Humana pulls out of UK as another private provider admits reforms are no “gold rush”

BMJ 2011; 342 doi: (Published 24 January 2011) Cite this as: BMJ 2011;342:d490
  1. Nick Timmins
  1. 1Financial Times

Humana, the giant US health insurer, is pulling out of the United Kingdom, unconvinced that Andrew Lansley’s plans to hand over the commissioning of perhaps £70bn (€82bn; $112bn) of NHS care to GPs in England will necessarily open up a lucrative market in commissioning support.

Humana’s decision comes as other potential providers of the wide range of skills needed—from data analysis to negotiating and procurement skills—also seem to be making cautious assessments of the opportunities that the market will yield, at least in the short term. These companies include Bupa, Tribal, and the US owned Aetna and UnitedHealth.

The coalition government’s plans, set out in full in the longest NHS bill in history on 19 January (BMJ 2011;342:d418, doi:10.1136/bmj.d418), have seen health sector unions, including the British Medical Association, voice fears over large scale involvement of private firms in commissioning or even a takeover of it.

Humana made a major investment in the UK in 2006, offering new ways to improve care of patients with long term conditions and support for primary care trusts in the commissioning of NHS care.

That came as the Labour government opened up the market for commissioning support to primary care trusts. To help with that the Department of Health drew up a framework contract to reduce the burden for primary care trusts and the private sector in negotiating such deals. It proved cumbersome, however, and few trusts used it.

Lee Phillips, Humana Europe’s marketing director, said last week that the focus of the US parent company of Humana UK had changed. But he added that the health department had now made it clear that the priority at the moment was to use existing primary care trust staff to support the emerging GP commissioning consortiums.

The 140 or so pathfinder consortiums are being given only a small allowance for the forthcoming financial year to develop their role. And although the final management allowance will be in the region of £25 to £35 a patient by 2013, precise details of what that will cover have yet to be spelt out.

As a result, Mr Phillips said, “the market for private sector commissioning support is unlikely to develop dramatically in the next year or so.”

Humana is looking to sell off its limited UK business (it employs 70 staff) and is likely to close its operations within six months.

Although potential private sector suppliers are in extensive talks with GPs, the indications are that the suppliers themselves will form consortiums, since few on their own have all the skills needed to support commissioning.

KPMG has teamed up with the National Association of Primary Care (a grouping of GP enthusiasts for commissioning), UnitedHealth, the commercial law firm Morgan Cole, and others to form a “commissioning partnership.” It has won a contract across London to support the development of pathfinder consortiums.

Kingsley Manning, executive chairman for health at Tribal, said that potentially £1.5bn a year could be spent on commissioning, “but we don’t expect a huge and growing market in the near future,” not least because the private sector itself has limited capacity to provide all the support that consortiums will need.

He said, “We are chiefly working in partnership with PCTs [primary care trusts] and others.” Over time, he added, “I suspect that the market will evolve into a small number of larger scale players. But while we are cautiously optimistic we do not expect this is going to be a gold rush.”


Cite this as: BMJ 2011;342:d490


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