A private company that won a 10 year contract to run a failing GP surgery in east London has pulled out after three years- doctors are warning that it is a taste of things to come.
It was billed as a move that would transform the quality of healthcare for patients in one of Britain’s poorest areas. In late 2007, the primary care trust (PCT) in the east London borough of Tower Hamlets handed Atos Healthcare, a subsidiary of the French multinational IT firm Atos Origin, a 10-year contract to manage a failing NHS GP surgery.
The decision to choose a private firm with a limited record in providing healthcare in the face of rival bids from two well-regarded local NHS GP practices sparked controversy. Local doctors passed a motion of no confidence in Tower Hamlets PCT.
Angry medics and patients, fearful of the potential impact of the privatisation of this part of the NHS, staged a protest march, and wrote to MPs and the PCT to complain about the decision.
Alwen Williams, chief executive of the embattled PCT, assured patients that Atos’s stewardship of the St Paul’s Way medical centre in Bow would mean much-needed “major new service improvements”.
Although Atos ran an NHS walk-in centre in nearby Canary Wharf, it was better known for its expertise in healthcare technology rather than primary healthcare. And Tower Hamlets faces some difficult challenges. It has the third highest level of multiple deprivation in England, significant numbers of children living in families that depend on benefits, the highest rate of overcrowding in London and a 49% non-white population.
“As a multi-ethnic community, we have a disease spectrum that’s a lot wider than many areas,” says Abdur Rahim, a GP at Chrisp Street health centre in Tower Hamlets, which was part of one of the losing bids. “This is a very challenging area.”
Now, barely three years on, Atos has just walked away from its deal, having failed to revive St Paul’s Way’s fortunes. The PCT says that in November, it and the firm “mutually agreed to terminate the contract with an exit date of 31 March 2011 in order to allow for safe transfer of patient care and for effective plans for staff to be made.”
Local GPs, whose expertise was overlooked in 2007, have been put in temporary charge of the centre while the PCT decides its next step.
“Atos never had any experience of running GP surgeries. They didn’t know Tower Hamlets or the health needs here. They put their bid in with the lowest cost, but that isn’t the same as showing they could best meet the local people’s needs,” says Rahim.
Now doctors are warning that the company’s failure is a foretaste of what lies in store if health secretary Andrew Lansley’s attempt to impose a competition-driven model of healthcare on to the NHS in England becomes reality.
“St Paul’s Way is a very cautionary tale. There’s an unavoidable contradiction between running something to maximise profit as opposed to running a service designed to meet the needs of patients,” says Anna Livingstone, a GP who opposed Atos’s takeover. She feels that the case offers a telling example of the pitfalls of competitive commissioning and questions the ethics of a system where big companies can walk away from contracts after outbidding smaller providers.
“There really was a huge amount of anger. Patients and ourselves were angry not only about privatisation but privatisation with a company that we had never worked with before and that had no track record in general practice,” she says. “Still, we thought this might be a testing ground for Atos, that they would work hard to provide a good practice. They had good doctors there. But we were naive. The low-cost contract they had won was impossible to deliver on.”
Data from Ipsos Mori’s GP Patient Survey shows Atos failed to lift St Paul’s Way from the bottom of Tower Hamlets’ patient satisfaction league table.
In 2009-10, only 41% of St Paul’s Way patients said they could access a doctor’s appointment within 48 hours, compared with the Tower Hamlets average of 72%. Just over a quarter said they were able to see their preferred doctor most of the time, less than half of the borough average and way below the national average in England.
Doctors working at St Paul’s Way concede that patients have been unhappy with appointment arrangements for some time. Fahim Chowdhury, clinical lead at the surgery, insists that the practice could get patients seen within 48 hours, but says that it often struggled to arrange appointments for patients with specific doctors. He says improvements were made to the continuity of care, thanks to Atos replacing locum GPs with a stable staff of five doctors, all of who still work at St Paul’s Way.
Chowdhury says lessons can be learned from Atos’s experience. He was impressed by the company’s employee relations, the stability it brought to a practice that had undergone turbulent times, the administrative and managerial support, and its readiness to leave clinical matters in the doctors’ hands. Yet it highlights the difficulties facing private providers looking to get involved in frontline healthcare provision, which the coalition’s “any willing provider” vision of the NHS will encourage.
“The NHS can learn from the efficiency of private business. In this day and age GP practices can’t ignore things like budgets,” Chowdhury says. “If a private company is going to make money in this area, it will be one that is well established in providing primary care. Atos didn’t have that. It came to St Paul’s Way at a tough time. There was a financial crisis and it was taking over a practice that is incredibly demanding.”
Clare Gerada, chair of the Royal College of GPs, says the saga raises troubling questions about how healthcare in the new era will operate. “What will the failure regime be for private providers? What will happen if such providers go bankrupt and can’t deliver services they promised?” she asks.
“The risk is that patients could be left in the lurch, and without access to the appointments or operations they were expecting. St Paul’s Way shows that some people may not be able to sustain a service at the price they’ve taken it on at and that the promised quality of patient care may not be delivered. Competition should always be on quality rather than price.”