A private equity-owned company that holds contracts for almost 50 GP surgeries in London has been found to be in “serious breach” of its contracts by local commissioners, something which was highlighted by Campaigners from North East London Save Our NHS in April this year.

The company Operose, once a subsidiary of US corporation Centene, gained the GP contracts through its acquisition of AT Medics in 2021. But in December 2023, Operose was sold to another company – HCRG Care, which is owned by the UK private equity group Twenty20 Capital.

How did the breach take place?

A new owner is required to apply for a ‘change of control permission’ from local NHS commissioners.

Back in November 2023 T20 Osprey Midco Ltd, a newly set-up subsidiary of Twenty20 Capital through which the acquisition took place, applied for change of control permission from local ICBs. At this point a ‘due diligence exercise’ began to assess the new owner. However

HCRG Care completed the acquisition, including taking control of the APMS contracts in December 2023, but the ICBs only became aware that a ‘Change of Control’ had taken place when notified by HCRG Care in March 2024.

As a result, HCRG Care (as AT Medics on the contracts) has breached a clause in the APMS contract, which the ICBs consider to be a ‘serious’ breach. The surgeries are within North East London, North Central London and North West London ICBs.

Pending approval from primary care leaders in the borough, NWL ICB will issue a ‘breach notice’ to the company, which contains the following wording

‘We consider this to be a serious breach and are currently considering what further action to take under the Contracts. This breach notice is entirely without prejudice to, and we fully reserve, our ability to exercise any of our rights under the Contracts and to enforce any of the terms and conditions of the Contracts, at any time. This includes, without limitation, our right to terminate the Contracts.”  

Since Operose’s takeover by HCRG Care, it has lost two APMS contracts to East London Foundation Trust (ELFT)

HCRG Care was formed by the acquisition of Virgin Care in December 2021 by private equity firm Twenty20 Capital.

This is the second time within three years that these London GP surgeries serving around 500,000 patients have changed ownership. The chain of surgeries was acquired by Operose via its takeover of AT Medics in 2021. At the time the takeover was controversial and in May 2021 a patient at an AT Medics surgery applied for a judicial review into the awarding of the GP contracts to Operose. The legal challenge against NHS North Central London CCG was based on four grounds, which included ‘the lack of any engagement or involvement with patients’ by the CCG. However, the case was dismissed by a High Court judge in February 2022.


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