Panel, an independent advisory panel, and Monitor.
And Sally Collier, who “has an extensive background in senior leadership positions in procurement and regulation in the public sector, and was the first chief executive of the Cabinet Office buying agency, the Crown Commercial Service.”
With a pedigree like that, it would be astonishing if the IPCPP report had come up with anything other than a ringing endorsement of the ICB’s decision.
The Panel was responding to a challenge by Shropdoc to being ranked fifth out of six bids for the contract (with a total score of 68.52% compared to 86.85% for Medvivo).
In the process of rejecting all six challenges to the ICB’s process and decision, the Panel does however point out that the Provider Selection Regime legislation and regulations do not require any process of consulting stakeholders: “there are no specific obligations on commissioners in relation to stakeholder or market engagement in either the PSR regulations or statutory guidance.”
For that reason it endorsed the ICB’s decision to exclude local GPs from any involvement in the process (because the Local Medical Committee had declared its support for Shropdoc to retain the contract), and declared that a rudimentary process that consisted of “an engagement exercise over a three-week period, from 27 August to 17 September 2024” including “an online focus group and an online survey (completed by 579 people)” was enough consultation to fulfil the ICB’s obligation to act “transparently, fairly and proportionately.”
The Panel notes that: “Medvivo proposed a smaller number of additional clinical staff to that offered by Shropdoc”, and “In terms of non-clinical staff, Medvivo proposed substantially fewer non-clinical staff than Shropdoc.”
But the Panel did not question how this could possibly correlate with the ICB for some reason giving Medvivo “25% more points than Shropdoc on the quality based elements of its proposal.”
With a Panel so detached from any meaningful assessment of quality of care, it is no surprise to find they accepted the ICB’s argument that the difference in the number of non-clinical staff offered by the two bidders “was indicative of their different business models, and their different abilities to benefit from economies of scale, rather than being related to service quality.”
Obvious questions about how a company based 100 miles away could benefit from ‘economies of scale’ against an established organisation with more staff in place were not asked.
So it’s worth watching out for this “Independent” Panel. If any local health bosses want an easy way to justify their irresponsible policies, this seems like the way they should go.
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