It came as a thundering shock. Wellsbourne GP practice in Whitehawk, EastBrighton, has just been told it is losing its contract. NHS Sussex, the local integrated care board (ICB), is provisionally handing it over to a distant Leeds-based company whose main business is in owning and managing healthcare properties. This is a story about how parts of the NHS can slip awayto profit-makers, despite the government’s aim to put community first. The company, One Medical Group, won the bid by undercutting on price and proposing to add a walk-in centre. It’s not a lone case: some other ICBs erroneously put good NHS community services out for tender, and feel obliged to take the lowest bid.
To give you a rough portrait, in 2019 Whitehawk was ranked within the top 10% of England’s most deprived areas, and the most deprived in Brighton.According to a doctor from the practice, life expectancy in the area is 10% lower than it is on the other side of the city.The renowned Marmot review on health inequalities and their underlying social causes drew on Whitehawk as a study of deprivation. It’s the type of place that needs exceptionally socially committed GPs.
It’s not, in other words, where you would expect a private company to make money. Indeed, the last private company managing the GP practice quit, leaving services in disarray. The GPs of Wellsbourne now work as part of a not-for-profit community interest company. “We’re here because this is the kind of work we want to do,” said Posy Greany, a doctor at the surgery. Although they would be re-employed by the new company, she tells me they are likely to leave, as “working for a private for-profit provider doesn’t fit with our view of the NHS”. As Greany wrote in a local publication,Sussex Bylines: “It will dismantle a model that is working. It will scatter a team that has fought to earn trust.”
Within days of the news, a petition opposing the handover of the practice gathered more than 2,000 signatures. Wellsbourne is a hive of community activity. It works closely with Whitehawk’s food bank, community sports centre and youth centre. Artists run community projects there and volunteers tend to a community garden with patients. All of these services could now be at risk. The Care Quality Commission rates the practice as “good”, in an area where reaching all of the regulator’s targets is hard.
Here’s the puzzle. Andrew Lansley’s calamitous system that opened theNHSto “any willing provider” to compete for contracts was supposedly swept away in 2022, replaced with ICBs that strove for cooperation across all NHS and social services in England. Yet some ICBs still apply the old competitive impulse to NHS services, even though they now have an obligation to ensure that tenders help to reduce inequalities.
To be fair, the entire NHS is the under the whip toeliminate its £6bn deficit. The government has instructed ICBs to reduce their running costs by50% by October this year; the Sussex ICB has to achievecost reductions of 30%by 2025-26. Some ICBs are fading away. The government has introduced “integrated neighbourhood teams”, but the10-year planexplaining what these do still hasn’t been published. In my decades of reporting, the NHS was always on the verge of, or just recovering from, a major reorganisation. No matter how reasonable these might seem, their true cost is never counted. Re-disorganisations “take far longer than you think, end up costing far more than you anticipate, and leave you with a distracted and demoralised workforce,”writes the King’s Fund policy director, Siva Anandaciva.
Cost-saving in Whitehawk may be just one accidental fallout of the 2022 reorganisation. After all, the surgery’s privatisation goes against the coming plan to shift health into the community and emphasise social prevention. Greany told me that about 60% of her patients have long-term conditions such as diabetes, heart disease and mental health problems. They have specialfocused care practitionersgiving extra social support.
The Sussex ICB told me that national regulations meant it “had to follow an open procurement process, with the ability for all parties with interest in providing services to this community to submit an application”. Otherwise, its spokesperson said, private companies would challenge them in court. But King’s Fund experts told methat there is no obligation for ICBs to tender out existing NHS services – and that they can reject cheaper bids in favour of best “social value”.
The “social value” requirement sent most private operators into retreat. The large US company Operose hassold its GP surgeries,while Babylon hascollapsed. Beccy Baird, a primary care expert at the King’s Fund, told me the number of private companies running NHS GP surgeries has fallen by three-quarters since its peak a decade ago: now just 63 practices are run by private companies, amounting to about 1% of all practices across Britain.
Labour has stressed its willingness to use private services to clear waiting lists, but this is proving costly. Profits are still being made: just before the election, an ICB let out a huge contractworth up to £1.3bnto the private equity group HCRG Care (once Virgin Care), covering all community services across Bath, north-east Somerset, Wiltshire and Swindon. Meanwhile, long waiting lists are driving patients to buy one-off private treatments. According to the Health Foundation, the overall proportion of privately funded elective operations rose from 7.4% in 2019-20 to 8.3% in 2022-23.
Wellsbourne seems to be caught in Lansley’s competition-era time warp. With no experience of writing tenders, its current GPs hadn’t a hope against companies that have entire teams of people who specialise in tender-writing. The GPs have appealed, and the ICB could still change its mind. If not, they could appeal to Whitehall. Their local MP, Chris Ward, is defending them vigorously. “I’m strongly opposed to a for-profit provider replacing a local community one,” he told me. “This is a matter of principal, it’s what theLabourparty stands for.”
If this reaches Wes Streeting’s desk, surely he would reverse a decision that flies in the face of his own community policies. Setting that public example would halt other misguided ICBs wrongly still tendering out community services to private companies, and quietly privatising parts of our NHS.
Polly Toynbee is a Guardian columnist