Privatization of GP: judicial review awaiting verdict

7:16 p.m. February 3, 2022

The outcome of the judicial review of the takeover of general practitioner practices by a private practice will now be decided in the coming weeks.

The legal battle comes after a takeover by Operose Health Limited (OHL), a UK subsidiary of US giant Centene, was finalized in February 2021.

It was then that ownership of AT Medics Ltd (ATM), which runs 37 GP practices in London, was changed from six GPs to OHL.
The North Central London (NCL) Clinical Commissioning Group (CCG), responsible for eight surgeries involved, was one of 13 CCGs that granted approval.

Anjna Khurana, a patient at one of the affected practices and a labor councilor for the Tollington Ward, is challenging the NCL’s decision in court, saying it was illegal on three grounds: poor management, lack of investigating the financial stability of new businesses and the lack of transparency and public participation.

Cllr Khurana said: “Fundamentally for me as a patient I need to know that I am represented in this process and that my care is paramount.

“If the judge does not decide in my favor, the implication will be enormous. I think it actually brings into question a lot of how these decisions are made, what needs to be considered and what kind of due diligence is there,” she added.

CCG has the statutory power to authorize a change of control (ie ownership) of its sub-contractors. He should do so “unless there is a specific reason that the change of control would have an impact on the performance of the contract, in particular with regard to the patient’s experience”.

Banners outside the court.
– Credit: Stefania Di Cio

Adam Straw QC argued, on behalf of the claimant, that the NCL arbitrarily considered limited information obtained through the due diligence process and failed to consider other relevant circumstances.

“It’s problematic because it’s very limited. It says nothing about Centene and the financial problem it finds itself in,” he said.

The allegations are that Centene and its subsidiaries have a long history of fines and Centene had to settle a lawsuit for hundreds of millions of dollars for overcharging US health authorities.

There are also alleged concerns about the financial stability of the OHL.
The claims are dismissed by the defence, saying “appropriate and proportionate” due diligence checks were carried out and assurances were sought from ATM.

It also says Centene “is down six steps from AT Medics,” which would continue to be responsible for providing services. Although they accept Centene, they ultimately control ATM.

Fenella Morris QC, speaking on behalf of the NCL, said ‘no concerns were raised’ following the checks and they ‘had minimal reason to reject’ the change given that it there was no impact on services.

The NCL also failed to engage patients and stakeholders, including health officials from the five interested LAs, especially given the “overwhelming public interest,” according to the plaintiff.

These allegations are also denied by the NCL, saying that “the public was informed in advance of the decision” and given the opportunity to ask questions. They added that lay members, the Healthwatch and the local Board of Health and Welfare were involved as public representation.

Similar concerns were raised by 191 councillors, MPs including Labor leader Keir Starmer, mayors and assembly members.

At an NCL meeting in February 2021, councilors asked to revoke permission, but this was not agreed.

Cllr Khurana added: “What made me furious was that there was a lot of talk about rational decision making but they looked at Centene and they didn’t really factor it into the due diligence.”

A spokesperson for NCL CCG said: “We are committed to providing residents with high quality, safe and accessible care. Our commissioning practices regarding AT Medics have followed the same rules and guidelines that we apply to all of our GP contracts, with decisions informed by legal and national guidelines.

“The GCC is defending its decision and the process and will not comment further while a judicial review is pending.”

ATM operates several practices in Islington, Hackney, Brent, Newham, Tower Hamlets and Redbridge. The dispute concerns the NCL CCG and only concerns Islington.