Agenda item

To receive an update on the procurement of GP services and AT Medics.

The Chair introduced the item and explained that a deputation on the procurement of GP services (AT Medics) had been received at the Committee meeting on 12 March 2021. It was noted that there had been no time for officers to reply at the previous meeting so this item had been deferred. Frances O’Callaghan, NCL CCG Accountable Officer, Jo Sauvage, NCL CCG Chair, and Will Huxter, CCG Director of Strategy, were in attendance for this response.

Frances O’Callaghan acknowledged the concerns that had been raised. It was explained that the papers relating to the decision had been published on the CCG website. It was noted that the discussions had been split between a public meeting (part 1) and a private meeting (part 2) which dealt with any items subject to commercial confidentiality. It was highlighted that the Primary Care Committee was Chaired by a lay member and frequently had private (part 2) discussions where contracts were involved. It was explained that, in the public meeting, the decision was made subject to due diligence and checks with Companies House. It was noted that the company, Centene, was not referenced in the public part of the meeting but that this was an oversight as the company name was very clear in the private meeting documentation and was not due to any ill intent. Frances O’Callaghan apologised for anything that had been unclear.

It was explained that there had been a deputation on AT Medics in January 2021 which had been heard and responded to. The concerns raised were recognised and, in hindsight, it was acknowledged that it would have been better to proactively inform elected members. However, Frances O’Callaghan stated that she wanted to clarify what the CCG was able to do; it was explained that the CCG was committed to public sector provision but that private provision was permitted in the Health and Social Care Act 2011 and the CCG had a responsibility to act within the law otherwise it would be at risk of legal challenge and financial penalties. It was added that the CCG had now provided comprehensive responses to the deputation, councillors, and other groups and it was hoped that the position had been clarified.

In terms of next steps, Frances O’Callaghan stated that the CCG was committed to providing the best possible care. It was commented that the AT Medics contract could not be terminated but that it was rated as Good and would continue to be monitored. It was explained that, where there were workforce shortages, the NHS was sometimes reliant on external support. It was accepted that some elements of the process could have been improved but that the CCG had tried to ensure transparency and had acted in accordance with the law and other CCGs in London, including following advice from NHS England where relevant.

Jo Sauvage noted that this had been a pan-London decision, that the CCG was not able to reverse the decision, and it was unfortunate that North Central London (NCL) had been singled out in the media. It was explained that a number of practices across London were supported by AT Medics. The concerns expressed were understood but it was stated that ensuring continuity of service to residents, particularly during the Covid-19 pandemic and the largest vaccination programme in national history, was the most important priority. Jo Sauvage commented it would not be appropriate to cease the existing contracts and commence a competitive tender; it was added that procurement involved significant time and cost and often had unintended consequences. It was highlighted that the CCG and Care Quality Commission (CQC) would continue to monitor performance metrics and there was no reason to doubt that the arrangements would continue to provide good quality and safe services.

Members of the Committee expressed concerns that local residents did not want their care to be handled by Centene, a large American insurance company that did not have a good reputation in America, and that they felt that the decision had been made without consultation or scrutiny. It was suggested that the community members of the Primary Care Committee might have raised concerns and it was enquired why they had not been present in part 2 of the meeting. It was stated that the six directors of AT Medics had resigned in February 2021, despite previous assurances that the directors would remain in post; it was asked how much had been paid to the directors and who had made the decision to transfer the contract from AT Medics to Centene.

Frances O’Callaghan explained that a change in control in itself did not allow the CCG to object except in particular situations, such as where there would be changes to services. It was stated that appropriate reasons would be necessary in order to object and the legal advice received determined that an objection would leave the CCG open to legal challenge. It was added that there was a data protection clause in the contract which did not allow any data to be shared; this was common to all contracts for primary care practices. Frances O’Callaghan stated that she was not aware of the sums paid to AT Medics and that she would only be able to confirm the NCL members who had been involved in the decision, although the full details could be provided in writing. It was also noted that all attendees were permitted to be present during the public meeting but that only certain members were permitted to be present at the private meeting.

Some members asked about the quality of the legal advice provided. Jo Sauvage explained that the legal advice had been sought on behalf of NHS England and London CCGs. She noted that she would have to confirm the specific advisor and advice but that all papers that could be published had been published in relation to this decision.

The Committee noted that a key issue in this case was openness and transparency and it was commented that many councillors and residents had been informed of the change through unofficial channels. It was enquired whether residents had been told about the change and given the option to change services to an alternative organisation. Jo Sauvage acknowledged that choice was a fundamental element of the NHS but that there was no reason to question the current quality of service that was being delivered. It was explained that the contract would continue to be monitored, as was the case with all contracts, and it was noted that alternative provision might not be possible or practical.

It was enquired how services would be monitored to ensure that a good service level was maintained. Some members commented that the Committee should be informed when contracts were due to be renewed. Will Huxter noted that, where contracts were due to end, there was a process which included relevant forward planning but that there was a different process for a transfer of ownership. It was suggested that members could be provided with further information about procurement and the different lead in times. Jo Sauvage explained that monitoring was a standard process for all contracts and it would be possible for the Committee to have some more detail on performance monitoring. Will Huxter noted that a report could include additional details about the contract and more information on quality assurance.

RESOLVED

The Committee requested further information in relation to the following:

·         The technical details in relation to who took the decision about AT Medics/ Centene.

·         How much was paid to the directors of AT Medics.

·         Further detail about how the CCG seeks legal advice in general and further detail about the legal advice in relation to this decision.

·         Whether the CCG could have reached an alternative decision or challenged the legal advice based on the quality of the proposed company and whether there were any avenues for the CCG to challenge the decision after it had been made.

·         Whether there were any avenues for local authorities to challenge the decision, including through referral to the Secretary of State.

·         Additional information in relation to the AT Medics/ Centene contract and performance monitoring, as well as performance monitoring in general.

·         In relation to future decisions, some assurance that the five local authorities would be informed and, if there were any concerns or issues with the proposals, whether there would be any oversight or opportunity for consultation. Also, details of how local authorities and the public would be better informed about proposals and about how to communicate any issues.

The Chair explained that, once a response had been received in relation to these queries, the Committee could assess whether any further scrutiny was required. It was noted that this issue had highlighted the importance of trust and local accountability, openness and transparency, and ensuring that the Committee was informed about upcoming decisions.