A chain of GP surgeries in London run by a private company has been operating “without permission” from NHS commissioners since December 2023, according to campaigners from North East London Save Our NHS – in a “serious contract breach” 

The 49 surgeries were originally owned by US corporation Centene, via its UK subsidiary Operose, but in December 2023, Operose was sold to HCRG Care, owned by the UK private equity group Twenty20 Capital.

The GP surgeries are operating under APMS (Alternative Provider Medical Services) contracts, and a new owner is required to apply for a change of control permission from local NHS commissioners. according to campaigners, this was not officially been granted.

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. But later told North West London ICBs that it had unilaterally taken ‘change of control’ of the company on 28 December 2023. 

In April 2024, commissioners at the North East London, North Central London and North West London ICBs told campaigners that change of control permission had still not been officially granted by any of the ICBs affected.

So since December 2023 the GP surgeries have been operating without permission, noted NE London Save Our NHS campaigners, accusing it of a breach of the terms of the APMS contracts the practices have been operating under.

“under APMS contracts, once it comes to commissioners’ attention that contractors have changed control without prior authorisation, they must serve notice terminating the contracts ‘forthwith’.”

The ICBs involved told Pulse: ‘We have been informed that a “change of control” took place on 28 December 2023. The NHS was not informed of this at the time. We were written to on 15 March 2024 to inform us.

‘Under the terms of the APMS contracts, providers may not undergo a change of control without the NHS’s prior authorisation.

‘In light of this new information the NHS is now considering its next steps.’

GP contract changes

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 were 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.

The new owner of the surgeries, HCRG Care, is owned by Twenty20 Capital, a private equity investment company. Twenty20 Capital acquired Virgin Care in December 2021 and rebranded the company as HCRG Care.

What is private equity

Private equity is an investment area that is geared up to make as much profit for investors in as short a time as possible (usually 5-7 years). Recent years have seen an increase in private equity interest in health care companies in the UK, many of which have contracts with the NHS. Private equity has already made considerable profit out of the care and education sector in this country, at the expense of quality of care and safety.

For more details of how these companies operate and why they are bad news for the NHS see our overview here.


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