Agenda item

To consider any requests received in accordance with Part 4, Section B, paragraph 29 of the Council’s constitution.

Deputation 1

The Committee received a deputation from NCL NHS Watch and led by Professor Sue Richards, on the sale of AT Medics to a subsidiary of Centene Corp, which was large American health insurance company. The key points of the deputation were:

• Concerns were expressed with the decision by NCL CCG to agree a change in control of the 8 APMS contracts in North Central London which had hitherto been held by the company AT Medics Ltd, allowing them to pass over the contracts to Operose, a wholly owned subsidiary of Centene Corporation, a US health insurance company which provides medical cover for Medicare, Medicaid and the Affordable Care Act (Obamacare).
• Further concerns were expressed around the fact that Centene had received a number of fines from US regulators for regulatory breaches.
• It was suggested that there were strong public objections to this change, both politically in the affected boroughs as well on the ground with residents and in the local press.
• It was felt that the CCG would not have selected a subsidiary of Centene in open competition due to its poor track record and the political fallout from doing so. Instead, it was felt that the purchasing of AT Medics Ltd along with the contracts it held was effectively a Trojan horse to afford Centene access to NHS primary care contracts. It was felt that if this was allowed to go ahead, then this would only be the beginning and Centene would look to acquire more and more health contracts in the UK. The deputation party questioned what the CCG would do if they bid for more contracts in NCL.
• Contrary to assurances given to the Primary Care Commissioning Committee (PCCC) by the directors of AT Medics that they would remain in place and working practices would not be affected, all six directors resigned their position in February and had been replaced with employees of Centene and Operose. Particular concerns were raised that the CCG were aware of this when they subsequently ratified the change of ownership in late February.
• Concerns were also put forward that during the PCCC meeting on 17 December, no mention was made of Centene being involved. Instead, this information was confined to Part 2 of the meeting which was not made available to the public and from which all non-voting members, including the community member, was excluded.
• It was contended that NCL CCG was likely put under a lot of pressure by NHSE to waive through this change of control and it was speculated this was part of  a wider political strategy by the government to agree a free trade deal with the USA.

The following arose in discussion of the deputation:

1. In response to a question around what should happen now, the deputation party suggested that the CCG needed to acknowledge that they had created a big problem and that their actions had resulted in a lack of trust. It was also suggested that the JHOSC should seek assurances from the CCG about what their strategy was for future contracts.
2. In response to a question, it was clarified that there were four practices in Camden, two in Islington and one in Haringey and that the CCG should write to the patients in the affected practices and give them the option to either change practice or remain in place.
3. In response to a question, Professor Sue Richards stated that, ultimately, it was the CCG who had responsibility for agreeing this and she considered that the CCG could have re-procured the contract rather than authorise the change of control. There was provision for the Secretary of State to intervene, but he had declined to do so despite being directly questioned on this by the Shadow Health Secretary.
4. The Committee sought clarification as why the deputation party wanted NHSE to push this through. In response, the deputation party commented that this could be because they did not want any disruption of service or perhaps it was because of wider political pressures.
5. The Committee sought clarification as to who exactly was at the meeting of the Board of NCL CCG when this decision was made. Clarification was also requested as to why the CCG ratified the change in ownership even after the Directors of AT Medics resigned.
6. The Committee queried why patients weren’t consulted on this change of control of the contracts and how long the contract was in place.
7. The Committee raised concerns about the scrutiny of this process and what would happen if Centene did not meet the provisions of the contract, given their record in the USA. In response, the deputation party commented that all of these decisions were made several years ago before the creation of the joint CCG and it was speculated that the decision may not have received the level of consideration that it should have.
8. The Chair thanks the deputation party for their input and for answering questions where they could. It was acknowledged that they were not officers and could not be expected to know the answers to all of the questions.
9. The Chair set out that the JHOSC were due to have a special meeting on 19 March 2021 to consider this topic further and advised that any questions that were not answered would be put to officers at the next meeting.

Due to time constraints, the CCG representatives did not have an opportunity to respond to any of the points raised. It was agreed that this would be carried over to the meeting on 19 March 2021.

Deputation 2

The Committee received a deputation from Haringey and Islington Keep Our NHS Public, which set out concerns that the temporary Covid GP Access policy would become a  permanent policy in NCL. The deputation party was made up of Rod Wells, Frances Bradley and Jan Pollock. Chloe Morales Oyarce and Will Huxter from NCL CCG were also present. The key points of the deputation were noted as:

• Concerns were noted that if the temporary Covid GP access Policy became permanent then there was a serious risk of damaging health outcomes for vulnerable sectors of the population i.e. the elderly, the disabled, those with mental health issues, people with learning difficulties and autism, the BAME community and migrants.
• The deputation set out the clinical need for, and the right to face-to-face access to a GP/clinician. If face-to-face appointments were reserved largely for the elderly or the digitally illiterate, this would compromise safe healthcare for large numbers of other patients. It was suggested that face-to-face appointments allowed clinicians to assess patients and receive information which was not visible on a computer screen or via a phone, such as mobility levels, temperature etc.
• It was felt that access based on digital first exacerbated existing health inequalities. This was an issue for significant minority groups, such as people with mental health issues, learning difficulties the BAME community. Although digital access to a GP undoubtedly suited some people, particularly those with simple medical conditions or with easily diagnosable problem and who were comfortable with using digital technology. However, for other people, it was felt that this prioritising of digital delivery would reduce access.
• There was a need to tackle digital exclusion.
• The use of e-consult was deemed to be problematic as booking online appointments was not feasible for everyone and the system itself was not easy to use. It was suggested that a dedicated helpline was needed to offer support and, if that failed, patients should be allowed to contact the GP surgery directly. Only 4% of Haringey residents said they would use e-consult when surveyed by the CCG.
• Concerns were raised about how the work the CCG was doing to help people to gain digital access to primary care, through Primary Voices was being publicised so that everyone who needed help could be supported.

The following arose in discussion of the deputation:

1. The Committee noted concerns around digital inclusion effectively creating barriers to some patients and sought clarification about what some of the challenges to accessing GP services were.
2. In response to a question the Committee was advised that the deputation party were aware of problems in getting access to the online system and having to wait a long time on hold when trying to access services via telephone. There were also experiences around photos not being accepted or recognised. This was made worse by a lack of IT support.
3. In response to a question, the Committee considered that the elderly were particularly vulnerable to digital exclusion 59% of over 75s did not use the internet.
4. It was suggested that there were 9 million people who could not use the internet unaided compared to 26m who could.