Campaigners against privatisation of the NHS have written to Matt Hancock, Secretary of State for Health and Social Care, questioning the legality of the recent takeover of large numbers of GP surgeries in London by the US Corporation Centene following its acquisition of the UK company AT Medics.

In February 2021, Centene, via its UK subsidiary Operose Health Ltd, acquired AT Medics, which operates 49 GP surgeries across 19 London boroughs under Alternative Provider of Medical Services (APMS) contracts and standard contracts, providing services to around 370,000 people, with 900 employees. Until its takeover, AT Medics, was owned by six GP directors. 

The campaigners, including Allyson Pollock, director of the Newcastle University Centre for Excellence in Regulatory Science, Peter Roderick, Principal Research Associate, Newcastle University, Jackie Applebee, Chair, Doctors in Unite, Louise Irvine, Secretary, Health Campaigns Together, John Puntis, co-Chair, Keep Our NHS Public, Paul Evans, Director, NHS Support Federation, Steve Carne, 999 Call for the NHS, and Brian Fisher, Chair, Socialist Health Association, question the lack of transparency surrounding the takeover and whether the correct legal processes have been followed by all those involved –  AT Medics, 13 Clinical Commissioning Groups (CCGs) and NHS England. 

The letter requests that the Secretary of State exercises his power under section 48 of the Health and Social Care Act 2008 to request the Care Quality Commission conduct an investigation into NHS England and the 13 CCGs involved in authorising the take-over of the GP surgery contracts held by AT Medics.

Under APMS contracts, such as those held by AT Medics, the “contractor must not sell, assign or otherwise dispose of the benefit of any of its rights under the APMS contract without the prior consent of [NHS England]”. At some point in 2020, AT Medics Ltd sought prior authorisation from commissioners for the takeover and the transfer of the APMS contracts to Operose Health Ltd. and CCGs began the process to approve the change of ownership.

An investigation by the campaigners, however, has found a “lack of openness, transparency and misrepresentation” by the CCGs involved. The 13 CCGs involved – Barking & Dagenham, Brent, Central London, City & Hackney, Hammersmith & Fulham, Harrow, Newham, North Central London (NCL), Redbridge, Tower Hamlets, West London, South West London and South East London – have published very few documents on the change of ownership and held no public meetings.

The Lowdown’s story on the takeover published two weeks ago was triggered by documentation seen by a member of the public involved as a part of a patient participation group at one of AT Medics’ surgeries. 

Where CCGs have published information, such as North Central London (NCL) CCG, there were no meetings where the public could participate and any mention of Centene was not put in the public domain until after the CCG had made its decision. 

On 17 December 2020, conditional authorisation was given for a change of contractor for the APMS contracts at eight practices in Camden, Islington and Haringey, by NCL CCG’s Primary Care Commissioning Committee at a virtual meeting; the public were not allowed to participate.  At this meeting the presenter also said that there would be no change of directors at AT Medics, despite the change of ownership; this later transpired to not be the case.

The investigation by the campaigners has also brought to light a previous change of control for AT Medics Ltd in 2019, when it changed from a Ltd company to a Limited Liability Partnership (LLP), that the campaigners believe should have been reported to the CCGs under the rules of the APMS contracts. 

It is not currently known whether prior authorisation was sought or given for the change from Ltd to LLP. If this didn’t happen then, the campaigners note, it is “a serious breach under paragraph 63 of the APMS contract.”

Finally, the letter questions the involvement of NHS England in the process and the campaigners want the investigation to look at the “role, advice and instructions of and on behalf of NHSE in relation to the CCGs”, and establish whether any “improper influence or control was exerted.”  

AT Medics’ new owner, Operose Health was formed in January 2020, when Centene Corporation brought together its subsidiaries in the UK – The Practice Group (TPG) and Simplify Health. The Practice Group, which had a number of GP surgery contracts, was acquired by Centene in 2017. Operose’s direct parent company in the UK is MH Services International (UK) Ltd.

The takeover of AT Medics was finalised 10 February 2021, when the directors of AT Medics Limited resigned and were replaced by Samantha Jones (CEO of Operose and ex-head of NHS England’s new care models programme), Nick Harding (Director of Operose and formerly Senior Medical Advisor to NHS England for Integrated Care Systems and Right Care) and Edward McKensie-Boyle, Chief Financial Officer of Operose. 

Operose Health adds the AT Medics’ 49 London GP surgeries to its 20 GP surgeries and one urgent treatment centre in Birmingham. In addition, the company lists on its website ten ophthalmology services and a single dermatology clinic in Kent. 

Six of AT Medics’ APMS contracts are relatively newly acquired, won in early 2020 when it successfully bid on lots in the contract “PRJ736 — London APMS GP Contracts”. Each APMS contract runs for 15 years and the six are worth a total of just over £121 million. 

The US corporation Centene has over 30,000 employees in the USA and operates health insurance plans for around 2.9 million people in 24 US states. The company acts as an intermediary with Medicare, Medicaid, and The Health Insurance Marketplace System, as well as traditional commercial insurance. In early 2020, Centene took a large stake in Circle Health, the UK’s largest provider of private hospitals.

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