GPs set up company to prevent ‘McDonald’s-style’ practices

Posted on February 8, 2010. Filed under: News stories | Tags: |

Pulse | By Christian Duffin | 8 February 2010

An LMC is taking the extraordinary step of setting up a company to run out-of-contract practices on a short term basis – to block private sector companies stepping in.

Essex LMCs expect to finalise plans and register with Companies House this week.

The company, which as yet remains unnamed, would have six GP directors offering a service to PCTs of stabilising small practices for six months after a contract ends. This might be because of a doctor’s illness or death, retirement, emigration or poor performance.

Essex LMCs chief executive Dr Brian Balmer said: ‘I believe we’re the first LMC to formally attempt this. It probably means we are either very brainy or crazy.’

Currently, some PCTs bring in private providers temporarily when practices are out of contract, but this gives these providers an unfair advantage if they apply when the contract is later tendered, said Dr Balmer.

‘I don’t want McDonald’s-style practices. We want the practice to stay within the NHS, not become something corporate. The advantage is that we are independent, although we will not be coming in and running the practice.’

Fees for lawyers, accountants and set up charges amount to less than £5,000, funded by ‘external sources’, said Dr Balmer. He said if PCTs drag their heels in finding permanent contractors then the company will give notice of pulling out.

Dr Balmer said North East Essex PCT had responded favourably to the plans, although a PCT spokesperson said: ‘We will be meeting on March 17 to discuss the issue.’

NHS South West Essex recently announced plans to farm out ten GP practices as APMS tenders.

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Tories open up talks with private firms

Posted on January 13, 2010. Filed under: News stories | Tags: , |

Pulse | By Ian Quinn, Gareth Iacobucci | 13 January 2010

The Conservatives have opened talks with a series of private firms after pledging to step up the role of the independent sector in the NHS.

The party told Pulse talks were ongoing with ‘a wide range’ of providers from the private and voluntary sectors, as part of moves to create a more competitive NHS marketplace should it win the election.

But the policy, outlined in a manifesto document released last week, puts the Conservatives on a collision course with the BMA, which has issued a fresh appeal for politicians to slam the brakes on private sector involvement in the NHS.

A draft health manifesto, unveiled by leader David Cameron, confirmed plans for GPs to take control of real commissioning budgets, which could see practices working in partnership with private firms.

It states a Conservative government would ‘open up the NHS to include new independent and voluntary sector providers’, which would be allowed to compete on a level footing with NHS providers.

It is the Tories’ strongest statement yet on the role of the private sector in the NHS, and puts clear water between them and Labour – with health secretary Andy Burnham instructing PCTs to make NHS providers first choice in all tendering.

The extent of the Government’s U-turn was underlined after its new policy faced scrutiny from its own Co-operation and Competition panel. NHS Great Yarmouth and Waveney was referred for excluding non-NHS providers from a tendering process.

The Conservative proposals came just days after the BMA issued a set of resolutions, including a call for politicians to stop ‘wasting taxpayers’ money’ on ‘unnecessary and expensive commercial-sector solutions’.

David Stout, director of the NHS Confederation’s PCT network, said the Tories had indicated they were keen for GPs to partner with private firms such as UnitedHealth, Bupa and Humana on commissioning.


• Open up NHS to competition from private and voluntary sectors
• Scrap NHS targets
• Give GPs power to hold patient budgets and commission care
• Divert resources to poorest areas
• Cut NHS red tape by a third
• Unleash ‘information revolution’ by making detailed data about the performance of trust and GPs available online

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BMA calls for private firms to be left out in the cold in 2010

Posted on January 4, 2010. Filed under: News stories | Tags: |

Pulse | By Ian Quinn | 4 January 2010

The BMA has called on politicians to slam the brakes on private sector involvement within the NHS in 2010, as part of a New Year appeal to MPs.

In a set of resolutions, which the body says would ‘protect the future of the NHS’, it puts top of the list a demand for politicians to stop ‘wasting taxpayers’ money’ on what it calls ‘unnecessary and expensive commercial sector solutions’.

‘These scarce resources should be invested in the NHS where they will provide better value for money and help more patients,’ said BMA chair Dr Hamish Meldrum.

He added: ‘The political parties have been grappling with the current financial crisis and cuts in the public sector are being proposed from 2010 onwards. The BMA is calling on politicians to resist the false economy of making quick savings by cutting front-line NHS services.’

The list of resolutions also calls for the Government to focus on issues such as alcohol misuse, tobacco control and obesity.

‘Dealing effectively with these problems could save millions of premature deaths in the future. We hope this government – and any future government – will adopt our resolutions,’ said Dr Meldrum.


The full list of the BMA’s demands

1. Stop wasting taxpayers’ money on poor value contracts between the NHS and private companies.

2. Don’t cut frontline services, or penalise NHS staff to bail the country out of the financial crisis which was not of their making.

3. Safeguard funding for medical research and the education and training of clinical staff.

4. Work towards creating a tobacco-free society by 2035.

5. Set a minimum price per unit of alcohol and ban all alcohol advertising in the media.

6. Support and develop general practice to deliver high-quality care for patients.

7. Discourage trusts from cutting the time consultants can spend on initiatives to improve quality, patient safety and cost effectiveness.

8. Don’t raise the cap on tuition fees in 2010 – a move which would send the cost of a medical degree soaring and dissuade the less well off to study medicine.

9. Address the BMA’s serious concerns over the quality and continuity of junior doctors’ training.

10. Compel the NHS to lead by example by reducing its carbon footprint.

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Health matters: The privatisation of health care in Britain

Posted on December 22, 2009. Filed under: GP-led health centres, News stories | Tags: , |

FRFI 211 October / November 2009 | accessed 22 December 2009

Health care for London

‘The days of the district general hospital seeking to provide all services to a high enough standard are over’, said Sir Ara Darzi, responsible for the ten-year plan for reorganising health provision inLondon. Commissioned by Gordon Brown in 2007 and promoted to a ministerial post in the Department of Health, he resigned in June this year.

The NHS Next Stage Review Interim Report, published in June 2008, showed there were significant variations in access to and quality of primary medical care services across Britain. The Equitable Access to Primary Medical Care programme was launched to address this. This includes at least one GP-led health care centre in each Primary Care Trust area.

Darzi’s plan was to shift work from hospitals into polyclinics and urgent care centres. 150 polyclinics (GP-led health centres are linked to this model of service), with long opening hours, would provide community-based care at levels between GP practices and district general hospitals, including pharmacy, dentistry, social and mental health, x-ray and ultrasound services, blood tests and minor surgery.

Darzi’s changes opened the way for private companies to bid to run these centres. The Department of Health expects Primary Care Trusts to commission 15% of their services from the private sector. NHS London’s timetable included inviting suitable providers to tender by April this year and sign contracts for the preferred provider by December 2009. ‘Suitable providers’ include GP practices, NHS bodies, private sector companies and ‘third sector organisations’ such as charities. Clearly GP practices cannot compete equally with multinationals in such a bidding process, and whilst health centres may continue to be described as ‘GP-led’ for public consumption, they will in fact be run for profit by health care multinationals and consortia.

Fifty ‘GP-led’ health centres have already opened around Britain. In 17 of these, up to 80% of the GPs are newly qualified or are just finishing GP training. Once private companies take over, information about what they are doing may become commercially confidential.

On 31 July, Camden NHS awarded a ₤20 million contract for running its new GP-led health centre in north London to Care UK, a company that in April 2009 was criticised for the poor quality of its elderly homecare. Yet again, the decision was made two months before the conclusion of a public consultation. A legal challenge is being mounted.

US multinational United Health currently runs three GP practices in south Camden, despite local opposition. In August, Connect Physical Health Ltd (CPH) was awarded a three-year contract to provide physiotherapy services at the Royal Free Hospital, to treat over 11,500 people a year. The pay of staff who choose to stay will be protected but they will not be able to add to their NHS pension. Camden physiotherapy will now be fragmented while CPH manages the referrals, records and appointments from a central database in Northumberland, 350 miles away.

In Hackney, two ‘GP-led’ health centres are planned and again, sticking to the minimum legal requirement for consultation, it is clear that the Primary Care Trust in Hackney has not adequately informed local people.

Private finance and the crisis

The cost of private finance for hospital building has increased with the global financial crisis. Guarantees for repayments of capital to bond holders are now more risky and so this method has become more expensive. However, bank loans have also become more costly. Before the crisis, interest rates on bank loans were between 0.6 and 0.8% above basic bank borrowing rates; they are now 1.5-1.6% above this rate. The government’s plan to increase public borrowing to support the banking sector means that the public sector is locked into making Private Finance Initiative (PFI) repayments to banks at these higher rates. As Alyson Pollock of the Centre for International Public Health Policy at the University of Edinburgh says: ‘Having bailed out the banks at taxpayers’ expense, the government is further conflicted because in allowing the banks to charge an excessive premium for finance it is protecting shareholders’ and investors’ interests at the expense of the taxpayer, the citizen and public services.’

Cutting NHS staff

Management consultancy firm McKinsey has come up with solutions to the financial shortfall and reducton in NHS budgets. Commissioned by the Department of Health in England, it is advising a cut of 10% in the workforce by 2014. This will drastically affect health care provision. Money is however being wasted on the administration of the increasingly privatised system: it now represents 12% of the total NHS budget, compared to 6% in 1991 before the introduction of the internal market.

As the NHS is progressively broken up and its services sold off, concepts such as inefficiency and productivity become paramount whilst universal health care and needs-based planning fall off the agenda. Competition in this context prevents resources being directed to where they are needed. The privatisation of the NHS must be opposed for the health of us all.

Hannah Caller

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Creating an NHS family of shareholders

Posted on December 7, 2009. Filed under: News stories, Social enterprise | Tags: , |

Pulse | Practical Commissioning | Focus on…..Becoming a provider | 7 December 2009

A GP-owned private company is coming into its stride with provision and has just secured a £30m urgent care contract with two other providers. Vale Health’s commercial director John Butler explains

When the Department of Health launched practice-based commissioning in March 2005, the 21 GP practices that made up the Vale of Aylesbury PCT in Buckinghamshire were among the first in the country to embrace the concept. We were also early adopters of the potential of combining commissioning with providing.

The initial move was that the practices set up the United Commissioning Collaborative as the local commissioning body – a not-for-profit limited liability partnership. Once that was achieved, a small group of us began to look in depth at the providing side.

We had two reasons for wanting to provide services. First, we knew GPs were the best people to know what’s needed locally. Second, we realised that if we set up our own provider company, we would not only be able to design the services but actually deliver them as well, which had to be an enormous advantage in terms of ensuring the quality of care.

We started out with a social enterprise ethos, so setting up as a standard for-profit company was a secondary consideration. But it made sense that those involved should be able to profit from their efforts.

In May 2006, Vale Health Limited was registered as an independent legal entity.

To get started we needed seed funding, but realised that whatever investment was put into the company was ‘at risk’ money.

If the venture was a flop, there were no guarantees there would be a return.

With this in mind, we offered shares to the GPs and their staff, just to see if they wanted to invest. About 110 GPs and practice staff did so, buying between one and 10 shares at £100 each. The amount any one person could buy was capped so that one individual would not have undue influence.

Limiting the shareholders to members of the NHS family also facilitated the transfer of staff from the NHS to us. It meant we could employ NHS clinicians part-time without them losing their NHS pensions. When they’re working for us they’re still paying into their pensions, which removes a major barrier.

In the initial tranche we raised about £40,000, which enabled us to get started, then with a second share issue we raised more money. A board of directors including local GPs was set up to oversee the company and embarked on tendering for work.

Conflicts of interest

The issue of conflict of interest that profit introduces is real. Conceivably, to make extra money, we could divert people to our services who don’t need them. But we work very closely with the PCT as a partnership and are audited by them, which introduces stringent checks and balances. In addition, the clinicians we employ make their own professional clinical judgments that we can’t influence.

At the time, the DH was actively encouraging ‘a plethora of providers’ with the idea of promoting competition to raise quality and lower costs, so the PCT was fine with the private company idea. But it was keen that we clearly differentiated between commissioning and providing.

When we started off, Wendover GP Dr Johnny Marshall (see box, page 35) was chair of both arms but it became necessary for him to withdraw from chairing Vale Health to make the distinction clear. We haven’t gone back to the overlap we started with, but there is now a greater understanding with the PCT that the two sides working closely together is no bad thing.


Although we had the cash to get going, we initially found it difficult to work as cost-effectively as established organisations such as Community Health Bucks, the provider arm of the PCT. Our cost per service was high because we didn’t have the infrastructure behind us. We struggled with issues like this, which took an inordinate amount of time to surmount.

It has been a real saga to get the whole thing onto a contractual basis but the introduction of the Standard Community Health Service Contract simplified matters and we are just in the process of signing that off.

The delay has meant that, until now, we haven’t been able to offer contracts to clinicians working for us. The lack of contracts has also made it difficult for us to grow as a company because NHS contracts count for a great deal with banks and other funding sources.

However, we were fortunate on another level. Because PCTs weren’t commercially experienced when we started, the tendering process was easier then than it is now.

After an initial struggle, we eventually got a couple of services up and running.

Our pulmonary rehabilitation services began with nine programmes within the Vale of Aylesbury PCT in 2006. Further programmes have been rolled out across the rest of Buckinghamshire. Each programme was for eight weeks with a maximum of 10 patients.

In April 2008, our musculoskeletal community assessment and treatment service was launched across the whole of Buckinghamshire.

Both services were set up on a shoestring staff-wise – the day-to-day running of the company is carried out by two people including me and we subcontract most of the clinical administration work to the provider arm of the PCT.

In our musculoskeletal service, six specialist clinicians work for us part-time on a self-employed basis and we use specialist physiotherapists and podiatrists who are subcontracted from Community Health Buckinghamshire.

As we were given short notice to launch the musculoskeletal service it was a difficult start. However, we’re now up and running at 10 sites the length and breadth of the county with patient convenience in mind.

Annual running costs are hard to estimate at present because the business is constantly developing. The company has yet to meet its target profit for shareholders.

Growing the business

Having survived the initial difficulties, we knew we had to get more business to spread our overheads. At that point, the urgent care contract for Buckinghamshire came along to cover out-of-hours as well as attendance and admissions avoidance, which on its own involves coordinating many different services. It’s a complex single contract – possibly the most complex one ever put together.

It was far too big for us to do independently so we collaborated with providers in the south of the county, independent healthcare provider Harmoni and Chiltern Health, another GP practice-funded provider. This was partly because the costs and risks in tendering are high.

Completing the pre-qualification questionnaire, just to get on the tender list, can cost several thousand pounds. And the tender itself costs many tens of thousands of pounds.

Another thing that has become clear is the need for people who are skilled in tender work. GPs who are thinking of forming provider companies should be aware of this and not be afraid of collaboration.

Although competition was stiff, we won the tender on quality and value for money and started work on the contract in late summer last year. It was signed in early November and will come into play in March next year for an initial five years, worth more than £30m in total.


There are no clear figures yet for the outcomes of our musculoskeletal service but we are diverting significant numbers of patients out of secondary care and into community-based care. This is more accessible for patients, it benefits the local health economy and patient feedback shows that car parking is usually easy.

An evaluation of the pulmonary rehabilitation pilot carried out in 2005/6 showed the following (we would expect results to decline over the full 18-24 months):

• number of chest infections reduced by 65%

• number of hospital admissions cut by 53%

• number of GP visits for exacerbations of COPD reduced by 80%

• increased exercise tolerance

• 21% average increase in distance walked

• 88% of patients were still exercising

• course was a positive experience for 94% of patients

• 95% of patients had increased confidence in managing their condition.

Since then the service has extended and we are currently collating results that look encouraging.

The future

Among our future plans are extending services beyond the geographical confines of the Vale of Aylesbury, still using our in-house skills.

We are convinced our for-profit model is the way forward. Public services do not organise things cost-effectively, but the private company will be more efficient.

If they were in the hands of the NHS the services we provide would cost more than we charge.

Ultimately, if the ethos is to provide free care at the point of delivery, it doesn’t really matter who provides that care as long as it’s of the highest possible quality.

John Butler is commercial director and company secretary of Vale Health Ltd

The GP’s view

Dr Johnny Marshall is a GP in Wendover, Buckinghamshire, chair of the NAPC and a founder of Vale Health. Here he shares the lessons learned during the challenging process of setting up Vale Health’s services
‘Our services – particularly the community musculoskeletal service – have been a real success, but it’s been a difficult process. The PCT has been learning as it’s gone along and we are now heading towards a much faster service procurement.
We’re now looking at expanding our current services. It’s still very expensive to tender for new ones but with the urgent care contract under our belt we can work on expanding what we have.
Once you start looking at much bigger contracts, you realise you need to work in partnership. But you can still accelerate service design while keeping local ownership, which is very important.The reality is commissioning and providing are not separate. There is clear blue water between the organisations (Vale Health and United Commissioning). But you need to be careful that separation is not for separation’s sake. The two sides have much to learn from each other.The message to other GPs wanting to try a similar arrangement is that this is not without risk. You need to make sure you go in with your eyes open and plan very carefully. You need a sense of forward planning and make sure you think beyond step one.

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Private provision of NHS services under threat

Posted on December 2, 2009. Filed under: GP-led health centres, ISTC, News stories, Providers | Tags: , , , |

The Guardian | By Owen Bowcott | 2 December 2009

The government has reignited the political debate about private healthcare companies delivering NHS treatment.

Private companies could find they are not the preferred option for delivering NHS treatments. Photograph: Graham Turner

On a spotless hospital ward pensioners displaying fresh bandages were delighted their knees and hips had just been replaced by the NHS. The surgery had been as good as going private, they declared. Which was what, in fact, it was.

Their confusion was understandable. The sign at the door reads North East London NHS treatment centre. The unit may be based in the same complex as the local NHS King George hospital in Ilford, Essex, and free at the point of delivery, but it is an independent sector treatment centre (ISTC) – a commercial venture, with the surgery provided by private company Care UK.

The mix of private and public healthcare providers within the NHS means that it is hard to disentangle one sector from another. Senior consultants at the ISTC have contracts to work in both the adjoining hospital and the treatment centre; other staff are on loan from the NHS. No private patients are treated. Soon, medical students will be training in Care UK’s facilities.

Blairite triumph

The health market has been presented as a triumph of Blairite politics, enabling internal competition to spur on progress towards improved standards, say its supporters. The health secretary, Andy Burnham, this autumn endorsed that settlement, though, in almost the same breath, he inadvertently helped to destabilise it. “With quality at its core … the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision,” he told health thinktank the King’s Fund – before adding: “Where I stand in this debate … is that the NHS is our preferred provider.”

Labour’s pronouncements since then on patients’ rights, and what is known as the “private patient cap” – the percentage of private treatments that hospitals are permitted to carry out – have set political compasses spinning. While the private/public divide has not been a significant battleground between Labour and the Conservatives in recent years, competitive tendering processes and residual ideological suspicions are now reviving the dormant row.

Burnham’s promise that the NHS should be the “preferred provider” has been interpreted by the private sector as a snub, and by health unions as a signal of Brownite support for traditional Labour values.

Few are clear what “preferred provider” means. The Department of Health attempted unsuccessfully last week to explain by asserting that: “Where existing NHS services are delivering a good standard of care for patients, there is no need to look to the market.” It then qualified the position, explaining that: “Where [NHS] primary care trusts are commissioning new services, then we expect them to engage with a range of potential providers before deciding whether to issue an open tender. These decisions will be made locally, and we will not choose to exclude either NHS or private providers on grounds of ideology – quality and what is best for patients must always come first. This could well mean more private provision, not less.”

Mike Parish, chief executive of Care UK, initially dismissed Burnham’s phrase as merely a political “rebalancing act”. Since then he has become more anxious about its impact. “People have taken that original good intention and presented it as something much more substantive,” he says. “Across primary care trusts there are people who are enthusiasts in terms of reform and others who are uncomfortable with any concept of plurality. This [statement] could take things in a direction that was never intended. There’s a risk of a runaway horse. We are already seeing tenders being issued for the redesign of services with the invitation going exclusively to NHS providers only. It not only constrains the options for PCTs and patients, it’s also certainly anti-competitive. I don’t know if it’s even permissible.”

Parish estimates that 6% of all NHS work is currently carried out by private firms including Spire Healthcare and UnitedHealth UK. Care UK runs a further nine ISTCs, urgent care centres in Luton, and healthcare services in Brixton prison. The company is considering bidding for what would be the first privately run NHS district general hospital at Hinchingbrooke in Huntingdon. Parish fears the “preferred provider” publicity will blight his chances. He is proud of the firm’s very high patient satisfaction rates and its clinical record in the NHS of no cases of MRSA infections.

Landmark battle

Care UK has, however, just lost one landmark battle. Awarded the tender to provide a GP-led health centre by Camden PCT in north London, it had to abandon the contract last month when anti-privatisation campaigners won a judgment in the high court that forced the trust to go back and ask the public whether the area actually needs a GP-led health centre.

The government’s decision to review the private patient cap – while instructing Labour peers to vote down a proposal raising the minimum permissible level of private work to at least 1.5% of treatments in all NHS foundation trusts – has also helped to reignite the issue of private sector involvement in the NHS.

Sue Slipman, director of the NHS Foundation Trust Network, says trusts want to raise the cap, not in order to treat private patients but “because they want to go into joint ventures to bring in money to their hospitals and support expansion of NHS provisions”.

Burnham’s announcement that in future patients will be legally entitled to free private care if not treated by the NHS within 18 weeks has added a further twist to the debate. The British Medical Association is concerned that this will lead to more NHS work going to private providers, with destabilising effects on hard-pressed NHS services.

Back at the North East London treatment centre, the relieved patients were not perturbed about the origins of their free NHS surgery. Instead, they were looking forward to going home quickly.

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Privately-run walk-in centres ‘less cost effective’, study finds

Posted on December 1, 2009. Filed under: News stories | Tags: , |

Pulse | By Lilian Anekwe | 1 December 2009

Walk-in centres could deliver better value for money if they are provided by the NHS instead of private contractors, primary care researchers have concluded.

An evaluation of six pilot walk-in centres located in commuter train stations concluded that offering contracts to deliver these services to private providers commits the health service to an expensive contract ‘that can lead to a very high price per patient’.

Train station walk-in centres were launched by the Department of Health in 2004 as part of a £50million change to primary care services, with seven being funded for five years.

Researchers evaluated six of the seven on performance in a number of indicators between 2005 and 2007.

The average number of patients attending each centres was between 33 and 101 per day, which researchers said was ‘considerably lower than the planned capacity of 150-180′.

The estimated cost to the NHS of providing a private walk-in centre for the 5-year period was £3m for London based services and £2.6m for out of London services.

If the centres operated at their planned capacity, the cost per attendance would be £13. But based on actual daily attendance, cost per attendance varied by centre from £21 to £62.

Lead researcher Dr Alicia O’Cathain, senior research fellow at the school of health and related research at the University of Sheffield, questioned ‘whether commuter walk-in centres are the most cost-effective way of increasing access to care for minor illness in a working population.’

The research was published in the December issue of the British Journal of General Practice, along with an editorial written by the high-profile health policy researcher Professor Allyson Pollock.

In her editorial Professor Pollock, professor of international public health policy at the University of Edinburgh, launched a scathing attack on the Government policy on privately provided walk in centres, which she said provide nothing more than ‘instant gratification for the walking well’.

‘The question is: what [are] the opportunity costs for the NHS, patients, staff, and citizens of paying too much for these private-sector white elephants? How many services have been cut to pay for care? How much care have older people, the frail, or chronically sick had to forego to satisfy the whims and needs of the walking well?’

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Unions to investigate NHS providers that oppose US health reform

Posted on November 26, 2009. Filed under: News stories, Providers | Tags: |

Healthcare Republic | Nick Bostock | 26 November 2009

Unions have launched a campaign to protest at private healthcare firms working with the NHS but trying to derail proposals to extend public health provision in the US.

They point to the ‘irony’ of firms bidding for contracts to provide services for the UK NHS, but at the same time ‘spending millions to stop reforms’ that could offer services to the 47 million Americans who currently have no healthcare cover.

A global union – Workers Uniting – set up by UK union Unite in partnership with the United Steelworkers union, which operates in the US and Canada, has expressed ‘dismay’ at the firms’ stance.

Gail Cartmail, Unite assistant secretary, said: ‘The global union is launching an investigation of the preferred bidders chosen by the DoH to work within the NHS.’

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New procurement rules ‘may increase private provision in NHS’, says DH

Posted on November 24, 2009. Filed under: News stories | Tags: , |

Pulse | By Nigel Praities | 24 November 2009

Switching to the NHS being the ‘preferred provider’ may increase private provision in the health service rather than reduce it, says a DH spokesperson.

The claims come after newspaper reports of a backlash from business leaders and politicians against the Government’s decision to issue strict new guidelines to PCTs about the use of private providers.

Health secretary Andy Burnham first revealed in September that under-performing NHS providers would be given ‘at least two chances’ to improve before turning to alternative providers.

Ministers have denied this is a U-turn in policy, but the change has prompted criticism from former minister Alan Milburn and the CBI, according to The Times newspaper today.

A Department of Health spokesperson would not comment on the existence of new guidelines for PCTs, but said where existing NHS services are delivering a good standard of care for patients there was ‘no need to look to the market.‘

‘Where Primary Care Trusts are commissioning new services, then we expect them to engage with a range of potential providers before deciding whether to issue an open tender.

‘These decisions will be made locally and we will not choose to exclude either NHS or private providers on grounds of ideology – quality and what is best for patients must always come first. This could well mean more private provision, not less,’ he added.

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Public and Private Healthcare Provision

Posted on November 19, 2009. Filed under: GP-led health centres | Tags: |

Early Day Motion | EDM 109 | Diane Abbott | 19 November 2009

That this House believes that in order for healthcare to be truly public it must be free at the point of access and run by not-for-profit organisations; is concerned by recent developments which have seen private, profit-making companies awarded contracts to run NHS healthcare clinics; notes with concern that three clinics in Hackney are already being run by private, profit-making companies; further notes with concern that there are plans to tender out two new GP-led healthcare centres in Hackney, potentially to private, profit-making companies; further believes that all healthcare should be provided by bodies that have the interests of their patients, not their shareholders, as a priority; is concerned that privately-run healthcare centres tend to offer short-term contracts for GPs instead of allowing doctors to build up a knowledge of the local area; is further concerned by evidence that the bidding process for healthcare centres is biased in favour of private, profit-making companies who have considerably more financial and legal resources to devote to the bidding process; and calls on the Government to reverse its decision to allow private, profit-making companies to tender for healthcare centre contracts.

Early Day Motions

Early day motions (EDMs) are formal motions submitted for debate in the House of Commons. However, very few EDMs are actually debated. Instead, they are used for reasons such as publicising the views of individual MPs, drawing attention to specific events or campaigns, and demonstrating the extent of parliamentary support for a particular cause or point of view.

An MP can add their signature to an EDM to show their support. They can also submit amendments to an existing EDM. Although majority of EDMs are never debated, the group of EDMs known as ‘prayers’ may be debated. Prayers are motions to overturn Statutory Instruments (laws made by Ministers under powers deriving from Acts of Parliament). Further information on EDM procedure can be found in the Commons Information Office Factsheet Early Day Motions.

Up-to-date and searchable information on EDMs is available from the Early Day Motions database. The database is updated nightly with new EDMs and signatures added to existing EDMs. To look at EDMs from any session going back to 1989/90, select the session you want from the pull down menu in the top right hand corner of the screen. For EDMs and signatures prior to 1989/90, please contact the House of Commons Information Office (020 7219 4272).

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GP leaders ousted following private firm’s report

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

Pulse | By Lilian Anekwe | 28 October 2009

Exclusive: NHS managers are implementing draconian measures against GPs, including forcing local GP leaders to resign from their posts, following the recommendations of a private consultancy firm.

Guest_editor_stamp_120A report by accountancy firm KPMG has set out a series of measures to bring cash-strapped NHS Hillingdon back into the black, including appointing a new PEC chair more willing to drive efficiencies and clamping down on GP referrals.
Since the report was commissioned, Dr Chris Jowett, a GP in West Drayton, Middlesex, has resigned as chair of NHS Hillingdon PEC – for ‘personal reasons’, according to the PCT. Dr Sabby Kant, a local GP and former member of the PEC, said the PEC had ‘effectively been dissolved’ in response to the report.

Dr Mitcholl Garsin, a GP in Uxbridge, Middlesex, has also quit as chair of Hillingdon PBC group, although he remains chair of Hillingdon LMC.

The trust’s referral management scheme is to be scrapped and replaced with tougher management of GP referrals, with balanced scorecards to be used to penalise GPs for ‘inappropriate use of urgent care’.

It is the first of what is likely to be a series of cost-cutting measures introduced on the say-so of private consultants, after Pulse revealed the amount spent by trusts on consultants had tripled in the past two years.

NHS London parachuted in KPMG to audit NHS Hillingdon’s finances, and gave the trust just two months to apply the measures ‘to the letter’ in return for writing off its £20m deficit.

KPMG’s draft report, seen by Pulse, identifies the key reason for the overspend as ‘poor financial controls’ by NHS Hilling-don, but concludes that tough management of practices is the best way to balance the books.

‘GPs are not held to account for high referral patterns or inappropriate use of urgent care’, the report says, adding the PCT should review and manage primary care contracts ‘for value for money and quality [by] use of the balanced scorecard with incentives for compliance’.

The report warns demand for hospital services is ‘higher than planned’ even though the local referral management system successfully cut acute admissions for a range of conditions.

It urges the trust to review referral management and the urgent care centre at Hillingdon hospital ‘as an urgent priority’. Pulse understands six-month termination notices have since been served on both services.

KPMG said the PEC and the PBC group had failed to engage GPs, undermining their ‘ability to influence behaviours’.

The trust is facing a GP rebellion as it advertises for chairs who are prepared to, in KPMG’s words, ‘strengthen accountability for GP performance and their impact on PCT budgets’.

All 49 practices in the trust are now threatening to quit PBC.

Dr Garsin, chair of Hillingdon Health, the GP-led provider of the urgent care centre, told Pulse the PCT had made him choose between being PBC chair and LMC chair, because of ‘conflict’ between the roles: ‘They are putting all the blame on GPs – it’s incredibly unfair.’

A spokesperson for NHS Hillingdon said: ‘It is our duty to put in place cost-effective arrangements.’


Recommendation: ‘Reconstitute the PEC and appoint a chair who is willing and able to take clinical leadership… Consideration should be given to how to reduce the potential risk of role conflicts.’

Action: PBC chair told he could not hold that and LMC role. PEC dissolved, with chair to be replaced.

Recommendation: ‘It is suggested the PCT recive its performance management framework to ensure it is aligned to achieving the strategic goals for the PCT through improved clinical service cost-effectiveness.’

Action: Balanced scorecards and referral audits to be used to examine and reduce referrals within practices.

Recommendation: ‘GPs are monitored via the balanced scorecard but we understand there to be no consequence of good or poor performance. In the absence of these controls the PCT’s ability to influence performance and ultimately its financial position is at risk.’

Action: High referrers to be penalised while high-performing practices are to be given incentives for compliance.

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Alliance calls for NHS providers to get priority

Posted on October 26, 2009. Filed under: News stories, Press/News Releases | Tags: , , |

Pulse | By Gareth Iacobucci | 26 October 2009

The NHS Alliance is urging the Government to slam the brakes on privatisation of NHS services by adopting new rules on APMS tendering.

Under its proposals PCTs would be barred from approaching independent providers unless they could satisfy detailed criteria that existing NHS services were not meeting quality standards.

In Scotland legislation has already been brought in to bar private companies from taking over the running of NHS services.

It also backs the Department of Health’s advice to NHS trusts to give current providers ‘at least two chances’ to improve where they are found to be under-performing, and for alternative providers to only be considered as a last resort.

In a paper entitled Rebalancing the Market, launched at last week’ NHS Alliance Conference in Manchester, the organisation backs the Government’s shift in emphasis, and recommends a revamp to the way services are tendered for.

For years PCTs have been encouraged to court private providers to bid for APMS contracts but the Alliance advises that in the future, PCTs should only invite private bidders in to bid to run services where there are no current providers of sufficient quality willing to tender.

It also calls on SHAs and PCTs to offer ‘formal support’ to NHS bidders during the tendering process, and recommends bidders be assessed on their ability to provide continuity of care and engage with local patient groups.

Dr Brian Fisher MBE, public and patient involvement lead, at the NHS Alliance, who presented the paper, said: ‘This will respect the importance of continuity in integration of local services and organisations that have historically provided a good local service.

‘It will encourage competition where services are of insufficient standard or too expensive, without destabilising primary care provision when it is already good.’

Market forces need to be put in service of patients

NHS Alliance | 21 October 2009

NHS organisations should be the first choice for commissioners as preferred providers, says the NHS Alliance. 

In a paper entitled Rebalancing the Market, which will be launched at the NHS Alliance 12th Annual Conference in Manchester, the organisation suggests two new approaches to tendering and commissioning that would improve cooperation and increase efficiencies. 

The paper states that tendering for services to include private bidders should be encouraged only when there are no current providers of sufficient quality prepared to offer extended services or conventional GP services at the right price. 

Dr Brian Fisher, National Public and Patient Involvement Lead, NHS Alliance, and the paper’s author, said: “Too often, the result of a business model is an NHS organisation that looks for increased income, which can come at the expense of patient care. The Alliance would like to see market forces better directed to improve the service to patients.” 

Although working with the independent sector has its advantages, it also poses many challenges, not least to the patient who, instead of being at the centre of healthcare planning, becomes part of a tug of war between primary and secondary care. 

Independent sector organisations may be more expensive and exit the market when the going gets tough. They may also decide to cut costs using short-term and/or inexperienced clinicians.

The paper also highlights that collaborative commissioning, programme budgeting and horizontal/vertical integration could be the answer to creating an environment where all partners have a common interest in improving care pathways and producing efficiencies. It says: “It may be that a cooperative approach works in some situations and not in others – there may well be a mixed set of approaches both within and between PCTs.”

For a copy of Rebalancing the Market or to arrange an interview with Dr Brian Fisher please contact the NHS Alliance press office on 07951204999/ 


Notes to Editors
1. For more information, please contact the NHS Alliance press office on 07951204999/ 

2. The NHS Alliance is the only independent body that brings together primary care trusts’ chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.

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PCT faces High Court over contract award

Posted on October 22, 2009. Filed under: GP-led health centres, News stories, Polyclinics | Tags: , , |

Pulse | By Gareth Iacobucci | 21 October 2009

A PCT is facing a High Court battle over its decision to award a GP-led health centre to private firm Care UK.

Residents have begun legal action against NHS Camden over an alleged lack of consultation on the centre.

Legal firm Leigh Day and Co has issued an application for Judicial Review on behalf of claimant Bob Austin, a former councillor backed by anti-privatisation campaigners.

The case centres on a consultation document recently issued by the trust about its GP services, which included information about plans for a GP-led health centre.

The consultation was not due to finish until October but the PCT announced on 31 July that Care UK had been selected to run the clinic.

Opponents of the new centre, which will be located close to Euston station, believe it could lead to the closure of local GP practices and are demanding a full consultation.

Candy Udwin, chair of the Camden Keep Our NHS Public campaign group, said: ‘The consultation has been a sham. The PCT has chosen the site, awarded the contract and started advertising for staff before the consultation has even closed.’

Dr Mark Atkinson, NHS Camden chief executive, said the trust would ‘rigorously defend’ itself against the accusations.

‘No legal case has yet been lodged at the High Court. If that happens, NHS Camden will rigorously defend Camden patients’ rights to expansion of local GP services.’

The PCT also found itself at the centre of controversy over an APMS tender in 2008, when it awarded three local GP practices to UnitedHealth, despite a rival GP bid being rated higher for planned service provision.
Click here to find out more!

PCT threatened with legal action over Darzi centre

Pulse | By Gareth Iacobucci | 5 August 2009

The Keep Our NHS Public campaign group are threatening NHS Camden with legal action over an alleged lack of consultation on a new GP-led health centre in north London.

The anti-privatisation campaigners, supported by local GPs and patients, are demanding that the PCT suspends its plans for a new Darzi centre near Euston station, pending a full local consultation.

Legal firm Leigh Day and Co have served the trust with a letter before action on behalf of a local pensioner, Willibald Davies, which claims the PCT have not consulted adequately on the procurement, and should immediately cease the process until a full local consultation has taken place.

Opponents to the new centre, which will be run by private firm Care UK, believe it could lead to the closure of local GP practices in the area.

The controversy centres on a consultation document recently issued by the trust about the future of Camden’s GP services, which included information about the GP-led health centre.

Although the consultation is not due to finish until October, the PCT announced on 31 July that Care UK had beaten local GPs to run the clinic.

Local campaigners have also threatened to organise a public boycott of any new clinic if their demands for a full consultation period are not met.

The latest battle is the second time in as many years the PCT has found itself at the centre of controversy over an APMS tender. In 2008, the trust was heavily criticised for awarding three local GP practices to US-giant United Health, despite local GPs being rated as offering substantially better services.

Camden was also one of two north London trusts which held secret talks with private providers including Virgin Healthcare about running the country’s first fully-fledged polyclinic before the public had been consulted.

Rob Larkman, NHS Camden Chief Executive, said: ‘Since 2007 NHS Camden has made clear our desire to increase access to GP services for the people of South Camden, one of the most deprived areas of the borough. By the end of 2009 a brand new health centre with a brand new GP practice will open offering local people world class health care, at times convenient for local residents.’

‘It is incorrect to suggest that we are presently subject to a Judicial Review. No case against NHS Camden has been lodged with the courts’.

Fears over privatisation plan for GP centre

Ham & High | Tan Parsons | 6 August 2009

CAMPAIGNERS are threatening legal action over NHS Camden’s decision to hand control of a health centre to a private company.

Last Friday (July 31) the group confirmed that the contract to run a new GP-led health centre in Hampstead Road would be awarded to Care UK, a company that in April this year was criticised in a BBC Panorama investigation into the quality of elderly homecare.

Campaigners were also furious that NHS Camden’s decision was announced more than two months ahead of the conclusion of their Primary and Urgent Care Strategy consultation on October 9.

Leigh Day and Co solicitors have now served NHS Camden with a letter before action on behalf of Camden pensioner, Willibald Davies, who has diabetes. The firm has insisted that NHS Camden should immediately halt the procurement process and the signing of any contract until full local consultation has taken place.

Chairwoman of Camden Keep Our NHS Public, Candy Udwin, said: “We are appalled by the idea that more private companies could get a toehold in Camden family doctors services.

“The fact there’s been no consultation makes it even more appalling. 

“People want to see a family doctor who knows them and their problems and who sees them every time they go to the doctors.”

The proposed development is one of the so called ‘GP-led health centres’ that was being promoted by Lord Darzi before he resigned last month as health minister.

NHS Camden’s decision to select Care UK as the preferred bidder follows the controversial appointment of private American firm United Health to run three local GP practices in the south of Camden.

However, patients spokesman Neil Woodnick, who is chairman of the Camden Local Involvement Network, said that a consultation would only delay the inevitable.

He said: “Even if there is a judicial review and NHS Camden was forced to hold a consultation, you have to remember a consultation isn’t a democratic process. 

“They could still award the contract to whoever they choose.

“At the moment figures show there is overall patient satisfaction at the surgeries run by United Health, so I’m not that worried about the prospect of another private care provider. 

“But obviously we will monitor the situation closely and see how it works out. We are more concerned about how confusing it is for people in Camden now. 

“How do they know whether to go to accident and emergency, an urgent care unit or the GP-led health centre?”

A spokeswoman for NHS Camden said that no case against the organisation had been lodged with the courts at the time the Ham&High went to press.

She said: “Since 2007 we have made clear our desire to increase access to GP services for the people of South Camden, one of the most deprived areas of the borough.

“By the end of 2009 a brand new health centre with a brand new GP practice will open, offering world class health care at times convenient for local residents.

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Revealed: NHS secretly wooed private firms over polyclinics

Posted on October 7, 2009. Filed under: GP-led health centres, News stories, Polyclinics, Providers | Tags: , , , , , , , , , , , |

Pulse | By Steve Nowottny | 7 October 2009

Exclusive: The NHS secretly courted private companies at a series of high-level meetings to encourage them to compete for the new wave of polyclinics and GP-led health centres, Pulse can reveal.

Directors, chief executives and other senior figures from a who’s who of private health providers were invited to regular off-the-record briefings, held every six weeks, to get their advice on tendering and procurement of GP-led health centres and London’s polyclinics.

Details of the meetings, at which no minutes were taken, emerged only this week after Pulse successfully won a nine-month appeal under the Freedom of Information Act.

Attendees included Atos Consulting, Assura Group, Care UK and Alliance Boots (see below).

The last in the series of meetings, which were hosted by NHS London and designed to reassure the private sector about the Government’s commitment to opening up the market, was attended by then-health minister Lord Darzi, as well as UBS Bank, PriceWaterhouseCoopers and Dr David Bennett, whose former roles include head of policy at Number 10 and at influential management consultancy McKinsey.

Companies invited to the meetings subsequently bid for and won contracts for dozens of GP-led health centres around the country and have been among those bidding for London’s centres, although NHS London is refusing to reveal how many they have won.

But a briefing prepared for Lord Darzi ahead of the last meeting on 19 August 2008 reveals: ‘This group of private sector CEOs and senior officials meets roughly every six weeks… to discuss concerns of the private sector market in general but specifically issues relating to London polyclinics and how London is handling GP-led health centres.

‘It is now a forum for the market to offer opinions and advice in the run-up to tendering and procurement of primary care services through both models.’

The briefing adds that one function of the meetings is to ensure the NHS is aware of the confidence required to ensure City backing for any ‘ventures’ in primary care.

‘Lord Darzi will be aware the City has grown deeply sceptical about markets in health given the reversal of much of the wave two independent sector treatment centre procurement,’ the report adds.

LMCs responded angrily to news of the meetings, pointing out that GPs had not been invited to similar meetings.

Dr Michelle Drage, joint chief executive of Londonwide LMCs, said: ‘We’ve had our suspicions but it confirms everything we thought must be going on. It stinks – it’s appalling.’

Dr Drage said Londonwide LMCs had found it impossible to organise meetings with NHS London at a similar level to the private sector briefings.

‘I’ve had one such meeting in the past year, with the chief executive,’ she said.

Dr Nigel Watson, chair of the GPC subcommittee on commissioning and service development, said: ‘To brief them like this is blatant and seems very strange when everyone is talking about level playing fields.’

And Dr Sally Whittet, a GP in Lambeth, south London, added: ‘This is wrong. It goes against my idea of the NHS.’

However a Department of Health spokesperson said: ‘The accusation that private companies were ‘secret wooed’ is simply untrue. We have repeatedly made clear that in setting up GP health centres PCTs are expected to carry out an open and transparent procurement to ensure the fullest range of providers can bid including existing GP practices, voluntary and independent sector providers.’

He added: ‘Lord Darzi spent a year working on his review of the NHS and engaged with over 60,000 people – the majority of whom were frontline NHS staff, patients and members of the public. However, given their interests in the future direction of the NHS this also included private sector healthcare providers.


• Alliance Boots
• Atos Consulting 
• Assura Group 
• Ashley House 
• Care UK
• General Healthcare Group 
• HCA International 
• Nuffield Hospitals 
• PWC 

The documents that revealed secret meetings between NHS and private sector

Pulse reveals today details of a series of high-level meetings held last year between senior figures in the NHS and leading private sector companies last year.

Read the Department of Health’s final response to Pulse here.

Read the briefing note prepared for Lord Darzi ahead of the meeting on 19 August 2008 here.

Read the full list of meeting attendees here.

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It’s a conspiracy theorist’s dream

Posted on October 7, 2009. Filed under: GP-led health centres, News stories, Polyclinics | Tags: |

Pulse | Editorial | 7 October 2009

Politics, polyclinics and private companies – it’s the perfect recipe for paranoia. But as the saying goes, just because you’re paranoid doesn’t mean they’re not out to get you.

It turns out that all those suspicions that the Government was deliberately grooming the private sector for a key role in the polyclinic project, and intentionally tilting the playing field away from GPs, were entirely justified.

As Pulse reveals this week, NHS managers in London were holding secret, six-weekly meetings throughout the run-up to the polyclinic tendering process with a panel of 10 private companies, at just the same time that GP leaders were finding it almost impossible to gain an ear for their concerns.

Extraordinarily, in a modern political world that claims to be embracing transparency, no minutes were ever taken, even when former minister Lord Darzi joined the discussions.

The very existence of the meetings was only revealed under the Freedom of Information Act, and even then only after a nine-month appeal process, and once Lord Darzi had safely departed from his ministerial post.

But although the discussions were shrouded in secrecy, the briefing notes eventually released to Pulse are commendably open about their purpose.

‘It is a forum for the market to offer opinions and advice in the run-up to tendering and procurement of primary care services,’ they say, adding that the NHS was aware of a need to bolster the City’s confidence that ‘ventures’ in primary care would be rewarding.

It’s impossible to say whether those meetings made any difference to the tendering process in London, or elsewhere in the UK.

Nationally, around a quarter of Lord Darzi’s GP-led health centres have been awarded to private firms, while in London, where large federated polyclinics could in theory be even more attractive to the private sector, too few contract winners have been announced to establish the true picture.

But what can be said with certainty is that to allow private companies such extensive access during the period immediately before Lord Darzi’s plans were implemented across the country was astonishingly inappropriate. To hold those meetings in private, away from the prying eyes of doctors or patients, makes a mockery of the pledge to consult openly on the tendering process and remain accountable to the public. Never again will conspiracy theories about the privatisation of general practice be dismissed as the product of GP leaders’ fevered imaginations.

What GPs will be hoping is that this disturbing period in the development of primary care policy is now closed, with the departure of the man who was its main architect.

There are positive signs, with current health secretary Andy Burnham at last getting tough on independent sector treatment centres, and acknowledging that NHS providers need a fair chance to compete for contracts.

Let’s hope that if he decides to embark on a series of meetings with private providers, he at least has the good grace to be open about it.

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Privatisation is ‘Trojan horse’ threatening NHS

Posted on September 15, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | By Neil Durham | 15 September 2009

Government-supported privatisation initiatives are the ‘Trojan horse’ that could severely undermine the NHS, according to Unite/CPHVA.


The union backed motions at yesterday’s Trade Unions Congress in Liverpool yesterday calling for an end to the privatisation of the NHS, urging services to remain within the NHS delivered by its staff.

Gail Cartmail, Unite’s assistant general secretary for the public sector, said: ‘It is clear that the not-so-subtle encouragement given by the government for the various privatisation initiatives, such as the private finance initiatives and the misguided experiment with social enterprises, are the Trojan horse that could lead to the fragmentation of the NHS.

‘To create these so-called market mechanisms – that the British people have repeatedly said in opinion polls they don’t want – will cost an estimated £20bn. This is money better spent on frontline services – more health visitors, more hip replacement operations and more day surgery.’

  • Are unions facing a losing battle with the government over the privatisation of the NHS?
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The Private Sector and the NHS

Posted on September 4, 2009. Filed under: Arm's length providers, GP-led health centres, News stories | Tags: , , |

Pharmaceutical Field | 4 September 2009

The demands of world-class commissioning will mean increased collaboration between the NHS and the private sector. To stay ahead of the game, pharma companies need to be engaging with the private sector on a local level, argue Duncan Alexander and Mike Sobanja.cover


Despite many initiatives and government policies, the private sector has yet to play any major role within the NHS – especially outside England. Yet with escalating cost pressures and the very real prospect of a new government in 2010, there is little doubt that Strategic Health Authorities (SHA) and Primary Care Trusts (PCT) will begin to look more closely at opportunities for commercial partnership.

Indeed, while there is limited national consensus today, private sector initiatives continue to succeed at a local level. Given the current economic climate, pharma companies cannot afford to ignore these pockets of opportunity. It is only by understanding the very real differences in private sector/NHS collaboration at a local level that organisations will be able to respond effectively to the implications of strategic change, from world-class commissioning onwards.


Increasing competition

Since the Labour government came to power in 1997, there have been many grand statements and initiatives designed to increase performance and productivity across the NHS by introducing private sector competition.

Indeed, in January 2002, Alan Milburn, former Secretary of State for the NHS heralded the introduction of the private sector into the NHS, saying: “Our reforms are about redefining what we mean by the NHS. Changing it from a monolithic, centrally-run monopoly provider to a values-based system where different health care providers – in the public, private and voluntary sectors – provide comprehensive services to NHS patients.”

However, fears that such a strategy could lead to back door privatisation of the NHS certainly appear to be unfounded, with a number of initiatives failing to deliver real change or private sector involvement. And certainly across Wales, Scotland and Northern Ireland there is a clear move away from any private sector co-operation or collaboration.

But the changing economic environment will undoubtedly have a significant impact on NHS strategy over the next few years, especially in England, where the sheer volume of demand places huge cost pressures on PCTs and SHAs. Combined with an expected change of government in 2010, it is very likely that the NHS will be tasked with meeting clear targets for the use of private sector organisations to deliver services in a more competitive and cost effective manner.


Poised for change

Indeed, while the Virgin Group announced it had effectively put on hold its ambitious plans to take over and run GP surgeries in 2008, the company remains ‘very committed’ to entering the sector and will review the situation when the economy improves. 

Furthermore, the Department of Health remains bullish about the private sector’s role within the NHS, a spokesman recently asserting: “PCTs are expected to stimulate and shape the market, including a number of providers from voluntary, NHS, private, local government sectors and others.”

And private sector involvement with the NHS is occurring – albeit on a fragmented basis and at a local, not national level. Some 25% of contracts for the ‘Darzi centres’, for example, the GP-led health centres required to be introduced by all PCTs across the country, have been awarded to the private sector so far – although these include NHS hybrids that are simply relabelled organisations.

The Department for Health has also let a contract for the support of the development of practice-based commissioning, with five companies/consortia vying for contracts to give PBC a shot in the arm.


Defining opportunity

It is this highly fragmented response that is creating huge challenges for pharma companies today. And a fundamental issue to address is the speed with which PCTs respond to the demands of world-class commissioning, under which PCTs must become two separate organisations – the Commissioner and the Provider – by April 2010.

While the PCT’s commissioning side will not require many changes, it will be the establishment of the provider unit that will be of most interest, becoming as much as 80% of the PCT as it currently stands. The Department of Health has set a clear timetable for PCTs to undertake this huge change, with three stages – Arms Length Status (April 2009), Direct Provider Organisation (October 2009) and complete independence (the externalisation of the provider arm) by April 2010.

However, every SHA and PCT is progressing at its own pace – with early adopters and clear laggards. According to the latest figures from Cegedim Dendrite, 6% have achieved Arms Length Status by April 2009, 13% are significantly ahead of target and are already Direct Provider Organisations (DPO), with 66% on target to achieve DPO by October 2009.

Furthermore, different regions have adopted different strategies, with London splitting into five Commissioning Collaboratives (specialist commissioning groups) and six PCTs currently taking part in a national Community Foundation Trust Pilot Programme, under which they will be no longer be assessed by the SHA after a year’s operation and assuming the required level of governance and financial expertise.

The challenge for pharma companies is to assess and understand the progress of these individual NHS organisations in embracing world-class commissioning and understanding the implications for new business development.


Building for the future

While the private sector involvement in the NHS will undoubtedly remain small – at least until the next election, pharma companies cannot afford to ignore the opportunity. Indeed, the continued perception that both the NHS and, by association, pharma companies will be unaffected by the current economy is, quite frankly, ridiculous. With the escalating levels of public debt any government will be forced to claw back funding over the next few years. Should a Conservative government take over in 2010, the NHS is likely to experience a massive policy shift that will force SHAs and PCTs to work far more closely with the private sector.

Pharma companies cannot operate in an information vacuum. This private sector/NHS co-operation will continue to be introduced on a piecemeal, local basis. In this climate it is essential to maximise opportunities, operate efficiently and, furthermore, build relationships with key individuals who will be increasingly involved in defining the NHS/private sector model.

Without up to date information on changes in attitude and adoption at a highly granular – preferably PCT – level, pharma companies simply will not be able to respond effectively to any new commercial opportunity.



Duncan Alexander is OneKey Director at Cegedim Dendrite, where he is responsible for managing the existing client base and the co-ordination of all UK commercial activities. Cegedim Dendrite has over 35 years experience in providing value added information and CRM solutions to the pharmaceutical industry and healthcare professionals.

Mike Sobanja is Chief Executive of the NHS Alliance – the independent body that represents NHS primary care. Values-based, the NHS Alliance is the only organisation that brings together PCTs with GP practices, clinicians with managers and board members, and NHS primary care with its patients. The NHS Alliance membership and its national executive are fully multi-professional.

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Unite campaign to halt NHS privatisation backed by thousands

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

Healthcare Republic | 28 August 2009

Unite/CPHVA presented a letter signed by 3,000 NHS members to the DoH calling on health secretary Andy Burnham to halt the privatisation of the NHS.

It was presented by Karen Reay, Unite’s national officer for health.

The campaign is part of Unite’s Health B4 Profit campaign designed to preserve the NHS as ‘a publicly owned, publicly accountable, universal and comprehensive health service managed and run for the public good’.

Unite estimates that £20bn would be spent on creating the bureaucratic market infrastructure for privatisation.

Ms Reay said: ‘We are asking Mr Burnham to protect the heart and soul of the NHS in England and roll back these costly and dangerous plans.’

Mike Parish, chief executive officer of Care UK, the largest provider of healthcare services to the NHS, said: ‘Patients are benefiting from the increased choice that is coming from the introduction of additional providers of NHS services.

Waiting times are reducing, quality is rising and innovation is being stimulated by opening up the NHS to the real world of people being given choice.

‘The best way for the NHS to reconcile rising public expectations and constraints on public spending, is not to take away choice for the public, but to increase it. This will enable the NHS to deliver more with less and will safeguard the founding principle of care free at the point of delivery.’

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Tory MPs back expansion of private sector role in NHS

Posted on August 27, 2009. Filed under: News stories | Tags: |

Pulse | By Gareth Iacobucci | 24 August 2009

The majority of Conservative MPs support moves to give the private sector an increasingly prominent role in the NHS in the future, a new survey has found.

The cross-party poll of 150 MPs found that Conservatives, younger MPs and those from the south of England were most likely to view the NHS as unsustainable in its current form, and most supportive of the need to involve the private sector.

The survey by COMRES on behalf of BMI Healthcare – which will come as a blow to Tory leader David Cameron’s campaign to present the Conservative party as ‘the party of the NHS’ – suggests that the predicted high turnover of MPs at the next general election will lead to greater support for the private sector.

Over three quarters of Conservative MPs agreed that the NHS should fund patients’ treatment through private providers if it reduced waiting times, compared to 47% of Labour and 55% of Lib Dem MPs.

Similarly, 67% of Conservatives agreed that patients should receive co-payments for treatment funded jointly by the NHS and the private sector, compared to 36% of Lib Dems and 14% of Labour MPs.

Party disagreements were stark on whether private providers should be invited to run NHS hospitals where they had failed to meet minimum standards of care, with 84% of Conservatives agreeing, compared with 30% of Lib Dems, and just 17% of Labour.

Over two thirds of Conservative MPs supported the introduction of income tax relief on standard rate income tax for private medical insurance, compared to just 5% of Lib Dems and 1% of Labour MPs.

Similarly, 55% of Conservative MPs supported the introduction of tax relief on private healthcare fees, compared to just 1% of Labour MPs.

The survey found that 72% of MPs born before 1950 believe the current NHS model is sustainable for the next 60 years, compared to 42% of MPs born after 1960.

There was also a regional split of opinions – with 82% of MPs from the North believing the NHS is sustainable, against 52% in the South.

Andrew Hawkins, chief executive of Comres, said: ‘These results show that Conservatives and younger MPs are more sympathetic to the role private sector companies can play in the NHS than their older, non-Tory counterparts.

‘Given that we can expect a relatively high turnover of MPs at the next General Election – perhaps more than a third of the House – we should expect that the direction of travel for the House is towards more support for private sector involvement in the health service.’

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Tories back private healthcare plans

Posted on August 24, 2009. Filed under: Journals | Tags: |

Health Service Journal | 24 August 2009

A poll has revealed that two-thirds of Conservative MPs support tax relief on private health insurance, reigniting controversy over the party’s commitment to the NHS.

Chancellor Alistair Darling accused the party of having “two faces” when it came to healthcare.

Shadow health secretary Andrew Lansley insisted the Conservatives were committed to ensuring people had access to high quality healthcare without the need to take out private insurance.

However, he said a “serious debate” was needed on how healthcare was best delivered through the NHS.

Some 66 per cent of Tories supported tax relief on standard rate income tax for private medical insurance, according to a poll of 150 MPs.

In contrast, the ComRes poll for private hospital group BMI Healthcare revealed that 1 per cent of Labour MPs and 5 per cent of the Liberal Democrats backed the idea.

More than half the Conservatives – 55 per cent – backed the introduction of tax relief on private healthcare fees, compared with only 1 per cent of Labour MPs.

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