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IN an alarming twist in the spiral of NHS privatisation, 49 GP surgeries serving 375,000 patients in 18 London boroughs are being taken over by Centene, a giant health insurance corporation which stands accused in the US courts of failing to provide adequate health provision, underpaying medical staff and conspiring to fleece taxpayers out of millions of dollars.
The GP practices affected include the St Ann’s Road Surgery, which is in the ward I represent on Haringey Council.
The ownership and control of GP practices by large private-sector companies is not new. Although it has been continued and entrenched by subsequent Tory administrations, it was the Blair and Brown Labour government, eager to expand the role of the market in healthcare, which opened up the NHS general practice sector to the profit motive and commercial operations in 2004.
This involved the introduction of APMS (Alternative Provider of Medical Services) contracts, which allowed commercial firms to tender to operate publicly funded primary healthcare provision and to employ GPs on salaries. Thus the companies could acquire chains of GP practices and seek to run them at a profit.
Taking immediate advantage of the opportunities created by the New Labour legislation, the London-based company AT Medics was founded in February 2004 and has since grown to become the biggest commercial operator of GP surgeries in England (neither Scotland nor Wales have implemented APMS contracting).
By 2017 the firm was expanding rapidly, acquiring the contract to run the St Ann’s Road Surgery, along with many others. In 2020, AT Medics was employing over 800 staff and made an annual profit of £7 million.
It is this company that has now been bought by the US-based firm Centene, via its British subsidiary Operose.
Through Operose, Centene already owned 21 GP practices in England. Following the takeover of AT Medics, Centene will be now be profiting from provision to over half a million general practice patients.
Operose also draws income from 12 other NHS contracts for ophthalmology, dermatology and cataracts services, in parts of London including Haringey and in several counties. In addition, Centene has a £41 million stake in the Babylon GP at Hand app-based London GP service, which is part-owned by Saudi Arabia’s sovereign wealth fund.
What are the implications for patients and the NHS? A look at the operations of Centene in its home country gives us cause for concern.
The company focuses on channelling the element of public funding in the US for healthcare, via the Medicaid and Medicare systems, to providers for the very poor and for people over 65 who are entitled to receive that care; and, in recent years, giving coverage to those who have access to health insurance under the Affordable Care Act (Obamacare).
Within this system, Centene enhances its income by minimising the health treatment that patients are able to access and maximising charges to the public authorities.
This model is successful. Centene made profits of $2.8 billion (£2bn) in 2020. Annual remuneration to its CEO Michael F Neidorff was $26.4 million (£19.1m) in 2019 (the latest figure available).
In some cases it has been uncovered that Centene’s practices have gone beyond the limits of legality.
Coordinated Care, one of Centene’s web of subsidiary companies, was fined £1.5 million in 2017 by the Washington State Insurance Commissioner for failing to provide an adequate network of health providers — resulting in policyholders being unable to access treatment or being faced with surprise medical bills.
Further lawsuits on similar grounds have been instigated against Ambetter, another subsidiary of Centene’s.
An additional major legal action against Centene was won in August 2020. Accused of extortive, punitive and collusive pricing behaviour, the main company along with Ambetter and Novasys (yet another subsidiary), were found by a jury trial in the federal court in Arkansas to have been deliberately underpaying emergency room doctors.
The firms were liable for $9.4m (£6.8m) in underpayments to front-line emergency physicians.
The most recent expose of Centene’s US business practices took place on March 11 this year, when the state of Ohio filed a lawsuit against Centene for, to quote the attorney general’s press release, “An elaborate scheme to maximise company profits at the expense of the Ohio Department of Medicaid” by means of using its web of subsidiary firms and subcontractors to misrepresent pharmacy costs.
Accusing Centene of running a “conspiracy to obtain Medicaid payments through deceptive means,” Ohio Attorney General Dave Yost said: “Corporate greed has led Centene and its wholly owned subsidiaries to fleece taxpayers out of millions,” adding that “Centene’s actions are deeply concerning and have a direct effect on the most vulnerable Ohioans.”
Meanwhile in London, resistance to the Centene takeover deal has been gathering pace. A crucial role has been played by my local councillor colleague Sarah James, Haringey cabinet member for adults and health.
Cllr James helped to expose this deal, challenging the lack of transparency in the endorsement by the North Central London Clinical Commissioning Group of the NHS of the transfer of primary care services in its area to Centene and she has co-ordinated the five local authorities in the area (Haringey, Barnet, Enfield, Islington and Camden) to oppose it.
Campaigning work, initiated by Doctors in Unite, Keep Our NHS Public and We Own It (whose petition against the takeover now has approximately 50,000 signatures), has started to involve a wide range of people in the boroughs directly affected to pressure Matt Hancock to use his powers to block the transfer of GP surgeries to Centene.
Even Keir Starmer has added his voice in opposition to the Centene takeover — despite that the anti-socialist wing of the Labour Party which he represents being the origin for the creeping commercialisation of primary care.
This is proof of the resilience of the change in public understanding, made under Jeremy Corbyn’s Labour leadership, of the need to roll back privatisation in the NHS. On Friday March 19 dozens of local people took part in a socially distanced protest against Centene outside the St Ann’s Road Surgery in Tottenham.
St Ann’s is an ethnically diverse area with low average incomes and many residents are badly impacted by the health effects of inequality. People in my ward need reliable, high-quality primary care, not a commercial service run for profit — and in that, they are far from being alone.
Noah Tucker is a Labour councillor for St Ann’s ward, Haringey.
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