The bureaucratic side of health care in England is complex. Government takes money from general taxation and gives it to NHS England. NHS England uses some of that money for highly specialised...
Exemplary
The bureaucratic side of health care in England is complex.
Government takes money from general taxation and gives it to NHS England. NHS England uses some of that money for highly specialised services where it makes sense to have a small number of national centres, and gives most of the rest of that money to regional bodies called Integrated Care Boards (which are part of Integrated Care Systems). The ICBs commission health care services for their regions. Services are commissioned through a competitive tender system. Any organisation can apply to provide a healthcare service. The provider organisations are usually NHS organisations (NHS Trusts or NHS Foundation Trusts), but they don't have to be, and commissioners are (I think) legally forbidden from having a preference for NHS provision over private provision. We do have a few private providers of NHS funded services. Some examples might be Cygnet Group who run some mental health hospitals.
The other large group of private provision of NHS services are GPs. Strictly speaking, GPs are independent contractors, set up to deliver almost only NHS services, commissioned solely by the NHS.
If you're a GP you might form a "GP Surgery" with 4 or 5 other doctors. This gives you some economies of scale. For example, you can employ practice nurses and a practice manager. If you're a GP surgery you might want to club together with some other GP surgeries so you can buy a building and call it a health centre, and have say 4 different GP surgery businesses (each providing 4 to 5 GPs) running from the building. You'd be able to have a room for phlebotomists to do all the blood draws.
Centene felt that GPs entered the profession because they wanted to do doctoring, not because they wanted to be small business owners, and that if there was one large organisation doing the business stuff it could take over GP surgeries and get some kind of return on its investment. So they set up Operose Health and bought out a load of GP surgeries.
One of the advantages to me of Operose
(At the moment everyone in England has access to free GP care. GPs can ask for ID, but they must register you even if you can't provide it. Unfortunately, many GPs don't know this. One of the things I was doing before pandemic was to gently remind GPs that they've misunderstood their contracting arrangements and ask them to make changes to their website. When a town has 27 independent GPs this is tricky but achievable. When it has one large provider like Operose it's much easier. I found Operose were always receptive when I spoke to them, and were keen to do the right thing.)
What went wrong?
The twin disposals signal an abandonment of Centene’s UK strategy, which was meant to create a seamless pathway to private healthcare by buying up taxpayer-funded GP services and encouraging doctors to refer patients to its chain of 53 Circle/BMI hospitals in England, those people said.
This was not going to work. If I go to the doctor and they say "have you thought about going private?" I'd say "I've paid my taxes, where's my service?" and then "no, I've got no money". A lot of people making use of GP services are in similar situations. They have a complex interplay of poor health and low finances. Trying to upsell expensive healthcare to poor "customers" is dumb.
It also feels like a massive conflict of interest.
Centene’s purchase of Operose GP surgeries in 2021 faced court challenges by anti-privatisation campaigners. Although their case was not upheld, activists viewed the purchase as a sign of the increasing privatisation of the NHS.
People were concerned about the private ownership of NHS GPs, but GPs have always been independent contractors, they've always owned those businesses. The bad thing that was happening was pushing NHS patients toward private provision: this is clearly unethical. The NHS is very popular, and there are a lot of campaigning groups set up around the NHS. But lots of them appear to know very little about how the NHS actually works. It's a bit frustrating.
Anyway, Centene leaving the UK market is Yet Another Example of private providers having a go at running NHS services but not being able to do it for the NHS money that's offered. At some point government will have to face the fact that we're going to have to raise taxes to pay for all the stuff that we've run into the ground over the past 10 years.
"Yeah, but that's Labour's problem! Look at all the taxes they've foisted on you. VOTE CONSERVATIVE!" Honest to God, the way the entire nation has been run the past 13 years is a travesty. The...
At some point government will have to face the fact that we're going to have to raise taxes to pay for all the stuff that we've run into the ground over the past 10 years.
"Yeah, but that's Labour's problem! Look at all the taxes they've foisted on you. VOTE CONSERVATIVE!"
Honest to God, the way the entire nation has been run the past 13 years is a travesty. The fact that our electorate is so financially / data / numeraically illiterate means they keep falling for the same behaviours time and time again.
The bureaucratic side of health care in England is complex.
Government takes money from general taxation and gives it to NHS England. NHS England uses some of that money for highly specialised services where it makes sense to have a small number of national centres, and gives most of the rest of that money to regional bodies called Integrated Care Boards (which are part of Integrated Care Systems). The ICBs commission health care services for their regions. Services are commissioned through a competitive tender system. Any organisation can apply to provide a healthcare service. The provider organisations are usually NHS organisations (NHS Trusts or NHS Foundation Trusts), but they don't have to be, and commissioners are (I think) legally forbidden from having a preference for NHS provision over private provision. We do have a few private providers of NHS funded services. Some examples might be Cygnet Group who run some mental health hospitals.
The other large group of private provision of NHS services are GPs. Strictly speaking, GPs are independent contractors, set up to deliver almost only NHS services, commissioned solely by the NHS.
If you're a GP you might form a "GP Surgery" with 4 or 5 other doctors. This gives you some economies of scale. For example, you can employ practice nurses and a practice manager. If you're a GP surgery you might want to club together with some other GP surgeries so you can buy a building and call it a health centre, and have say 4 different GP surgery businesses (each providing 4 to 5 GPs) running from the building. You'd be able to have a room for phlebotomists to do all the blood draws.
Centene felt that GPs entered the profession because they wanted to do doctoring, not because they wanted to be small business owners, and that if there was one large organisation doing the business stuff it could take over GP surgeries and get some kind of return on its investment. So they set up Operose Health and bought out a load of GP surgeries.
One of the advantages to me of Operose
(At the moment everyone in England has access to free GP care. GPs can ask for ID, but they must register you even if you can't provide it. Unfortunately, many GPs don't know this. One of the things I was doing before pandemic was to gently remind GPs that they've misunderstood their contracting arrangements and ask them to make changes to their website. When a town has 27 independent GPs this is tricky but achievable. When it has one large provider like Operose it's much easier. I found Operose were always receptive when I spoke to them, and were keen to do the right thing.)What went wrong?
This was not going to work. If I go to the doctor and they say "have you thought about going private?" I'd say "I've paid my taxes, where's my service?" and then "no, I've got no money". A lot of people making use of GP services are in similar situations. They have a complex interplay of poor health and low finances. Trying to upsell expensive healthcare to poor "customers" is dumb.
It also feels like a massive conflict of interest.
The court case was mostly dumb. Here's the ruling: https://www.bailii.org/ew/cases/EWHC/Admin/2022/384.html
People were concerned about the private ownership of NHS GPs, but GPs have always been independent contractors, they've always owned those businesses. The bad thing that was happening was pushing NHS patients toward private provision: this is clearly unethical. The NHS is very popular, and there are a lot of campaigning groups set up around the NHS. But lots of them appear to know very little about how the NHS actually works. It's a bit frustrating.
Anyway, Centene leaving the UK market is Yet Another Example of private providers having a go at running NHS services but not being able to do it for the NHS money that's offered. At some point government will have to face the fact that we're going to have to raise taxes to pay for all the stuff that we've run into the ground over the past 10 years.
"Yeah, but that's Labour's problem! Look at all the taxes they've foisted on you. VOTE CONSERVATIVE!"
Honest to God, the way the entire nation has been run the past 13 years is a travesty. The fact that our electorate is so financially / data / numeraically illiterate means they keep falling for the same behaviours time and time again.
Link without paywall: https://www.msn.com/en-gb/money/other/centene-to-sell-gp-clinics-and-hospitals-in-uk-market-exit-ft/ar-AA1fYgw3
And here is an archive link to the Financial Times story posted.