The recent take-over of 34 GP practices in London by a US health insurance conglomerate offers a stark reminder of why we need a Social Guarantee. According to the principles underpinning the Guarantee, all providers of essential services must subscribe to public interest obligations that favour collaboration over competition and reinvestment over profit extraction. Operose Health, which took over the London practices and already provides primary health services for around 500,000 patients in the UK, is a subsidiary of Centene, a multinational corporation which competes in the global marketplace to earn profits for its shareholders.
Operose took-over the practices from AT Medics, a company set up by 6 NHS GPs in 2004. Most GP practices in the UK are independently owned but fully integrated into the NHS. But as this latest takeover shows, creeping privatisation has allowed foreign companies to buy up segments of the NHS and run them for profit. Many deplore this shift, and its effects on health services.
GP surgeries have not traditionally been commercial organisations. The vast majority are part of the NHS family, work to NHS contracts and within budgets fixed by the NHS to provide staff and services. Traditional GP surgeries do not have shareholders to whom they are obliged to pay an annual dividend, unlike commercial companies such as Centene. A major concern focuses on the possibilities of such companies reducing costs in order to maximise profits. This could impact adversely on the services offered to patients, for example through shorter consultations and down-skilling of staff.
Another concern is about achieving effective due diligence about the performance of non UK companies. Centene has a poor financial reputation in its own domestic market and has numerous claims out against it. The takeover has attracted criticism on account of this problem, as well as lack of transparency in the process, and poor public consultation and engagement. The takeover happened without any public debate and the GPs’ patients had no say in the matter.
Some doctors have been warning for years that US healthcare firms are circling to swoop on the NHS. Their fears have been dismissed by politicians and senior NHS managers who claim that the NHS is not being privatised. Dr Jackie Applebee, chair of Doctors in Unite, the UK trade union, points out that the arrival of Centene on the GP landscape ‘reveals yet again, that this is a lie. In reality the NHS is being parcelled up and sold off under the radar.’
The Social Guarantee supports a range of models of service ownership and control. But it insists that all providers follow the same principles - defining values that protect the public’s interest in high-quality services for all according to need not ability to pay. These support not only collaboration and reinvestment of surplus revenue, but also ‘meaningful participation in planning and delivering services by residents and service users’ and ‘fair pay, secure conditions and high-quality training and career development’ for service workers.
They also stipulate that services be sustainable and promote ‘sufficiency within planetary boundaries’. The concept of sufficiency has no place in the logic of global capitalism. No wonder that the per capita carbon footprint of healthcare in the United States is two and a half times greater than in the UK and three and half times greater than in several European countries.
Health services in the UK should be provided either by the NHS or by not-for-profit UK companies. Treating health services simply as commercial products is inconsistent with high quality patient care and is ethically unacceptable.
Dr Isky Gordon retired consultant at Great Ormand Street Hospital NHS Trust and a Social Guarantee Taskforce Member.