NHS Unlimited? Who runs our GP services

A study of GP services put out to tender by the NHS

Executive Summary download PDF

A new breed of proft motivated private companies is, largely unseen, winning the majority of the contracts put out to tender to run GP services. Until now many of these companies have been described as GP-led companies. We have found this to be misleading as it suggests that they have a non commercial focus and are managed by GPs, when in fact many of these companies have a proft making intent and a traditional corporate management structure. We found 18 examples of private companies that were started by groups of GPs but are now in the process of business expansion.

A small number of companies have a sizeable portfolio of NHS contracts. There are 9 companies with 10 or more contracts to run GP health centres or surgeries. Chilvers McCrea, described as a GP led company runs 35 surgeries across the country. Care UK and Assura, both public companies have the largest number of contracts to run the large health centres with 11 and 12 each.

Local GP practices are fnding it hard to afford to bid for contracts according to anecdotal evidence, which could lead local GP practices to be squeezed out as the NHS market matures.

Social enterprises are only picking up a small number of GP contracts and have not so far evolved a signifcant market share despite a signifcant push from government.

The instability of the NHS market is becoming clear as those providers not making enough profit, can and do pull out of NHS contracts. Chilvers McCrea have already stepped away from providing a GP service in Southend, as it felt it was fnancially unviable. Public company Assura has told shareholders that they are considering selling off their primary care business (Over 60 NHS contracts) in response to the lack of proft being generated.

To win contracts to run GP-led health centres and surgeries it helps to have experience but it is not essential. Most of the large corporate providers come from a background in residential care and or treatment centres. Including Care UK, Bondcare Medical Services. Nestor Primecare and Atos healthcare. A notable exception is Assura, a property development company with an interest in pharmacies that now runs 12 GP led health centres.

Public scrutiny of these new providers of NHS services is very diffcult. Their business strategies and approach to generating proft does impact upon the quality of the service and yet this information is often not collected by government or not made available by the companies themselves.

The complex structure of ownership makes it diffcult to track who controls the service and where public money is going. For example Harmoni started as a GP cooperative, became a private company is involved with social partnership and has stakes in multiple other companies that have won GP contracts.

Employing fewer GPs and more nurses is one cost cutting strategy of the proft motivated providers. The proportion of nurses is going up sharply and they outnumber GPs in many of the supposedly GP led health centres.


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