A month ago Sussex Bylines ran an account of the intended termination of the contract for the Wellsbourne GP surgery in Whitehawk, East Brighton. This was the first the wider public knew about it and since then the dismay and alarm have snowballed.
The crux of it is that, unless a decision is made to put a halt to this process, a much-loved, nationally-lauded, multidisciplinary practice is likely to have to hand over all its good work to One Medicare, part of One Medical Group, a Leeds-based, for-profit company whose business is owning and managing healthcare GP services.
Despite the furore, NHS Sussex, through the local Integrated Care Board (ICB), is proceeding with its decision. Two internal appeals (i.e. the ICB marking its own homework) have failed and the final appeal is now with the Independent Patient Choice and Procurement Panel, under NHS England. Their report is expected in the next few weeks and we await its conclusion.
An exemplary campaign
It’s worth just summarising the formidable depth and breadth of the campaign against the decision, which began with our original article in Sussex Bylines. This was followed by articles in the Brighton Argus and Brighton and Hove News, plus the medical press.
Gill Williams and David McGregor were the first among a number of councillors to offer support, as did the new MP for Kemptown, Chris Ward who stated: “I’m strongly opposed to a for-profit provider replacing a local community one, this is a matter of principle, it’s what the Labour party stands for.”
In an interview with the BBC he said he had requested the Leeds company to withdraw, given that BBC journalists had revealed widespread local astonishment at the drawn-out process, the eventual decision and the failure to consider the significant social value of the existing arrangement.
The Guardian picked it up with a forceful piece by Polly Toynbee who spoke to several of the parties involved. Former MP, Lloyd Russell Moyle, added weight to the campaign with a detailed account of events following conversations with NHS officials, the local council and members of the local community.
Sussex Defend the NHS organised a Tug-of-War at the Brighton War Memorial on 14 June, attended by staff, patients and volunteers from Wellsbourne Healthcare, which the good guys won against the profit-making companies. Councillors David McGregor and Andrei Czolak were also there to give their support.
Pressing questions
The ICB is as expected standing firm. When the hullabaloo first kicked off, they issued a statement saying: “This process is still under way and, as a result, we are unable to comment further until the procurement has officially been completed. However, we have seen and are aware of the concern being raised.” That’s good, but there are a number of obvious questions as to how it is we got here.
- Polly Toynbee suggests there needn’t have been a tender process at all, that ICB are allowed to reject cheaper bids in favour of those with “social value”. The existing arrangement was working fine, as evidenced surely by the 3,000 names on the MP’s petition. So why has all this fuss and energy – with its associated cost in public money and other resources – been necessary?
- There are reports that the performance record of One Medical in maintaining its other contracts is not all that it might be. Can we be told about this? Polly Toynbee writes that One Medical has withdrawn from a number of its contracts and that the number of other private companies running services has fallen substantially recently. She reports that the large US company Operose has sold its GP surgeries, while Babylon has collapsed.
This suggests that the economics of running GP surgeries is harder than these companies are willing to concede. Local residents remember only too well the poor performance of the private provider that operated in Whitehawk before Wellsbourne CIC was established.
- In order to generate a profit for its shareholders, One Medical will need to change the Wellsbourne model and make cuts. Can we be told the details of this? Given that the current model relies on socially committed GPs, how much staff cutting does the new company expect to have to implement?
- We suspect the transition costs in switching from one management model to another quite different one will be significant and, almost inevitably, greater than expected. These costs are probably not included in the proposal budget. Can we be told? And what about the risks of failure? Are these costed in too?
- And why is getting all this information so difficult? Can the public see the scores for the different proposals? We understand the winning bid was not, as it was first assumed, on the basis of it being a cheaper proposal. So what did One Medical bring to the party that the existing contract holder is not doing?
- The decision to terminate Wellsbourne was made by NHS Sussex Integrated Care Board. Who are the ICB exactly? How do they get appointed and who are they accountable to? We don’t get much reassurance from the very corporate ICB website.
- How long do members of such boards typically stay in place? Can we be assured that, if problems arise with the new contract, these individuals will still be around to clean up the mess?
- Finally, in his long post, Lloyd Russell Moyle, writes that: “It is essential One Medical understand their presence is not welcome and that the community stands behind Wellsbourne.” Chris Ward has explicitly called for them to withdraw. Would even the most hard-nosed corporation really want to take this contract on in the face of such community resistance?
Getting on with what you’re best at
Enough for now. We’ll know the decision soon.
We’ll know whether the Wellsbourne team (of course not perfect but, in the current funding crisis, admirably engaged and getting results) will be allowed to continue. We’ll know whether it will be allowed to pick itself up from this confusion and get on with what its best at.
We’ll know whether it will be given a chance to grow, adapt and continue to improve patient care, or whether the baby will be hurled out of the top floor window with the bath water, so generating a further groundswell of opposition and acrimony, with all the associated extra costs.
Surely this can’t be the way to run the health service?
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