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?
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.