The unresolved saga of Care UK’s Walk In Health Centres in Park Ward, Halifax and Todmorden seems like another example of the mess that happens when the government tries to privatise the NHS.

I have put in a Freedom of Information request to West Yorkshire Commissioning Support Services, to find out what’s going on.

Why have we got these privatised GP Centres anyway?

Basically because the New Labour government’s “Practice Plus” initiative required all Primary Care Trusts to open one so-called Darzi Centre, or GP-led health centre.

“Practice Plus” was part of the New Labour government’s “Our NHS Our Future” review – described by Colin Leys and Stewart Palmer in The Plot Against the NHS, as a reconfiguration of the NHS that aimed to create a privatised healthcare market.

Driven by this requirement, NHS Calderdale awarded the contract for the 2 GP Walk In health centres in Halifax and Todmorden to Care UK, a private health care provider and tax evader. The two GP-Led Health Centres opened in April 2009.

Lord Darzi, a professor of surgery, was brought into the Department of Health by the Brown government in order to advise on “ big investment opportunities opening up in primary health care” (Leys & Player).

He recommended taking key aspects of secondary care – eg diagnostics, day surgery and management of chronic illnesses – out of NHS hospitals into new GP-led health centres which could be run by for-profit providers, under a new kind of primary care contract – the ‘Alternative Provider Medical Services’ (APMS) contract.

Hence the term Darzi Centres.

“What was really in prospect was corporate control of both primary care and a large part of existing NHS secondary care…” Leys and Player(p 45)

The APMS contract offered a significant opening for the private sector to get into primary care. Private companies like Care UK, winner of the contract for the Park Ward and Tod Walk In Health Centres, were awarded 40% of the first wave of Darzi Centre contracts.

These contracts also opened the door for private primary care providers to become involved in commissioning healthcare.  Leys and Player (p78) quote one private primary care provider, The Practice, as saying that GPs who don’t want to be involved in commissioning health care through the new Clinical Commissioning Groups “are asking us to do it on their behalf.”

High costs compared to ordinary GP practices

The first phase of the new centres, which included those in Tod and Park Ward Halifax, were extremely expensive compared to ordinary GP practices. Leys and Palmer (p48) report that on average, the Darzi Centres received three times more payment per patient from Primary Care Trusts (PCTs) than ordinary GP practices.

“PCTs found that they were paying up to £300,000 a year in running costs for some centres which had hardly any patients.”

An investigation in July 2011 showed that  one in four Darzi Centres had registered fewer than 500 patients. A Southampton GP, Dr John Glasspool, found via a Freedom of Information request that a Southampton Darzi Centre had registered just 1,220 patients, despite receiving £907,000 in 2011/2. It meant the centre received around £743 per patient per year – more than seven times the average funding for a GP practice.

It is not public knowledge what the cost is per patient for the Care UK Halifax and Todmorden GP-led Health Centres under the 2009 contract, or how this compares with per-patient payments for ordinary GP practices. This is part of my FOI request.

2011 – Care UK decided to end contract early 

Leys and Palmer write (p47)

“The centres may have helped to make corporate provision of primary care seem more normal, and to prepare the way for shifting specialist care out of NHS hospitals into whatever facilities the private sector might eventually decide to set up. But their own career proved short-lived…in February 2011, the Department of Health indicated that the whole project would be, in effect, wound up.”

In March 2011, the NHS Calderdale Board was informed that  Care UK and Calderdale NHS had agreed that they would mutually terminate the contract at the end of January 2012. Various interim arrangements accompanied the agreement to end the contract, mostly about reducing opening hours and capping the number of walk in patients.

NHS Calderdale was not alone in the early termination of its Darzi Centre contracts. In October 2011, Pulse reported that Darzi Centres throughout the country were closing, and many Primary Care Trusts were paying out compensation for ending contracts early. The Pulse article quotes NHS Calderdale as saying that,

“it was re-procuring its Darzi centre contract after ‘mutual agreement to terminate’ with private provider Care UK. A PCT spokeswoman said: ‘We have re-negotiated the contract to reduce the hours of the walk-in service only and this was in response to low demand at certain times of the day.’ ”

It is not public knowledge whether NHS Calderdale had to compensate Care UK for ending its contract early – or what the financial consequences are of the subsequent agreement to extend the contract until October 2013 (see below).These questions are part of my FOI request.

2011 – NHS Calderdale decided to re-procure contract for the2  walk in health centres

In July 2011 NHS Calderdale advertised a re-procurement contract for GP services at the Park and Calder Community Practices, with no provision for Walk In services. As far as I can tell from the Supply 2 Health website, the advertised re- procurement contract was Calderdale PCT Equitable Access to Primary Medical Care, Reference number 5J6/11/0003. This contract was advertised for a likely term of 5 years, with an option to extend, and the likely value of the contract was between £4.5m-£5.6m. The start date for the contract was January 2012.

In October 2012 the  NHS Calderdale, Kirklees and Wakefield District Cluster Procurement Committee agreed to

“ approve the recommendation of the preferred bidder to deliver NHS Calderdale’s Equitable Access Phase 1 re-procurement scheme; and approve the recommendation of reserve Preferred Bidder to deliver NHS Calderdale’s Equitable Access Phase 1 re-procurement scheme should it prove not possible to reach contract close with the preferred bidder.”

The Procurement Committee minutes don’t name the preferred bidder, but they do state that the contract was worth £4.92m. I don’t know how this compares to the cost of an ordinary GP practice for a similar number of patients. This, and the name of the provider that won the contract, are part of my FOI request.

The re-procured contract was apparently due to start in 2012, but it had not been implemented in January 2013, when Care UK’s Park Ward Halifax and Tod health centres were due to close following the agreement to end Care UK’s contract early. However,  Calderdale Councillors for the Park and Todmorden wards opposed the closures and they have stayed open, under an extension to the original Care UK contract.

Debbie Graham (Head of Service Improvement, Calderdale Clinical Commissioning Group) emailed me that responsibility for managing the Care UK contract for the Park Ward & Tod walk in centres passed to the NHS West Yorkshire Area Team on 1 April 2013, and she “believes” that the walk in centres

“are still provided by Care UK for an extended period until 30 September 2013.  They are providing walk-in on the same basis as the pre-extended contract on both sites.”

Start for re- procured contract postponed to May 2014

The next plan was that the re-procured contract would start on 1 October 2013,  replacing Care UK services at Horne Street (in Park Ward, Halifax) and Todmorden.

But in a 21 July 2013 email, Debbie Graham explained that plans have changed, and that “a new model will be mobilised” for the two walk in centres in May 2014. This delay is because,

“Calderdale CCG has commissioned the West and South Yorkshire and Bassetlaw Commissioning Support Unit to help establish its longer-term model for unscheduled care.  This work has taken the form of an in-depth look at the evidence base and economic case for community/primary care based care provision, and includes a good deal of public engagement to determine the future model.

The programme for this work means that we would not have a new model in place before May 2014.  This would mean a gap in current walk-in centre provision, between October 2013 (when the current contract ends) and May 2014 (when the new model will be mobilised)

Therefore our aim is to commission an ‘interim’ service to cover weekends and Bank Holidays during this period.  As well as providing a service which is important locally, the interim service will also provide an opportunity for learning which can inform the new longer term service model.  The costs of the interim service would be determined by the procurement process which is just about to start.”

Debbie Graham’s email also states that the Horne Street (Park Ward) site

“will belong to to the new provider from 1 October, and therefore the CCG is unable to confirm whether negotiations with the provider regarding the site might be possible.  However, the CCG is committed to commissioning a Walk-in Centre in both parts of Calderdale (Park Ward and Tordmorden) during the interim period.”

Why does Calderdale want these privatised health centres, now that central government no longer requires us to have them?

Why do these centres need to continue, given Ms Graham’s negative assessment of their value to Calderdale Council’s Adults, Health and Social Care Scrutiny Panel? She stated that the walk-in services in Park and Todmorden wards

“had had no discernible impact on the number of attendances at Accident and Emergency. It had also been hoped that the walk-in service would provide primary care to people who are not registered with a GP, but in fact hardly any attendances at the walk-in services are from people who do not have a GP. She said that there is no evidence that the walk-in services had improved health outcomes.”

In general, I’m totally opposed to cutting health care. But these Darzi Centres seem like Trojan Horses for privatisation, rather than rationally planned solutions to people’s health needs. So why not let the Centres die a death, and use the £4.92m of the re-procured contract for something better?

Like improving A&E and existing GP practices.

Which begs the question of why the West and South Yorkshire and Bassetlaw Commissioning Support Unit is only looking at unscheduled care in terms of community/primary care provision – and not looking at ways of improving A&E.

Unscheduled primary care – a way in to primary care for private companies

Unscheduled primary care has been an increasing problem since the GP contract that came into effect in 2004. This new GP contract was a strategic move on the part of the New Labour government, eager to marketise the NHS.

Leys & Player report that on the surface, the new GP contract seemed to give GPs everything they wanted – a massive pay rise, and the possibility of opting out of out-of- hours cover – from 6.30pm to 8.30am on weekdays plus all day and night at weekends and public holidays. Most GPs took the opt-out.

A National Audit Office report, cited by Leys and Player, shows that

“the Department of Health had fully anticipated that 90 per cent of GPs would opt out of providing out-of-hours care.”

The extent of GP’s abandonment out-of-hours care provision “undermined the legitimacy GPs had previously enjoyed as the sole providers of primary care.” Leys and Player (p34)

It also meant that

“out-of-hours provision was seen as useful entry-point into primary care for private companies…Companies such as Serco and Take Care Now were quick to take the chance.” (Leys & Player)

Time will tell whether the West and South Yorkshire and Bassetlaw Commissioning Support Unit recommend further privatisation of primary care, when they produce their longer term model for providing unscheduled care.