US-owned GP and community health company bids for bargain basement GP contract

Operose Health, a US-owned company previously named Centene UK that is headed up by two former NHS England bosses, is bidding for a bargain basement GP contract tendered by Nottingham and Nottinghamshire Clinical Commissioning Group.

Of the two former NHS England bosses that now run Operose Health – one is the former Director of New Care Models, the other is the former Senior Clinical Advisor for the NHS England Accountable Care Systems’ Primary Care Development Programme.

Operose Health is also an accredited supplier of commissioning support services, listed on the Health Systems Support Framework under its previous trading name of Centene UK.

We asked Nottingham and Nottinghamshire Clinical Commissioning Group if they have any commissioning support contracts with Operose Health/Centene UK via this Health Systems Support Framework. Update 29 January 2021 – the Clinical Commissioning Group’s Freedom of Information Officer has replied

“The CCG does not commission any services via the HSSF framework contract.”

FOI response ref no N/20/3177, received 14.1.2021

The contentious procurement process is opposed by the local Health Scrutiny Committee and MP

The new contract for the Platform One Practice seems designed so that patients with chronic or multiple conditions will receive less treatment or be excluded altogether. The budget is being cut so the enhanced services such patients currently receive from the practice (which has a LOT of patients with substance abuse and mental health problems and homelessness) are no longer provided. Patients are being moved to other GP Practice registers, often miles from their Platform One practice.

According to the British Medical Association, Nottingham City Council’s health scrutiny committee has written to the Clinical Commissioning Group with ‘significant concerns’ about the Commissioner’s decision. It has asked them to pause the procurement process and look to extend the contract with the existing Practice while a review of the process is carried out.

A Platform One Practice spokesperson told the British Medical Association they would lose around £400,000 a year under the new contract, and would have to make 40 per cent of staff redundant on the new budget. She said:

‘We cannot provide that care under the current framework of the financial offering that has been offered.’

The Lowdown reports that the Clinical Commissioning Group’s Equality and Quality Impact Assessment states that the contract on offer would downgrade the enhanced care currently available to the patients on the list of the Platform One GP practice (rated “outstanding” by the CQC), to “core primary care services.”

The Centene Corporation Connection

Operose Health is 100% owned by the US company Centene Corporation and was formed in early 2020 when Centene Corporation brought together its UK subsidiaries – The Practice Group (TPG) and Simplify Health.   Operose Health is now looking to take over the cut-price contract for the Platform One GP practice in Nottingham, after the Nottingham and Nottinghamshire Clinical Commissioning Group slashed Platform One’s funding in a contentious new contract.

Operose Health was formerly known as Centene UK: according to documents filed with Companies House, Centene UK changed its name to Operose Health in November 2019.

In 2017 Centene UK was paid £2.7m by Nottingham and Nottinghamshire Sustainability and Transformation Partnership to “integrate” the Partnership’s member organisations into an Accountable/Integrated Care System. NHS England had instructed Sustainability and Transformation Partnerships to partner with organisations across the world with experience of Accountable Care Systems.

In January 2019 the former NHS England Director of New Care Models Samantha Jones became CEO and President of Operose Health, formerly known as Centene UK.

Operose Health’s Chief Medical Officer Dr Nick Harding formerly worked at NHS England on secondment as Senior Clinical Advisor for the NHS England Accountable Care Systems’ Primary Care Development Programme and for Right Care (a set of spending benchmarks authorised by NHS England that’s widely used in various Integrated Care Systems to “standardise” commissioning of elective/planned operations – which ends up meaning “cuts”).

Why does Operose Health want such a cut-price contract? And why have the Commissioners come up with it?

A “bargain basement” version of NHS GP and community health care services could be seen to conform to Operose Health’s US parent company’s origins – Centene Corporation started out as a sub-prime health insurance profiteer in the USA’s midwest.

Asked why Operose Health is going after low-paid GP contracts in Nottingham eg One Platform Practice, the company stonewalled,

“As a confidential, public sector procurement process is taking place, we are unable to comment on the query regarding the One Platform Practice.”

Operose Health supply Health Systems Support services under the name of Centene UK, their former trading name

Following its Capita subcontract as System Integrator for the Greater Nottingham Accountable Care System, in 2018 Centene UK was listed on 9 of the 10 lots on the Government’s new Health System Support Framework. The Framework has the explicit function of providing the “support services” needed to get Integrated Care Systems up and running. Specifically: “digitisation of services and the use of data to drive proactive population health management approaches across Primary Care Networks (PCNs) and integrated provider teams.

This means companies on the Framework are authorised to sell NHS commissioners/ Integrated Care Systems the skills and software required to analyse patients’ confidential GP records and identify those deemed to be at risk of costing the NHS a lot of money. NHS England has estimated that £300m of business will be done through the Framework over four years.

Under the new Primary Care Network contract, NHS England is paying GPs to make sure that the potentially high-cost patients identified through analysis of patients’ confidential GP records, hook themselves up to wearable technology and submit to remote monitoring and participation in behaviour change schemes – such as NHS England’s Diabetes Prevention Programme. These behaviour change schemes are cash cows for private companies. For example, NHS England’s Diabetes Prevention Programme is provided by 5 private companies.

Operose Health have admitted that where Centene UK Limited is listed as a Health Systems Support Framework accredited supplier, “this is our former trading name”. So in fact Operose Health is the supplier of Health Systems Support Framework services that are listed as supplied by Centene UK.

We also asked Nottingham and Nottinghamshire Clinical Commissioning Group’s Communications Team about what contracts, if any, the Clinical Commissioning Group have with accredited suppliers on the HSSF list of suppliers. But their FOI team replied that the Clinical Commissioning Group “don’t commission any services through the HSSF framework contract.

Centene UK’s “Most Costly Can of Worms” contract with Greater Nottingham Accountable Care System

Back in 2017, Centene UK was subcontracted by Capita to act as System Integrator for the Greater Nottingham Accountable Care System (now known as Nottingham and Nottinghamshire Integrated Care System). The Accountable Care System was under instructions from NHS England to partner with organisations across the world with experience of Accountable Care Systems.

It was also required to to deliver the entire range of NHS and social care services to the whole population, on budget designed to cut £millions off the area’s NHS and social care budget by 2020/21, compared to then-current spending.

In 2017 999 Call for the NHS gave the Greater Nottingham Accountable Care System’s £2.7m contract with Centene UK its “Most Costly Can of Worms” Award. Here’s why.

Via its US parent company Centene Corporation, Centene UK was able to draw on a discredited Spanish model of Accountable Care System known as the Alzira model, run by the health management company Ribera Salud. Centene Corporation had recently bought into Ribera Salud as a means of accessing the health care “market” in Latin America and in the European Union.

The Alzira model involved Ribera Salud running an area’s entire health service and hospital buildings, paid for with a mix of private and public money. It didn’t seem to matter to Nottingham Accountable Care System that the Valencia government had recently outlawed the Alzira model and started the process of bringing the health service back into direct public management and provision, after a police investigation into Ribera Salud corruption.

Plus, so flawed was the system that in 2013 mass health workers’ strikes, combined with a High Court injunction, forced the resignation of Madrid’s health minister and the Madrid government’s abandonment of its plan to impose the Alzira system on six public hospitals.

A feature of the Alzira (and other) models of Accountable Care Systems is that they pass financial risk to providers. This is meant to incentivise greater efficiency, but is far more likely to incentivise cherry picking patients whose treatment represents good value for money – and to hell with the rest. This is what happened with the Alzira system of “accountable care” in Spain.

This seems to fit with the Nottingham and Nottinghamshire Clinical Commissioning Group’s cost-cutting contract for the Practice One GP Practice, which cares for many patients with complex health care needs – but won’t be able on the basis of this shrunken contract.

Regardless, Ribera and Centene found favour with Dr Stephen Shortt, a Nottingham doctorpreneur with a bewildering array of jobs that included Accountable Care System lead in Greater Nottingham. Announcing the Centene UK System Integrator contract he said,

“Ribera and Centene have transformed public care systems across twenty-five states in America and in Spain. Centene is not a provider but an integrator of care.”

For its part, Centene UK’s ambition as the Nottingham Accountable Care System Integrator was,

“to be part of bringing about the successful delivery of a new model of care in England, gaining knowledge and experience in the English NHS and Care system.”

Now it seems that having gained some of that knowledge and experience, Centene UK is putting it to use through its new subsidiary Operose Health, run by former NHS England bosses responsible for developing that new care model.

As the former NHS England Director of New Care Models, the CEO of Operose Health Samantha Jones is well placed to bolster Centene Corporation’s expansion here. So is the former Senior Clinical Advisor for the NHS England Accountable Care Systems’ Primary Care Development Programme, Dr Nick Harding.

West Yorkshire Operose connection

In addition to its five contracts for GP services in Nottinghamshire, Operose holds another 16 elsewhere in England. 2 are in Leeds.

Operose Health also run Wakefield Community Ophthalmology Service and Wakefield Community Cataracts Service. Wakefield has form with privatised cataract operations contracts – SpaMedica has most of the NHS cataracts operations contracts for Wakefield, Kirkles and Calderdale.

Update: Operose Health Ltd takes over AT Medics in London

The Lowdown reports (4.2.21) that Operose Health Ltd is taking over AT Medics. One of the leading providers of primary care services in London, AT Medics operates 48 GP surgeries, serving around 370,000 people, with 900 employees. Until the takeover it was owned by six GP directors. Misleading information about the change of ownership has been presented to all Primary Care Commissioning Committees across London.

AT Medics Ltd told the Primary Care Commissioning Committees via their due diligence process that Operose Health Ltd would only take control of the AT Medics Holding Limited Liability Partnership. But on the same day that Operose Health took control of the Holding company, it also took control of all all four AT Medics companies – including, crucially, the AT Medics Ltd GP company that holds the Alternative Provider of Medical Services contracts for all the GP surgeries.

With their 21 existing GP contracts, this will give Operose Health Ltd ownership of 70 GP practices- considerably more than the 49 held by the Modality super-partnership.

Remember what Dr David Wrigley warned in 2014? The private takeover of GP practices is nearing.

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