NHS forced to close walk-in health centres because they are ‘too popular’

Posted on June 23, 2011. Filed under: Closure | Tags: , |

Bureau of Investigative Journalism | June 23rd, 2011 | by Melanie Newman

Walk-in health centres are closing or having their opening hours reduced because they have proved so popular they are becoming unaffordable.

Most of the centres opened less than three years ago under a flagship Labour scheme aimed at improving access to primary care and reducing demand on A&E services.

But instead of being used by people not registered with a doctor, the walk-in centres have also proved extremely attractive to patients unable to get timely or convenient appointments with their own GPs.

This has meant demand for the services has often been far higher than anticipated and now primary care trusts (PCTs), many of which are struggling to balance their books, are being forced to cut opening hours, or even close the centres.

Flawed thinking over policy 
Research by the Bureau has identified 18 centres across the country that have been closed, are under threat of closure or have substantially reduced their opening hours.

Instead of unregistered patients, most of those seen at walk-in centres are people that have been unable to get a convenient appointment at their GP surgery.

In Yorkshire Bradford’s Hillside Bridge centre, which was opened in 2008 by then health secretary Alan Johnson, was expected to provide care for 540 walk-in patients by 2013. By December last year it was already seeing 1,530 patients, with no corresponding fall in A&E admissions registered in local hospitals. The centre’s opening hours are  currently under review.

This April a centre in Bedford had its opening hours cut by an hour and a half a day because excess demand meant it was running £100,000 over budget.

walk-in service in Barnsley closed last October after being overwhelmed by four times theexpected number of patients. And in Calderdale, West Yorkshire health bosses are reviewing the future of two walk-in centres where demand has put huge pressure on the facilities. Their hours have already been cut.

Health chiefs in many areas incorrectly predicted the centres would mainly attract patients not already registered with family doctors, and they expected A&E attendances to plummet as a result. However there is little evidence that this has been the case. Instead many of the patients seen at walk-in centres are people that have been unable to get a convenient appointment at their GP surgery.

NHS Calderdale medical director Matt Walsh told the Yorkshire Post the centres were unaffordable: “The level of demand is much higher than we commissioned. The majority of patients using the walk-in are doing so with non-urgent conditions in core hours when they could be seen by their own GP practice,” he said. “There has been no reduction in A&E attendances and patients have not chosen to register with the practice.”

Closures across the country
Other areas where centres have closed or are closing despite their popularity include Salford andNottingham which have each closed two walk-in centresManchester, which is closing three, andStockport, whose centre is closing during GP opening hours. NHS chiefs are considering closing a further centre in Peterborough.

In Trafford a centre has been closed since December 2010, “until further notice”.

In the South East, Haringey PCT axed a walk-in centre in March after deciding it was “not an appropriate use of resources”. And last year NHS Bromley blamed its entire primary care deficit on its walk-in centres contract, which it claimed had created “artificial” demand for services.

In some areas local pressure has forced PCTs to rethink their plans. In Southampton, a walk-in centre has been reprieved after former health secretary John Denham declared it was  “too important to close” but its opening hours are to be slashed. Two centres in Derby will also be kept open for a further two years following a local outcry over  plans to close them.

GPs have complained that the centres are paid far more per patient than their own surgeries receive.

In February 2011 the Government announced the NHS Commissioning Board would review all GP-led health centre contracts once they had expired. It said it would be up to GP consortia to decide whether they wanted to re-commission the “open access” parts of the centres.

GPs have complained that the walk-in centres are paid far more per patient than their own surgeries receive.

NHS Partners Network, which represents private providers of NHS services, said it would challenge the decision to review the contracts under competition law if it became the basis for a nationwide round of closures.

Research by the Bureau earlier this year found six privately run commuter health centres based at railways (three in London, and one each in Leeds, Manchester and Newcastle stations) were also being closed. However unlike the general walk-in GP surgeries, the commuter centreswere failing to attract enough patients.

In 2010 the flagship commuter centre in Manchester’s Piccadilly run by Atos Healthcare shut, a contract for a centre in Liverpool Street was not renewed, and Newcastle’s commuter centre (Care UK) closed in April 2011. This month the NHS confirmed that the Leeds’ centre would also close.

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Recession forces Chilvers McCrea to drop APMS contract

Posted on April 28, 2009. Filed under: News stories, Providers | Tags: , , , |

Pulse | By Gareth Iacobucci | 28 April 2009

A squeeze on bank lending is forcing private providers to ditch APMS contracts, Pulse can reveal.

Chilvers McCrea Healthcare, which manages over 30 practices across the UK, has been forced to terminate its contact to run an APMS practice in Essex because of the tough economic climate.

It is the latest in a series of private sector withdrawals from primary care which appear to pose a serious threat to the Government’s drive to ramp up competition.

The company’s decision to stop running the Pier Medical Centre in Southend, which includes two surgeries, comes just weeks after its chair, Dr Rory McCrea, warned GPs would find it increasingly difficult to make a profit on APMS contracts.

South East Essex PCT is now having to search for a new provider for the contract, which runs out in 2010.

Dr McCrea told Pulse: ‘Due to the current economic climate, it was not sustainable for Chilvers McCrea Healthcare to carry on the contract to manage the practice.

‘Chilvers McCrea, like many companies across all sectors, is debt funded and currently banks are going through a period of being nervous about lending.’

A spokesman for the PCT said: ‘ChilversMcCrea is continuing to deliver services until 2010. During this time we will secure a new provider through the procurement process to ensure there is a seamless transfer of services.’

The move comes after private firm Atos Healthcare recently pulled out of running an APMS practice in Berkshire due to the financial climate and low demand for services.

Both Atos and United Health also dropped out of the running for a tender in Sheffield prior to the award of the contract.

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Atos Healthcare: NHS Walk-in Centres

Posted on April 23, 2009. Filed under: Uncategorized | Tags: , |

Atos Healthcare 

Flexible access to primary care is the key to delivering health services that meet the needs of modern society.

The NHS introduced seven new Walk-in Centres (WiCs) in England, run by independent sector providers. These complement existing primary care services such as GPs and hospital accident and emergency departments. They provide patients with a range of services, without requiring an appointment.

Contracts for two of the WiCs were awarded to Atos Healthcare. The first was opened in Manchester on 17 November 2005, and the Canary Wharf WiC opened on 21 April 2006.

The services offer treatment for a range of conditions such as:

  • Coughs, colds and flu-like symptoms
  • Emergency contraception and advice
  • Hay fever, bites and stings
  • Minor cuts and wounds
  • Muscle and joint injuries
  • Skin complaints – e.g., rashes, sunburn and head lice
  • Stomach ache, indigestion, constipation, vomiting and diarrhoea.

Patients can simply turn up at any time from 7am to 7pm, Monday to Friday. If more convenient, they can also make an appointment.

Treatment and advice is provided in purpose-designed medical centres staffed by dedicated teams of nurse practitioners and doctors.

Continuity of care is important so, with the patient’s consent, details of key aspects of the consultation are sent to their GP.

The performance and quality of the service provided by Atos Healthcare is monitored by the Department of Health and the host Primary Care Trust using reports generated by the centre’s bespoke IT system. The centre operates under a robust clinical governance framework with clear lines of responsibility to Atos Healthcare’s Chief Medical Officer.

The Atos Healthcare run NHS Walk-in Centres in Manchester Piccadilly and Canary Wharf were recently awarded the Grand Prix: Best Operational Project across all sectors at the Public: Private Finance Awards 2007. The awards recognise the improvement in public services that the Walk-In Centres have delivered and the benefits that they have brought to the local community.

According to Andrew Ridley, Director of Primary and Community Care Commissioning, Tower Hamlets PCT, Atos Healthcare demonstrated “a strong focus on collaborative working with local stakeholders”.

To learn more about how we are helping the NHS provide primary care, contact Atos Healthcare.

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Feature: Private practice

Posted on April 22, 2009. Filed under: GP-led health centres, Integrated care, Journals, Providers, Social enterprise | Tags: , |

British Medical Journal | Andrew Cole, freelance journalist | 21 June 2008

1 London | a.cole71@ntlworld.com

Contracts to allow general practices to be run by private companies were supposed to be a last resort, but is this really the case? Andrew Cole reports

APMS (Alternative Provider of Medical Services) was once just another of the myriad health service acronyms that English general practitioners (GPs) were expected to master. But in recent months the APMS procurement process has become all too familiar and has led to fears it could threaten the foundations of general practice.

It’s a surprising turnaround. When APMS was launched it was billed as an unexceptional, indeed laudable, attempt to bring new blood into areas where practices had failed or had severe doctor shortages. In those situations contracts would be put out to tender and would be open to all comers—theprivate or voluntary sector or existing NHS practices.

Initially that’s how it worked. But recently the number of APMS schemes has risen sharply while the criteria for choosing this tendering method seem to have widened. The trend gained momentum with the government’s edict late last year that 100 new general practices and 150 polyclinics be procured through APMS.

A survey by the general practitioners’ magazine Pulse in January showed a third of trusts were now tendering for APMS contracts compared with just 10% six months earlier. And when it comes to the procurement process itself, the private sector seems to be winning hands down. Another survey by the same magazine suggests that although around half of shortlisted bids come from NHS practices, only one in 10 is successful, with 91% going to private companies. Private companies are also consistently undercutting practices on price, often by as much as 25%.

St Paul’s Way

One recent example of this phenomenon is St Paul’s Way Medical Centre in the heart of Tower Hamlets, which was put out to APMS tender last year. After an exhaustive procurement process the contract was finally awarded to private providers Atos Healthcare, even though two highly respected local practiceswere also on the shortlist.

The decision sparked angry protests from local health staff and patient groups. It also provoked a vote of no confidence in the trust by the local medical committee and an apparent change of heart by the trust on future tenders. But it also raises the question of whether general practices can ever compete on a level playing field with some of the larger, private organisationsmoving into primary care.

The St Paul’s Way practice is in one of the most socially deprived areas of London. Over two thirds of its 10 500 population is Bangladeshi, and rates of coronary heart disease and mental health problems are almost twice the national average. Consultation rates are also 50% higher than average.

There had been concerns about the practice’s performance for some time so when the husband and wife partners retired in 2006, it was no surprise that the trust stepped in to take over its management.

What was more surprising was that a year later it announced it was putting the practice out to APMS tender rather than working with neighbouring practices to find an internal solution.

“GPs in Tower Hamlets have worked very well with, and have a great deal of respect for, our primary care trust,” says John Robson a GP at nearby Chrisp Street Health Centre. “So it was a double blow to us that having established this good working relationship it then decided to look outside for a solution. In a sense it was a vote of no confidence in local practitioners. One wonders whether there was some external pressure on the trust.”

Dr Robson and his colleagues at Chrisp Street and the adjoining practice at Bromley by Bow decided nevertheless to bid for the APMS contract. They were two of 50 organisations or individuals that initially expressed an interest. This was reduced to a shortlist of five, two of whom withdrew, leaving the final selection between Bromley by Bow, Chrisp Street, and Atos Healthcare.

On the face of it the two local practices looked clear favourites to win the contract. Both have national reputations for innovation and quality. The Bromley by Bow Centre has been a flagship for social enterprise and integrated working and runs several community volunteer projects in the area.

Meanwhile Chrisp Street has established a high reputation for its teaching, innovation in information technology, and progressive clinical care. Two partners work as senior lecturers at St Bart’s and the London Medical School and have led the implementation of clinical care guidelines in East London trusts. They also pioneered web based services across the trust.

Yet in December it was announced the 10 year contract had been won by Atos Healthcare, a subsidiary of the £4bn ({euro}5bn; $8bn) multinational giant Atos Origin. Its health involvement includes providing the information technology for the NHS Choose and Book programme and running two walk-in centres, one at nearby Canary Wharf. But at the time it won the St Paul’s Way contract, it had no experience in general practice. According to its bid, its only clinical acquisitions were the two walk-in centres. Since then it has also successfully bid against local GPs for a new practice at Shinfield in west Berkshire.

Fair competition?

The reasons for its success are revealing. All three shortlisted bidders promised the same extended hours of 8 am-8 pm on weekdays and 8 am-5 pm on Saturdays and had similar scores on most aspects of medical performance. So everything eventually came down to non-clinical issues—in particular, managing a multiuse building, procurement, branding, and price.

That is where Atos came up trumps. Not only was its price 6% lower than the lowest general practice bid, but as a large corporate bidder it had clear inbuilt advantages in marketing and administration.

As far as Dr Robson is concerned, the process shows that the scoring system is “a loaded dice,” heavily weighted against existing small scale practices.

At the same time he feels the scoring seriously underplayed several key features of good medical practice. “We teach 90 medical students a year and put a huge effort into making that happen.” The practice also makes a big contribution to the local economy through its many links with the trust and wider population but also through nurturing a homegrown workforce. But the marking system ignored or gave only nominal weight to these factors.

A large corporation can also afford to write off initial losses in order to get a foothold in the market. He confesses his practice had grave doubts whether the price it quoted in the tender was sustainable. “We went right to the margin if not beyond—but even so Atos undercut us.”

The process was hugely demanding on a small practice’s resources. Chrisp Street spent £12 000 on legal and consultancy fees with one manager and one GP devoting half their time to the bid for three months. In total it spent at least £35 000 on the undertaking.

Joe Hall, a GP at rival bidders Bromley by Bow, agrees the bid was a massive diversion from day to day working. In fact, it was so time consuming he has doubts whether the practice could afford to do it again. “You don’t run general practices with the capacity to do this type of thing.”

Interestingly, another bidder, the south London based Hurley Group, withdrew from the process a week before the final selection partly because of serious doubts about the economics but also because it felt it was not sufficiently local to provide the right support. “The more we examined it, the more we felt itneeded the old-fashioned style of GP who is truly part of the local community,” explains GP Clare Gerada. “If our practice was on their doorstep we would have gone for it. But it needed staff to be attending community meetings, going to local schools, and helping in every way to transform that practice.”

She was shocked when she learnt neither of the local practices had won the contract. “They are two of the best general practices, and it is a shame they will not be able to help a practice crying out for GP leadership and also for the economies of scale a local practice could introduce.”

Tower Hamlets primary care trust insists the final decision on St Paul’s Way was made entirely on merit, with Atos winning “against very high quality proposals from other bidders . . . because of the quality measures they will have in place and the breadth of services they will offer local people.”

However, many local health professionals are unconvinced. Local medical committee secretary Paddy Glackin believes trust managers were taken aback by the final decision, made by an independent selection panel. He also thinks they came under pressure by London region to choose the APMS route in the first place.The local medical committee’s subsequent vote of no confidencereflected real concern that, following the Atos precedent, six other practices under direct trust management would now face an external tendering process and might end up in private hands.

In the event, and under clear pressure from local GPs, the trust has produced a plan whereby five of the practices will be given 12 months to show they can run themselves independently before a final decision on their future is taken. Only if they fail this test will APMS tendering be considered.

Atos Healthcare has now been running St Paul’s Way Medical Centre for nearly five months and claims to have already made several improvements, including extended opening hours, booked appointments, and a walk-in service. It has also refurbished the centre to provide more modern facilities and aims eventually to move into purpose built premises nearby. And it plans to meet regularly with patients to discuss the quality of their service.

Referring to the reasons for its successful bid, Nigel Beverley, director of NHS Services at Atos Healthcare, said it had won because it had shown “it will provide more NHS services to local people and that it is able to provide high quality services.”

The Tower Hamlets experience is being replicated in many other parts of the country. But the government dismisses talk of creeping privatisation of primary care services. According to health minister Ben Bradshaw, even if all the contracts currently being tendered went to private companies—”which they will not”—it would only add up to 3% of the market.

But Dr Glackin is less sanguine. Originally, he says, APMS was designed as a way of supporting inner city areas that were run down or had insufficient doctors. “What’s happened is it has become the only contracting vehicle for any new services that are being offered or provided. So potentially [privateprovision] could expand very rapidly.”

The other problem is that general practices simply do not have the resources or expertise to compete for tenders against large multinational private companies. “It’s just not a level playing field,” says NHS Alliance chairman, Michael Dixon.

“General practices are finding it difficult to put in really professional bids at the moment. And they’re not in a position to loss lead in the way private companies can so their bids will tend to be higher. Asking the average general practice to put in a bid of the sort Atos can put in is like asking a small version of David to fight a much larger version of Goliath.”

Competing interests: None declared.

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GP-led firms are the big APMS winners

Posted on April 17, 2009. Filed under: GP-led health centres, News stories | Tags: , , , , , , , |

Pulse | By Gareth Iacobucci | 18 November 2008

Companies led by GPs are the big winners in the Government’s rollout of APMS services and are dominating the bidding for services across the country, a new analysis reveals.

But a new breed of business-minded GPs are blurring the boundaries between general practice and the private sector and in some cases pitting GP against GP.

One GP-led company has now secured a contract to run services hundreds of miles from the practice at which it is based, yet local GPs are often struggling to win bids.

Academics from the Health Services Management Centre, based at the University of Birmingham, found that since 2004 113 tenders had been won by new market entrants, including a long list of new born GP companies.

GP-led firms have won ‘significantly more practices than either corporate providers or social enterprises’, it adds.

Well known companies such as United Health, Atos and Care UK make up just 9% of the total figure, with GP-led companies gaining 89% of contracts, and not for profit social enterprises the remaining 2%.

But the researchers admitted it was now increasingly difficult to distinguish between GPs and private providers.

Professor Chris Ham, professor of Health Policy and Management at the University Of Birmingham, who led the research, said ‘Quite a lot of the GP bidders have turned themselves into separate companies to bid for contracts, and quite a lot of the corporate bidders have strong GP involvement. The categories we’ve been using in the past are increasingly unhelpful.’

The rise of APMS has had another controversial twist, pitching local GPs against bidders often from far afield. Pulse revealed in September that many local GPs had failed to make it past even the initial stages of bidding for Darzi centres.

Professor Ham said the research had revealed widespread concern about the quality of local bids, which had been embarrassed by more professional bids by GPs turned entrepreneurs.

‘This had created a tension between needing to ensure the conditions for open and fair competition, but wanting to support and encourage local practices to bid.’

Local GPs have often found themselves outgunned. Last week, Kent-based GP group Malling Health was announced as preferred provider for a new Darzi practice in Weston-Super-Mare, North Somerset, nearly 200 miles away.

Dr Peter Maksimczyk, a GP in Weston-super-Mare, who lost out to the Malling Health bid said: ‘I can’t see how GPs from Kent can pick up the difficulties. Practice is different in towns like Weston. It’s very difficult to see this as anything other than a complete slap in the face.’

But Dr Thomas Reichelm, development lead for Malling Health, said: ‘We’re aware there might be some initial rejection but we’re fairly confident that by meeting people in person, we’ll be able to convince them we have no bad intentions.

‘We’ve already started the process of finding out the local sensitivities and what matters locally. It’s quite refreshing to bring a new outlook and perspective.

DEFINING ‘NEW’ PRIMARY CARE PROVIDERS

GP-led companies
Companies set by GPs for the purpose of bidding for general practice and other primary care contracts. Have access to NHS pension scheme. Key players: Chilvers McCrea (37 practices), SSP Health (11 practices), Aston healthcare (9 practices), Intrahealth (8 practices)

Corporate providers
Investor owned companies, usually operating for profit. Do not have access to the NHS pension scheme. Key players: United Health UK (5 practices), Care UK, (3 practices), Atos healthcare (2 practices).

Social enterprises
Not for profit organisations – often set by groups of healthcare professionals, which reinvest any profits back into the organisation. NHS staff still transferring into new social enterprises and delivering NHS care can stay in the NHS pension scheme. Current players: Central Nottinghamshire Clinical Services, (Nottingham) Willow Bank (Stoke)

Source: Health Services Management Centre – Choice and Competition in Primary Care: Much ado about nothing?

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