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Closure of GP practice in Camden was a casualty of NHS changes, says inquiry

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4545 (Published 03 July 2012) Cite this as: BMJ 2012;345:e4545
  1. Tom Foot
  1. 1London

A public inquiry into the closure of a GP surgery in north London that was run by a private company says there is “a serious loophole” in the national contract for alternative providers. It raises concerns about two other practices in the area.

Camden Road Surgery closed on 13 April, four years after it was taken over by US health giant UnitedHealth, leaving more than 4500 patients without a doctor.1

The inquiry panel of three councillors—chaired by Labour councillor Angela Mason—said there was an “urgent need” to find a replacement for the closed surgery, adding: “We remain concerned about the remaining two contracts held by The Practice at the Brunswick Centre and King’s Cross, as contracts will end in 2013.”

The panel was convened by Camden’s health scrutiny committee, which is responsible for monitoring NHS activity.

UnitedHealth was awarded five-year contracts by Camden Primary Care Trust to run three surgeries in 2008. The trust became part of NHS North Centre London Cluster, along with four other primary care trusts, in April 2011.

The inquiry’s report found a “serious loophole” in the original contract that allowed surgeries to be suddenly sold to another firm, The Practice plc, in April 2011. There was no competitive tender—as is normally the case—and the new company was not vetted by its NHS paymasters.

The report said: “In our view primary care by GPs should not be a commodity traded in the private market and prompt action should be taken to remedy this.”

The report said that a “lack of planning” had led to the failure of NHS North Central London to find alternative premises for a new surgery. The use of multiple locums was criticised for breaking a “continuity of GP care provided by the practice’s former owner, Robert Harbord.”

The surgery was a “casualty” of NHS cuts, major NHS reorganisation because of the Health and Social Care Act, and changes to NHS policy on who could provide GP services, says the report. The manner and timing of the closure, especially the lack of consultation with other GP practices, led to “unnecessary anxiety” among patients.

The inquiry heard from GPs, NHS officials, patients, and anti-privatisation campaigners.

It concluded there was an urgent need for a new surgery in the area of the old practice.

Mason said the manner in which Camden Road Surgery was closed was unacceptable.

The increasing trend towards privatisation could have quite a massive effect on the notion of having a doctor, she warned. “We are moving to a situation where there is a real possibility that GPs are subservient to private providers,” she said.

Mason added: “It was disappointing that The Practice and UnitedHealth did not attend [the inquiry] and that does send out a message of concern.”

At a public meeting on 27 June to present the findings of the inquiry Mason said: “There was no legal redress for NCL [North Central London] and we were concerned about the issues about the criteria used in the contracts.

“Our suspicion throughout the inquiry was that it was closed down for being too small and inefficient.

“We also are considering the question of privatisation. In our view, if this is going to happen, where contracts go to private company providers, we do believe that does raise issues of sustainability about that group of providers. There are key issues that need to be seriously addressed in contractual provision.”

The health scrutiny committee said the new NHS Commissioning Board should see the report and pay particular attention to concerns raised about the national contract for alternative providers and the need to reflect local knowledge and experience and patients’ experience.

Notes

Cite this as: BMJ 2012;345:e4545

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