An investigation by BBC’s Panorama, including using an undercover journalist to work as a GP receptionist, has found that Operose, the UK’s biggest chain of GP surgeries, has let less-qualified Patient Associates (PA) see patients without adequate supervision leading to claims that the company is putting profits before care quality.

There are also reports from admin staff that some correspondence has not been processed and has waited to be seen by a GP or pharmacist for up to six months.

Operose, owned by the giant US healthcare insurer Centene, built its GP surgery business through the acquisition of first The Practice plc in 2016, with 20 GP surgeries, one urgent treatment centre, and some other community ophthalmology services around England, and then London-based AT Medics in early 2021, which gave the company an additional 49 surgeries in London. The company now has over 600,000 NHS patients on its lists at 69 surgeries.

The Panorama investigation, which was shown on the BBC the evening of 13 June, sent an undercover journalist to work as a receptionist at one of the company’s 51 London GP surgeries. It was at this surgery that a GP said they were short of eight doctors and the practice manager said they hired the less qualified PAs because they were “cheaper” than GPs.

PAs have completed a science degree and two years of postgraduate studies, rather than the 10 years of medical education and training for GPs.

A PA can see patients and support GPs in diagnosis and patient management, but is supposed to have supervision from a GP. At the Operose surgery the undercover journalist was told by PAs that they saw all sorts of patients, sometimes without any clinical supervision and that the practice treated them as equivalent to GPs.

Panorama’s investigation included talking to a dozen former employees from across the Operose group, from which further evidence was gathered that PAs were doing the same job as a GP, even though they had less experience and less qualifications, but they were also earning less money and so cost Operose less to employ.

Operose’s level of GPs was found by the investigation to be much lower than average, with just over 0.6 full time equivalent GPs per 2,000 registered patients, compared to the average of 1.2 full-time GPs, whereas Operose employs six times as many PAs as the NHS average.

Panorama also uncovered evidence of problems at Operose’s centre that deals with patient-related correspondence, where Panorama was told some correspondence had been waiting to be seen by a GP or pharmacist for up to six months.

After viewing the footage, Prof Sir Sam Everington, a senior practising GP at an unconnected partner-run practice, said he was concerned for patient safety.

The company denies putting profit before patient care and told Panorama that it has recruited 38 GPs in the past year and is in the process of recruiting more. It also pointed out that the Care Quality Commision has rated 97% of its practices as “good” or “outstanding”.

The Lowdown has been following the rise of Operose in England for a number of years. The company was formed in 2020 when the US company Centene Corporation brought its UK subsidiaries – The Practice Group (TPG) and Simplify Health – together under a single name. Separately, Centene has a 40% stake in Circle Health, the UK’s leading private hospital chain.

The company’s activity in the area of GP practices stems from its acquisition of The Practice Group in 2016. By the time of its acquisition, The Practice Group held contracts at 20 GP surgeries and ran a small number of contracts for community services, however since its beginning in 2005, the company had fared badly financially. It was also associated with a number of issues, including the employment of a high number of locums at the company’s surgeries, due to the difficulties the company had recruiting salaried GPs.

The company’s takeover of AT medics in 2021 was challenged by campaigners on the basis of lack of consultation with the public. However, the challenge was dismissed by a high court judge in February 2022. 

For a full backgrounder on Operose see our page on the website.


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