This site is intended for health professionals only

At the heart of general practice since 1960

Dr Neil Goulbourne: ‘We want to provide care for as many patients as possible’

Virgin Care has reinvented its approach to general practice, underpinning a low-key roll-out of services with a forward-thinking business model. Could it offer a blueprint for GPs’ future, asks Steve Nowottny

Here’s something you may not know about Virgin Care: the GP heading up its sortie into general practice is a card-carrying socialist.

Until recently Dr Neil Goulbourne was vice-chair of the Socialist Health Association and he remains a member, an affiliation that might seem somewhat intriguing given his day job as head of corporate development and innovation at one of the largest private providers of NHS care.

Not so, he insists, as we meet at Virgin Care’s HQ in central London, directly adjacent to and in-no-way-symbolically looming over BMA House. ‘I’ve never had a concern about who’s providing care, certainly not about if they are for-profit or part of the existing NHS,’ Dr Goulbourne says. ‘The important thing from my point of view is the quality and cost-effectiveness of care.’

The political views of its lead GP are not the only way in which Virgin Care is defying expectations. After an explosive entry into primary care six years ago failed to translate into gains on the ground, the company has regrouped and adopted a softly-softly approach that is seeing it make steady inroads into the market.

It is doing so using a model that, while once associated with the ultra-competitive private sector, now seems increasingly relevant to traditional GMS and PMS practices. Sharing back-office functions, offering online access and providing extended hours is now standard policy at many practices, while GPs will shortly be thrust into the NHS market when they are forced to compete for enhanced services and grapple with relaxed practice boundaries.

Even an all-salaried GP workforce looks less controversial in light of the recent debate over the sustainability of independent contractor status. Whisper it, but could Virgin offer a blueprint for GPs’ future?

Evolution

Some 3,000 GPs attended the company’s roadshows in 2008, as it touted the profit-sharing potential for practices that joined the Virgin network. But the model never caught on. Instead Virgin Care reinvented itself in 2010 with the acquisition of Assura Medical, which ran joint ventures across the country with groups of GPs providing services over and above core general practice.

Since then, the company has evolved further, ditching the joint ventures to avoid possible conflicts of interest and focus on bidding for larger contracts. Now it runs almost 300 NHS services, with more than 5,500 staff, and treats 2.5 million patients a year – mostly in intermediate care and community services.

As part of that, it operates 32 primary care services, including 23 GP practices operating on APMS contracts.

‘There’s a whole range,’ says Dr Goulbourne, who trained as a GP in Cambridge and London, joined Assura in 2009 and then became Virgin’s first national head of primary care before moving to his current role.

‘We run services for asylum seekers and also for homeless people. We have some new practices in city centres, where you get a particular type of patient demographic, and we have some more established practices in very settled areas.

‘The reason most of those contracts are put out to tender is they have challenges associated with them – unstable staffing in terms of GPs, or other operational differences. So we adapt our approach according to the circumstances.’

There is plenty of variation between practices – at a surgery for asylum seekers, for instance,  patients are routinely triaged by nurse practitioners, with GPs offering longer half-hour consultations for those with

A glimpse of the future?

Virgin’s practices are scattered across England but work within regional management structures, with one regional manger covering several sites, and Dr Goulbourne says: ‘There are definitely some economies of scale.’

Extended hours come as standard, with most practices open 12 hours a day and at weekends, a feature that Dr Goulbourne says helps limit A&E attendance and is ‘hugely valuable’ to patients. Online access is also a particular focus, with Virgin testing a new video-conferencing platform and hoping to roll it out early this year.

‘I wouldn’t want to say we’re different from a lot of practices – there are plenty that have forged ahead impressively with these things,’ says Dr Goulbourne. ‘It’s a matter of some of the rest of general practice catching up.’

If Virgin Care does offer a glimpse of general practice’s future, then the way in which it employs its GPs is of particular interest. Former RCGP chair Professor Clare Gerada’s recent call for GPs to give up independent contractor status and embrace a salaried future prompted huge debate, but Dr Goulbourne says Virgin’s 170 GPs see real benefits in the model.

‘There’s a chance as a GP to be “just a sessional doctor” if that’s what you choose. You can see patients when they’re there, but without the administrative and management responsibilities.

‘But you can also take the opportunity to develop an expertise and share it across several sites, or take on a leadership or management role, regionally or nationally as I did. There are lots of opportunities that our scale gives us.’

He won’t discuss how much GPs are paid, other than that it ‘meets the market value’. But he is keen to stress Virgin goes to some lengths to keep its staff happy, citing the example of a surgery he used to work at where GPs were asked what made a difference to their working day.

‘One of the most important things to them was to make sure they had a clean and tidy room that they could easily access with all the kit and that things like parking were sorted out for them. So we systematically went through that service and made sure the GP’s day was as clutter-free and stress-free as possible so that they could focus on seeing patients.’

For many GPs though, the concern will not be joining Virgin, but being in competition with it. Despite Virgin’s deliberately low-key approach, the private sector looks set for a rapid expansion within the NHS market this year, particularly primary care, as enhanced services go out to tender, choice is ramped up and practice boundaries are scrapped.

Dr Goulbourne acknowledges ‘this is an area of concern for GMS and PMS practices’ but won’t be drawn on whether Virgin will bid for LESs, saying only that ‘we have to take each opportunity on its own merits’. He is tight-lipped too on whether Virgin will seek to benefit from the abolition of practice boundaries from October, perhaps by opening the doors of its convenient city-centre surgeries to long-distance commuters.

‘It’s not a decision we have taken and it is something we would have to negotiate,’ he says. ‘We want to provide care for as many patients as possible because we believe we can deliver a good service – but that’s got to form part of a cohesive whole.’

In the meantime, the company seems well placed to continue its under-the-radar expansion, with a number of new bids currently under consideration. Virgin Care mark II certainly won’t shout about its success – but GPs would do well to pay attention.

Readers' comments (7)

  • I wonder how much these virgin APMS practices are paid per patient and how their capitation compares to a standard GMS practice. I suspect the discrepancies will explain why they can function in the "challenging" areas who have to provide wrap around care sometimes for less than £80 per patient per year.

    Unsuitable or offensive? Report this comment

  • How are you being paid to run this article?

    Unsuitable or offensive? Report this comment

  • David Fox - don't be cynical. Perhaps it is time to consider changes to how GP is run. The current system is unsustainable. GPs are increasingly stressed and part of the reason for that is that we are not businessmen at heart. I work in Scotland and unfortunately I can't see Virgin etc venturing into Scottish GP in this way - at least, not until Salmond has been kicked into touch later this year.

    I think there are lots of people who would love the idea of letting really good businessmen haggle with government for contracts, and then paying GPs a salary to do their job. The independent contractor stuff is a millstone around our necks. If the NHS was set up tomorrow do you really think that would be the model we would follow?

    Unsuitable or offensive? Report this comment

  • I agree that backroom function's of virgin will benefit primary care and allow clinicians to concentrate on clinical care.

    If its a system that proves to retain doctors I concede to being a cynic. In truth though the system is better for GPs and protects patients if GPs buy in managerial services rather than vice versa.

    As a gp under 40 I am deeply suspicious of a majority employer of GPs. GPs of the future need to think about this.

    Unsuitable or offensive? Report this comment

  • Dr David Barrett

    Attended one of the company’s roadshows in 2008, it was easy to see they were in it for "the long game".

    No surprises that they have the funds to dynamically adapt to changing market forces. I'm sure the new video-conferencing platform will be wonderful, do away with home visits altogether so that the Virgin Helipad can be used by commuter patients happy to fly in from outside the practice boundaries. Brave New World..

    Unsuitable or offensive? Report this comment

  • Virgin have the scale and resources to make investments that can achieve the best cost and win them bids. Their investments which may be at a significant loss in a single area, can then be replicated nationally at marginal cost and start to win them profits. Independent GP Federations cannot compete with this. They could invest the same locally but would then be unable to replicate nationally. That is why I founded Quality Practice: to enable practices to work together in a national network in which they share ownership and control. I would be interested to know of other ways in which we as GPs could compete with the likes of Virgin?

    Unsuitable or offensive? Report this comment

  • hmm, virgin pay market rates do they? now is that marked rate for a salaried gp? trust me guys, keep independant contractor status. now also if he is so proud of how well and how happy the company is then he should be more open on this. I certainly would be. the reality is that GP's who see patients are merely the foot soldiers! a salaried market means a pay cut for GP's and trust me you will still have to deal with bloods, post, coding etc. i would suggest that people do carry out locums in these surgeries to see how they operate. much could be learnt from this.

    Unsuitable or offensive? Report this comment

Have your say