You may have seen the story recently around a US insurance giant taking over a number of practices in London. This was headlined as ‘NHS GP practice operator with 500,000 patients passes into hands of US health insurer’ in the Guardian, and ’37 NHS GP practices have been sold off to a private US healthcare firm’ in various local papers.
I’ll be honest, these headlines have left me feeling a little uncomfortable. The framing of this is that it represents the continued selling off of the NHS. But I simply can’t agree.
We didn’t run this story at the time. This isn’t because we are government apologists, or are involved in a cover up. The simple truth is that this is an APMS contract that has changed hands between two profit-making companies and this is not a story we would normally cover. There has been no change in the status of these practices: either you count APMS practices as ‘NHS’ – in which case they remain ‘NHS’ – or you say this practice has changed from one private business to another.
(As an aside, I completely reject the idea that all GPs are the private sector anyhow. In no normal business do you have a single contract with one organisation, and you have no say in the negotiation of this contract.)
You might have some concerns with the nature of the new provider. The new owners are actually a UK company, Operose, who are themselves owned by Centene, the US giants. The company running these contracts before was AT Medics, a UK company. But, again, this isn’t how the story is being framed. I haven’t heard any issues around Operose (although I have heard good things about AT Medics). I’ve only heard problems with the ideology around ‘NHS’ practices now being run by a US insurance firm.
You can, of course, ask why a US insurance firm wants to take over a number of APMS contracts and get a foothold in the NHS. And today’s news, that Operose’s chief executive is joining Number 10 as a policy advisor, will fuel these concerns. I understand these concerns.
But there could be a number of reasons why Operose, under Centene’s umbrella, want to run these contracts. My feeling is the most boring explanation: that APMS contracts (which has been a privatised part of the NHS for 17 years now) are fairly lucrative – especially compared with GMS and PMS – and they see this as a safe revenue stream.
Even if I am wrong, I am fairly certain that the idea that Centene are readying themselves for a takeover of more NHS services – through the further selling off of the NHS – ignores all the evidence. Because the NHS is simply not being sold off, at least not in the sense the campaigners argue.
Why do I think this? First, I feel that the riches on offer to provide NHS services are not something that appeals to big companies. Because, despite many reactionary protestations, NHS bodies are incredibly efficient in providing services. What they – and I include GPs in that – provide for a relative pittance is incredible, and there is no way private companies would be able to appease shareholders with the profit margins they can make on that.
I spent my first few years at Pulse trying to prove that the Lansley reforms in 2013 had led to ACME Co taking over vast swathes of the NHS. While there were a few examples at first of private companies winning contracts, this trailed off once it became apparent that NHS organisations provided these much more efficiently. When the private sector did take on contracts – even to deliver administrative services, like Capita – they soon realised that the money involved was nowhere near enough.
And the new White Paper actually waters down the dreaded Section 75 of the 2013 reforms that stated new contracts would need to be put up for tendering process.
Second, while I think that many in the Conservative Party ideologically believe in the supremacy of the private sector, the bigger facet of their ideology is holding on to power. And ‘selling off’ the NHS would be electoral suicide – especially if it involved investing more money to make the NHS ‘sellable’ in the first place.
I have a lot of sympathy for the causes of those saying the NHS is being sold off. But, on this, I would say we should retire this bogeyman. For me, there is a way in which the health sector is being privatised. By starving the NHS of funding throughout the past decade, the Coalition and Conservative Governments have gone some way to creating a two-tier system, where those who can afford to simply jump the increasing waiting lists.
This Government has created a lot of bogeymen – so let’s at least pick the right one.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org.