Without ever mentioning the private health care companies by name, a recommendation to extend Calderdale’s Virgin Care and Locala GP contracts without putting them out to tender was agreed pretty much as a formality at the first meeting of Calderdale’s Commissioning Primary Medical Services Committee.

The Virgin Care GP contract was the main topic of discussion, since it runs out this September. The extension will take it up to April 2017.

The possibility of not extending the Virgin Care contract was only mentioned once and then dismissed immediately, on the grounds that this risked causing the company to walk away, and patients would have to find other GPs.

But no one could answer questions about the Virgin Care GP practice’s quality and value for money.

The Virgin Care Meadowdale GP practice has health centres in Elland, Sowerby Bridge
and Ovenden, but only employs one permanent fulltime GP. It has had problems keeping staff over the last 12-18 months, but in addition to the GP it has an Advanced Nurse Practitioner, a Practice Nurse and part-time clinical staff.

Calderdale Clinical Commissioning Group’s Chief Officer Dr Matt Walsh acknowledged that the contract management had been such that there was no information that could provide answers to questions about the Virgin Care GP practice’s quality and value for money.

The Committee Chair John Mallalieu wondered if the contract is worth it, since the Virgin Care GP practice only provides a service to just over 1% of the population.

Dr Brooks, the Chair of Calderdale CCG Governing Body, pointed out that the contract was targeted at a list of 6K patients, but there are only 2K patients registered with the Virgin Care Meadowdale GP Practice.

Katherine Hilliam, an NHS England employee, said,

“There was an income guarantee in the contract for a period of years, but that doesn’t extend into the extension period. You can reset it at the price that it should be for the number of patients.”

Dr Caroline Taylor questioned whether it was a good use of public money to spend it on this contract.

But Calderdale CCG Finance Officer Julie Lawreniuk warned,

“We need to make sure we don’t have a contract management conversation here.”

The Committee agreed to extend the £780,000/year Virgin Care contract to April 2017, and to support the work of Calderdale Clinical Commissioning Group officers in assuring the quality of the Virgin Care GP services and managing the contract, which had barely happened over the last two years.

The Locala contract extension takes the contract for Locala’s Community GP centres in Todmorden and Park Ward Halifax up to 2020.

Debbie Robinson, Calderdale CCG’s Head of Primary Care Quality and Improvement, presented a Report containing the recommendation to extend the contract. The Report admitted that Calderdale Clinical Commissioning Group has:

“ capacity and quality issues in relation to commissioning and contract management of primary medical care.”

And Committee member Dr Caroline Taylor told the meeting,

“This report raises so many questions and we don’t know the answers to any of them.”

Calderdale Clinical Commissioning Group Chief Officer Dr Matt Walsh replied,

“Can we find the data that will answer these questions? The contract management process is unclear. It will need more contract management and this may need to be quarterly.”

But NHS England employee Katherine Hilliam told the meeting that, in terms of the company providing a service that the CCG is unsure of, the Meadowdale practice was not an outlier in NHS performance data.

NHS England was responsible for Calderdale’s GP contracts – including the privatised Virgin Care and Locala contracts – until April 1 this year, when control of commissioning GP services transferred to Calderdale Clinical Commissioning Group.

Kate Smythe, a lay member, asked if the patients would notice any decision that was made in the committee.

Ms Robinson replied,

“Only if we change anything.”

Dr Walsh said,

“Patients would notice if we did decide to end the contract and that’s a risk.”

Ms Robinson added,

“If the provider walks away, patients will have to find an alternative GP.”

Dr Brooks said he had to belatedly declare an interest, as a GP in an area that abuts on the Meadowdale practice. He suggested that:

“Dispersing 2K patients now is less of an issue that dispersing 4-6k later.”

Committee Chair John Mallalieu advised being realistic about how much increase in patient numbers will be achieved in the next 18 months of the contract extension.

Dr Walsh said the order of events was that they needed quality assurances about the Meadowdale GP practice, and then a contract management procedure in place. He said,

“Then we can test the market for the practice.”

Dr Caroline Taylor asked

“So should we tell them to stop marketing their practice?”

Dr Walsh quipped,

“Whatever they’re doing isn’t working.

But we may need to have a conversation with the provider. We want to know more, to inform what happens at the end of the extension.”

Why are private companies providing GP services?

The VirginCare and Locala GP contracts are time-limited Alternative Provider of Medical Services (APMS) contracts – unlike the traditional General Medical Services (GMS) GP contracts, which last until the GP retires or leaves. This means that in APMS GP centres, continuity of care is at risk and companies can walk away from contracts if they aren’t profitable enough.

APMS contracts were introduced by the New Labour government as a way of opening primary care to private health care companies, and NHS England is pushing for them to become the default option for GP practices.

A recent study published in the Journal of the Royal Society of Medicine found that APMS practices provided worse quality care than practices on GMS or  PMS [Personal Medical Services] contracts, even when demographic differences such as age and deprivation were taken into account.

Dr Robert Morley, who Chairs the British Medical Association General Practitioners Committee’s contracts and regulations subcommittee said the results were ‘no surprise whatsoever’.

He added:

‘So the whole thing has been an unmitigated disaster. And yet we still have NHS England with a default position that if a practice closes or a contract is terminated, this has got to go out to APMS procurement because they’re frightened of any sort of challenge over the competition regulations.’

Virgin Care – hiding behind the NHS logo

Information about Virgin Care- provided NHS services in other parts of the country is available on the NHS for sale website

The NHS has sold off over 230 services to Virgin Care.  But since 2013 Virgin Care has also lost contracts and has had to close walk-in centres in Basingstoke and Bath.

The company is controlled by Richard Branson and his family through a complicated network of companies in the UK and elsewhere including in tax havens.

Tax justice accountant Richard Murphy reports that the company structure – with thirteen holding companies, some of them offshore, between Virgin Care and the parent company in the British Virgin Islands tax haven – makes it unlikely that Virgin Care will pay any tax in the UK in the foreseeable future.

Updated 27 June with background info about APMS contracts