Sussex Bylines has written at length about Wellsbourne Healthcare in Whitehawk and how, over seven years, it has become something rare in modern primary care: a locally-rooted GP surgery operating as a Community Interest Company widely admired for its commitment to social value, prevention and community engagement. The story now is how it has found itself at the centre of a test case around the vagaries of NHS commissioning, one that generated both significant controversy and a successful local campaign.
Early last year, and despite the surgery delivering the service well, NHS Sussex put the contract for GP services in Whitehawk out to tender and awarded it to a Leeds-based corporate provider. Informed sources suggest the Integrated Care Board (ICB) was never obliged to do this.
We have covered the extraordinary local reaction as patients, clinicians, councillors and the local MP rallied quickly and effectively. A petition gathered more than 3,000 signatures in days. Impassioned coverage spread from Sussex Bylines to The Guardian, BBC, Brighton Argus and the medical press.
The decision overturned: a rare U-turn
When, after months of fuss a decision to overturn was finally made, the Independent Patient Choice and Procurement Panel judged NHS Sussex to have breached procurement regulations in four respects, most notably failures of transparency and fairness; and failure to adequately record the process. Given that every tiny parish council meeting in the county is assiduously recorded by an attentive notetaker with a pencil, it surely beggars belief that a meeting to re-assign £20mn of public funding from a popular local body to a distant corporate was not minuted.
At the heart of the anger was a simple question: why would the powers-that-be even want to replace a thriving, community-based, non-profit provider with an external corporate chain?
We still don’t know the answer.
NHS Sussex has made no significant statement but it has now been confirmed by Brighton & Hove City Council that KPMG has been commissioned to do another review of the process. This is expected to report in April, with recommendations to be considered by the Council’s Health Overview & Scrutiny Committee (HOSC) later in the year.
Of course the 12-month extension that was granted when the first review reported is already nearly halfway through and, these things being what they are, it will probably take the entire length of the extension to decide whether there will be another procurement process or whether to continue as is. Impartial observers might be wondering WTF are these costly hot-shot consultants doing?
Where things stand now
Reversals of this kind are exceptionally rare and the campaigners have rightfully been celebrating their success. But, as we see, the story is not over.
And just to muddy the waters further, and entirely coincidentally, of course, the senior leadership landscape has shifted. The CEO of NHS Sussex has moved to a role in Kent as part of wider national restructuring. Just who KPMG is going to talk to, and without even minutes to assist them, has not been divulged.
From within Wellsbourne itself, the mood is one of uncertainty and there is concern that the NHS is more than ever preoccupied with budget cuts and restructuring and that cost saving measures will always be top of the agenda.
A policy contradiction?
The indecision is striking because the government’s own 10-Year Health Plan, Fit for the Future, places heavy emphasis on shifting care from hospital to community, strengthening neighbourhood health centres, and prioritising prevention and continuity.
Brighton & Hove has already pioneered this direction through the Whitehawk health hub model. Wellsbourne has operated in close alignment with this philosophy – de-medicalising aspects of care, building trust, and engaging residents who may otherwise feel alienated from clinical services.
The procurement dispute therefore raises a broader policy tension: if the national strategy intends to champion community-based, preventative, integrated care, why was the contract for a successful locally-embedded social enterprise not extended?
Why the CIC model matters
To grasp this argument better, it is helpful to take a deeper dive into what a Community Interest Company (CIC) is. A CIC is a legally recognised social enterprise with a formal community benefit purpose.
The CIC model explicitly contrasts with a corporate provider, which is set up to maximise shareholder returns. The key points with a CIC practice is that: (i) surpluses stay local, to fund service improvements, preventive programmes and/or workforce development; (ii) decisions are driven by community need, not margin growth.
There is no doubt that these were the issues that resonated strongly during the Wellsbourne campaign last year. The community is not persuaded that a corporate model would deepen community trust or continuity. People don’t like the idea of essential services becoming profit streams.
Is there a bias?
An ongoing issue throughout this whole story is whether the procurement-scoring methodology adequately captures “social value” and continuity of care, the deliverable that the current surgery is best at and which the community clearly values. The appeal panel’s findings suggested shortcomings in how this was assessed, making it apparent that CICs can find themselves undervalued relative to large organisations adept at bid-writing and cost presentation.
And, at the risk of stating the bleeding obvious, it should be no surprise that the commissioning of KPMG – one of the ‘Big Four’ accountancy firms – to review the process has raised a few eyebrows. Firms like KPMG bring technical procurement expertise, but with their roots deep in the corporate world it’s questionable whether they are best placed to assess community health impact or the social value of integrated neighbourhood care.
The months ahead
The key moment ahead will come at the meeting where Brighton & Hove’s HOSC questions NHS Sussex and presumably seeks publication of the KPMG findings. Agendas and minutes will provide crucial signals. If the review concludes with recommendations for improved procurement processes but leaves open the possibility of re-tendering, the future of the existing set up will be in jeopardy once again.
As funding pressures across the NHS intensify, campaigners will need to be alert to commissioners naturally defaulting to simple models that they perceive to be financially safer or administratively straightforward. That’s always how the social value stuff gets lost.
Campaigners have congratulated themselves on the success of their efforts so far but vigilance is now essential. If re-tendering is proposed, it will be necessary to question how social value is weighted and this needs to do be done publicly and clearly.
The initial U-turn showed that public scrutiny can alter outcomes. But it also exposed the underlying dangers ahead. Everyone should be clear that a contract extension is not long-term security. If the aim of health reform truly is the delivery of care closer to home, rooted in trust and prevention, then Wellsbourne’s model is not an outlier – it is a prototype.
Protecting it will require attention, persistence and transparency. The community has already demonstrated its strength once.
It may need to do so again.
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