Sticky times for NHS privatisers

By Councillor Anjna Khurana and Prof Sue Richards

Introduction

Those of us who campaign to keep the NHS public sometimes wonder when the public is going to wake up to the threats of privatisation. A compliant BBC consistently takes the government line on this – that there is nothing to see here. But every now and again an issue crops up which restores our belief that the public will fight to save the NHS. One example is the takeover of 44 primary care contracts in London by Centene Corporation, the massive American health insurance company, earlier this year.

The story is one which shows central government, through NHS England, shaping what are supposedly local commissioning decisions, how local commissioning bodies with statutory responsibilities to their local populations ignore those in order to follow orders from above, and the way in which privatisation is deeply embedded in how the NHS functions. It also shows the bravery of individuals who resist and the diligence of campaigners who support them.

Background

GP practices were not incorporated into the NHS when it was set up in 1948, but worked as an integral part of it, usually as small companies run through partnership governance. Those great ‘reformers’ of the NHS, Tony Blair and Alan Milburn, changed the structure of GP contracts to allow for fully blown private sector provision of these services through the creation of Alternative Personal Medical Services (APMS) contracts. One small company, A T Medics, began to compete for and win APMS contracts.

They seemed harmless enough, the directors being six GPs who trained together at St George’s Medical School, but in 2019 they changed their structure to a limited company and then in 2021 they sold the company – reputedly for the sum of £140m to a UK subsidiary of Centene Corporation. A T Medics’ only real assets were their APMS contracts, so Centene was buying its way into a dominant position in primary care and is now the biggest single provider of primary care in England.

It was not completely plain sailing. The commissioners of those contracts had to be satisfied there would be no change in the quality of service to patients. And, lo and behold, they were satisfied – after totally inadequate due diligence, a completely secret consideration by the Primary Care Commissioning Committee which excluded the community members of their own committee, and a lot of pressure from up above.

The UK subsidiary of Centene, Operose, lost one of its directors early in 2021. Samantha Jones moved instead to be the Prime Minister’s adviser on health and social care, based in No 10.

Judicial Review

That is when things started to get sticky for NHS privatisers. One of the affected practices was Hanley Road in Islington, where Anjna Khurana, a councillor in Islington’s Tollington ward, was a patient. The local Keep Our NHS Public group made contact and with a wider group of campaigners convened by east London GP Dr Jackie Applebee, chair of Doctors in Unite, began a campaign to stop the Centene takeover.

North Central London Clinical Commissioning Group was responsible for Khurana’s practice and with the help of Anna Dews, of Leigh Day Solicitors we prepared a case for judicial review. When the Centene takeover news broke in the local press there was a huge outcry and this led to questions in Parliament and the issue being picked up by the national press.

We have now raised the £70k needed to pay the costs of the case if we lose. It has been easy. There is a lot of wealth among our local population and huge opposition to the takeover. If we need to convince people, all we have to say is: look Centene up on Google (another giant American corporate) and see the litany of fines and contract cancellations incurred by Centene, who specialise in the publicly funded healthcare provided in the US for poor people.

Anjna Khurana says: “It is so heartening to know I am not alone in my fear about what is happening to my GP practice and to so many across the country. So many people have pledged their support and donated to the crowd-funder set up to pursue this case. We all know how fortunate we are to have an NHS that is there whenever we need it, takes care of us from birth and looks after us regardless of what happens.

“When I read about the changes affecting my GP surgery, I was very surprised that I hadn’t been advised or consulted as a patient. As time went on and I learnt more – I became aware that the decision was ‘taken behind closed doors’.

“I felt vindicated when the judge agreed with our three grounds for appeal for the case to be heard – the flawed process in how the decision was taken, the worrying lack of ‘due diligence’ conducted and the lack of involvement or consultation.”

The full hearing in the High Court is likely to be early in the New Year and we are ready.

Councillor Anjna Khurana is a patient at Hanley Road practice. She has been living in north London for the past 25 years. She is currently a councillor for Tollington ward in the London Borough of Islington, and a trustee of the Hanley Crouch Community Association. She was diagnosed with Multiple Sclerosis in 2006.

Prof Sue Richards is a member of Islington Keep Our NHS Public. She was formerly a professor in the School of Public Policy at the University of Birmingham. She is national co-secretary of Keep Our NHS Public and a member of Islington Keep our NHS Public, one of 70 local branches. www.keepournhspublic.com

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