Cllr Clarke informed the Committee that two
deputations had been received:
- From Brenda
Allan on the issue of Operose Health – this deputation would
be received under this agenda item.
- From Jan
Pollock on the issue of Diabetes Services - this deputation would
be received under agenda item 8.
Brenda Allan, Chair of KONP Primary Care Working
Group, introduced the first deputation, explaining that there were
two main elements to the group’s concerns:
- The
replacement of GPs by Physician Associates (PAs), and
- The sale of
50 GP practices in London to a private equity company.
On the issue of PAs, Brenda Allan explained that
there were concerns about risks to patient safety as a result of
these changes, particularly following the recent death of a patient
who had been misdiagnosed by a PA at a medical practice in north
London.
On the
issue of the sale of GP practices, Brenda Allan explained that,
having acquired the practices in 2021, Operose Health had now
announced plans to sell the practices to HCRG Care Group on the
basis that they were not profitable, despite being paid more per
patient than under the previous owners. She said that there had
been little public consultation on this issue and proposed that
there should be a rigorous procurement exercise and scrutiny of
HCRG Care Group, and their owners T20, on their service track
record, financial viability, long term commitment and suitability
to provide primary care. She described deficiencies in the
performance of services previously taken over by HCRG Care Group
and concerns about their lack of transparency, which were set out
in more detail in the written submission to the Committee. She
concluded by expressing a preference for PCNs and GP Federations to
run the practices instead.
Brenda
Allan then responded to questions from the Committee:
- Asked
by Cllr White about the role of PAs and the training that they
received, Brenda Allan commented that PAs received two years of
training which was fewer than GPs, nurses or paramedics and that
their role were more suitable in hospital settings where they work
as part of a team with more supervision. However, she said that PAs
were now being employed in roles in place of GPs.
- Cllr
Cohen queried the current role and powers of the ICB over this
sale. Brenda Allan said that ICBs did have to approve the sale but
that their decision could potentially be subject to legal challenge
from the companies concerned.
- Asked
by Cllr Chakraborty about the evidence that the use of PAs in GP
Practices was having an adverse impact on patient care, Brenda
Allan said that there was plenty of evidence from patients on
delays to diagnosis and treatment as a consequence of being seen by
a PA rather than a GP and that the issue was that PAs were being
put in a role that they were not adequately trained to
do.
- Cllr
Revah expressed concern about the use
of PAs and highlighted the importance of consultation and
monitoring. Brenda Allan commented that the more primary care
services were sold off the more difficult it would be to deliver a
stable, quality service.
- Asked
by Cllr Cohen about the evidence of an impact on the quality of
patient care since Operose Health took over the running of the
practices, Brenda Allan said that there were well documented
concerns about patient care with some examples provided in the
written evidence to the Committee.
Sarah
McDonnell-Davies, Executive Director of Place at the NCL ICB, then
responded to the points made by the deputation. She explained that
the change of ownership required the approval of the ICB and that
this process had also occurred previously following the change from
AT Medics to Operose Health and had led to a Judicial Review. The
process this time would involve a broader engagement plan than the
first time. The ICB had legal levers at their disposal which
enabled them to carry out a process of due diligence, overseen by
the Primary Care Commissioning Committee, that looked at issues
such as financial standing, track record and potential for changes
to services. While this process would be thorough, the ICB would
not be in a position to reject the proposed changes without
operational grounds to do so. The ICB’s main priority was
therefore to do as much due diligence as possible and to add
safeguards where appropriate. The ICB was also doing what it could
to ensure that local providers had ample opportunities to access
primary care contracts.
Sarah
McDonnell-Davies then responded to questions from the
Committee:
- Asked
by Cllr Revah about the timeline for
this process, Sarah McDonnell-Davies said that the interim findings
were expected the following month which would be presented to the
Primary Care Commissioning Committee. A further review of evidence
by the Committee was then expected to follow. Cllr Revah suggested that there should also be further
engagement with the JHOSC.
- In
response to a question from Cllr Chowdhury about the suitability of
Pas, Sarah McDonnell-Davies said that this was one of a number of
new roles in General Practice as part of multi-disciplinary teams
under a national recruitment scheme and that the ICB had similar
questions and priorities on the implementation including that they
receive proper support and supervision. The case involving a
patient who died was the only serious incident that the ICB was
aware of and a full paper on this was expected at the Primary Care
Commissioning Committee. She added that the ICB had detailed
workforce data and so the ratio of GPs to PAs was
monitored.
Cllr
Cohen proposed that the Committee should formally support the
recommendations made by the deputation. This position was approved
by the Committee. Cllr Clarke proposed that the Committee submit
this in writing to the ICB with a response provided to the next
JHOSC meeting in March 2024.
The
main recommendation of the deputation was that:
“ICBs must conduct a full and widely
publicised consultation on the proposed sale so the public, patient
and carers can participate meaningfully in the decision
making.”
The
deputation also proposed an alternative approach:
The alternatives that ICBs and their Primary Care
Committees could adopt would secure a safer, more stable service
and better value for money:
- Enable
PCNs and GP Federations to take
over the Operose practices or support a
merger of the Operose practices with other
practices.
- Award a GMS contract to PCNs to
run practices, as has happened in Hoddesdon and Broxbourne PCN.
Hertfordshire and West Essex made this decision to secure the
long-term sustainability of the practice and care
provided.
- The
shortage of GPs, and particularly those wanting to be partners
might be improved if practices were paid even a percentage of the
14% extra per patient that commercial practices receive, as with
extra resources, the task of running practices would
be more attractive.
- Longer
term, establish within ICSs a body, e.g. PCN, GP
Federation or a new body e.g. a primary care board, to hold
NHS GMS contracts.
- Encourage practices to convert to anEmployee Ownership Trust (EOT) as
inMinehead., Somerset. Dubbed a John
Lewis model it gives all staff shares in the company.
EOTs cannot be sold and thus the practice become a
community asset, fixed by their GMS contract to the community they
serve. GP EOT accounts are open and transparent.
RESOLVED –
a) The Committee recommended that NCL ICB should
conduct a full and widely publicised consultation on the proposed
sale of GP practices to HCRG Care Group so the public, patient and
carers could participate meaningfully in the decision
making.
b) The Committee also endorsed the alternative
approach proposed by the deputation as described above.