The decision by Lancashire and South Cumbria Integrated Care Board (ICB) to award a contract to run a well-loved and successful GP practice in Chorley, Lancashire, to SSP Health, a large private primary care company, has been met with anger by patients and staff of the surgery, who have accused the ICB of not running a proper public consultation.
The whole process of choosing a new contract holder by Lancashire and South Cumbria ICB for Withnell Health Centre (WHC) was also conducted with virtually zero input from the public despite the ICB’s constitution proudly boasting that it will “put the voices of people and communities at the centre of decision-making and governance.”
The ICB has now apologised to patients and staff at WHC over the lack of information around a procurement process for the surgery contract and acknowledged that “more could have been done” to keep them [the patients and staff] informed about the process. It told the local paper the Lancashire Post:
“Further engagement could have made patients and staff more aware of the procurement process and that it could result in a different organisation taking over the running of the GP practice and due to this we would like to apologise.”
The campaign for the ICB to revisit the procurement process led by local councillors, GPs and local people continues, however.
The procurement process was triggered in December 2021, when a partnership between Dr Ann Robinson and Dr Mahtab Siddiqui ended. Dr Robinson was awarded a temporary 12 month contract by the then Chorley and South Ribble Clinical Commissioning Group (CCG), but the change triggered a competitive bidding process for the contract for providing care at the practice. The CCG has since been replaced by the regional Lancashire and South Cumbria ICB, who continued the process.
The only information received by the patients about the process was a single letter sent out in February 2022, saying the CCG has awarded a temporary contract to Dr Robinson for 12 months as “the least disruptive option for all parties” and there should be “very little to no impact on patients as a result of this change.”
The letter also reassured patients that they “should not be concerned about the future of the practice” and “the 12-month period will now be used to undertake all of the necessary due diligence steps required before a longer-term contract can be awarded.”
A patient survey was attached that could be filled in and patients were told that “any feedback you have about the practice and services you receive will feed into the wider analysis as part of the due diligence process.”
What the letter failed to outline is exactly what the process of awarding a new contract entailed and that it could lead to the loss of Dr Ann Robinson, who has been the principal partner at WHC for 10 years. As far as the campaigners are concerned, the letter and patient survey does not constitute a public consultation and the ICB’s apology indicates that it also now realises that this was not sufficient.
Even when a decision had been made in December 2022, only Dr Robinson was informed and given a ten day window to submit an appeal. Dr Robinson was told not to talk about the decision – a gagging order – until the end of the ‘standstill’ process 30 days later.
Patients only found out about the awarding of the contract to SSP Health and therefore the loss of Dr Robinson as the contract holder when it was leaked on Facebook by a member of staff at WCH in January 2023.
The news was met with dismay and anger by patients and staff, and now over 1,500 of the patients registered at WHC have lodged written objections to the ICB decision to take away control of the GP practice from Dr Ann Robinson. Monday 16th January saw the lifting of the gagging order on the staff at the surgery and on the 17th the staff of WHC gathered at the ICB headquarters to protest. Here they found that the envelope containing the 1,500 objections had not been opened and was still sitting at reception.
The ICB has since stated that the objections are now being “read and processed”, but what effect they could have on the completed process is unclear.
Several of the staff at the Withnell practice have said that they would rather resign than see the surgery handed over to SSP Health.
Dr Robinson, patients, staff and local councillors are angry that a surgery that scores highly on patient satisfaction and has such deep roots in the local community could lose its contract to a company they say whose GP surgeries score far worse on many measures including patient satisfaction. Dr Robinson told the Lancashire Post that:
“The current care that they [patients] get is absolutely wonderful and there is data to back that up. We have same-day appointments, a fantastic nursing team and the lowest A&E attendances across the whole of Chorley and Preston…My practice doesn’t have a problem recruiting either, because it looks after its staff and it pays them well.”
Margaret France, a retired GP and now a local Labour councillor and Chorley Council’s lead member on shared services, joint working and community wellbeing, who left the surgery in 2013 and passed it on to Dr. Robinson has also highlighted the high performance scores the Withnell surgery has in comparison to SSP:
“If you look at the percentage of patients who find it easy to get through to their GP practice by phone, you’ve got a national [average] result of 53 percent. Withnell Health Centre is at 82 percent and if I look along the line for SSP, there are an awful lot of red numbers [indicating scores below the national average] and the lowest is 16 percent”.
Across the 18 performance criteria listed, Withnell Health Centre is above the national average – sometimes significantly so – in 17 of them and equal to it in one.
Opposition also comes from GP surgeries in the surrounding area. Local GP surgeries and WCH are part of ‘Chorley Together’ a primary care network (PCN), that involves a collaborative arrangement to enable GPs to offer a wider range of services and more easily manage their affairs and recruit and retain staff.
Chorley Together’s business manager has written to the ICB board to express its members’ “dismay and concern” at what they describe as a “fundamentally flawed” procurement process concerning WCH.
The business manager, Claire Hounslea, also noted that the PCN would not be welcoming SSP Health to the network as:
“The values and behaviours of SSP do not align with [those] of Chorley Together PCN and its member practices… [the board] will not accept SSP into the PCN if they remain the ICB’s preferred bidder for Withnell Health Centre. We will not be intimidated or bow to pressure from the ICB to do so.”
As part of the campaign, Cllr France has met with Chorley MP Sir Lindsay Hoyle and shown him patient objections to the takeover. Sir Lindsay has “made contact with the Integrated Care Board to ask for this decision to be reviewed and for all concerns raised by local residents to be addressed before any further action is taken.”
Cllr France believes that the tendering process did not involve a public consultation process.
“It seems inherently unfair to me that the health centre can be passed over to an outside conglomerate without any public consultation whatsoever.” said Cllr France.
SSP Health managing director Amanda Carey McDermott last week insisted that its aim for the practice was to “retain the team, continue their good work and add to the services available to patients”.
She added that “As with all GP surgeries, Withnell Health Centre has always been privately owned, run with the local community as its primary focus, and this is something we do not want to change.”
Although it is true that WHC is privately run, as all GP surgeries are, there are major differences between a GP surgery where the resident GP or GPs have a single contract and a company that holds contracts for 40 GP surgeries.
Dr. Robinson told the local press that the interests of her patients will not be served by what she describes as “supermarket GPs”.
“These big practices cut services to the bone. I know for a fact that SSP took home £4m in profit last year, which is taxpayers’ money which should be spent on improving your access to GPs.”
SSP Health is wholly owned by the private company SSP Health Holding Ltd, which according to Companies House, has a single director and shareholder Dr Shikha Pitalia.
The company’s turnover in the financial year to end of March 2021 was £9.3 million, which led to £3.6 mn in profit and in the 2021/22 financial year turnover was £11.1 million and the profit was £2.3 million.
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