By John Lister

The giant American health corporation Centene has now completed a divestment of all its health care investments in England by selling off its subsidiary Operose, which had controversially acquired 60 GP practices, mainly in London.

This marks the end of what the Financial Times saw as an attempt by Centene to open up a ‘seamless pathway’ potentially enabling Operose-run GPs to refer to its own chain of hospitals. When Operose was put up for sale The London Press, quoting Victor Chua of Mansfield Advisors, a healthcare consultancy, explained why the strategy had failed to deliver:

“Centene has found it difficult to make Operose profitable because many Operose sites are in generally less affluent areas where recruiting GPs has been difficult. There was no natural cross-sell between the Operose GPs and the Circle Hospitals, which serve a different demographic, and the geographic overlaps are limited.”

So Centene decided to pull out, and this latest sale follows Centene’s sale in August of Circle Health Group, and with it Britain’s largest chain of small private hospitals, which they had only purchased in 2021, to Emirates-based Pure Health.

Although Centene, once the American company most heavily invested in British health care, has now dumped all of its overseas investments to concentrate on extracting the maximum profits from its home base in the US, the hospitals and the GP practices it has walked away from in England have now been bought up by new investors – and they, too, will be seeking profits.

PureHealth which bought Circle is the largest healthcare platform in the Middle East and has a diverse portfolio “comprising more than 25 hospitals, 100 clinics, multiple diagnostic centres, health insurance solutions, pharmacies, health tech, and procurement.”

The company has just made initial public offering (IPO) of 1.11 billion shares, representing 10 per cent of its share capital, with “robust interest on the first day.” It plans to list its shares on the Abu Dhabi Securities Exchange (ADX) on December 20, and claims to be “on a strong growth trajectory.”

PureHealth’s “international acquisitions and ambitious plans” also include the recent purchase of Ardent Health Services, the “fourth largest private healthcare group in the USA”. Whether its British investment in Circle delivers the required level of return is yet to be seen.

Now Operose has been sold, to HCRG Care Group, the company which took over Virgin Care at the end of 2021, raising questions over the future of the 60 Operose-owned GP practices.

Despite having lost some of the Virgin contracts it initially took over, HCRG has claimed to be running 21 GP practices, as well as urgent care services and community health services for the NHS.

However with this latest change of ownership many patients in Operose’s London GP practices will have been bundled through three different profit-seeking companies since 2021.

There were loud protests and legal challenges in 2021 over the way practices, complete with their lists of patients, were simply taken over when Centene, via its UK subsidiary Operose Health Ltd, acquired AT Medics, which operated 49 GP surgeries across 19 London boroughs.

This time it may even be possible that one or more of London’s five Integrated Care Boards that commission primary care might pluck up the courage to refuse to sign off on yet another sale. The Lowdown hears that Operose expects to continue as a going concern and continue running its GP practices, albeit with a change of parent company.

However they could face a rude awakening. HCRG is owned by venture capitalist group Twenty20 Capital, which boasts that it expects its investments to deliver “significant returns in 2 to 5 years”. What changes might be demanded to ensure its new GP practices deliver the required profit margins to Twenty20 Capital’s profit-hungry shareholders are yet to be seen.

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