Labour demands inquiry into delayed payments to trainee GPs (The Guardian: 3 November 2017)

Labour is demanding an inquiry into how trainee GPs did not receive their salaries from a private firm that is meant to pay them on behalf of the NHS.

Jonathan Ashworth, the shadow health secretary, has urged Jeremy Hunt to act after the Guardian disclosed that the delays had led to some family doctors being unable to pay their mortgage and having to seek help from a charity.

The British Medical Association (BMA) believes hundreds of doctors in England have been left out of pocket as a result of the errors by Capita.

Labour wants the Department of Health (DH) to step in to cover monthly salary payments due to trainee GPs which they did not receive from Capita in order to prevent hardship.

“I’m sure you would agree that trainee GPs seeking charitable support to feed their families and being unable to cover their mortgages is an entirely unacceptable situation which requires urgent rectification,” Ashworth wrote.

Capita won a four-year contract from NHS England, worth a reputed £1bn, to provide a range of support services between 2015 and 2019 to GPs in three areas of England – the Thames Valley, Yorkshire and the Humber, and part of Wessex – including paying trainee GPs’ more


GPs claim quarter of a million in missing payments from Capita and NHSE (Pulse: 7 July 2017)

GPs are seeking to claim a quarter of a million pounds in unpaid bills from NHS England, its support services provider Capita and other NHS organisations, after a GP pressure group enlisted debt collectors.

Pulse revealed last week that campaign group GP Survival was asking GPs and practices to come forward with details of missing payments since Capita was handed the Primary Care Support England contract.

GP Survival chair Dr Matt Mayer told Pulse that in less than a week he had been approached by 25 GPs or practices owed payments ‘approaching a quarter of a million’.

The debt collection group have assigned a case agent to review each complaint and determine whether the debt was recoverable and whether that would be from NHS England, Capita or another party.

Capita told Pulse it had not been approached by GP Survival directly but said GPs should use the ‘usual channels’ to contact it with any problems and it would solve them ‘as quickly as possible’.

Its support service division does have a support line for enquiries and complaints, but the latest satisfaction survey shows 61% of its users are dissatisfied with how effective this process is.

The contract, which runs from 2015-2021, ran into problems soon after services transferred from local offices to Capita's new national function, this included trainees going unpaid nationwide, missing payments and a log-jam in performers list applications that left qualified doctors sitting at home for six months.

Dr Mayer told Pulse that ‘the overriding theme’ from practices is that they have ‘sent email after email after email, each time they’re sent a reference number and a statement that it’s been escalated and then nothing happens'.

The cases he had been sent included practices where partners had taken pay cuts or not taken their drawings ‘because they’re paying registrars out of their own pocket'.

Dr Mayer said: ‘I’m getting a few emails a day from practices or doctors, at the moment I’ve got a list of about 25 cases, each one averaging about ten grand.

‘So you’re getting up to about a quarter of a million quid in combined debt, and that’s in less than a week.

‘We’re trying to break that cycle, the system of emailing and escalating things hasn’t worked.’ more


DH spends £2m on stalled NHS Professionals sale (HSJ: 6 July 2017)

The Department of Health has spent nearly £2m on the stalled sale of a majority stake NHS Professionals, the health service’s in-house temporary staffing agency.

The DH has spent £1.9m since February 2015 on lawyers and consultancy firms while it investigates selling a majority share in the company.

Philip Dunne said NHS Professionals saved the NS £70m a year

NHS Professionals, which is wholly owned by the DH, was set up in 2010 and works with 55 NHS providers to supply temporary staff. Previously it was part of the department.

The sum spent on the project, known as “Project Florence”, from 2015 to April 2017 includes: £997,000 with Deloitte; £459,000 with Pinsent Masons LLP; and £442,000 with PwC.

Health minister Phillip Dunne said in November that NHS Professionals saved the health service over £70m a year. 

The DH has not confirmed whether it has issued a tender to invite bidders to take a majority share in the company, as Mr Dunne said was planned.

Mr Dunne noted the continuing effort in the NHS to reduce spending on agency staff, which reached £3.7bn in 2015-16, and said further investment in NHS Professionals would help achieve more


Terrifyingly, the NHS is about to get some of its money from hedge funds – this will be quantum leap in privatisation (The Independent: 9 May 2017)

It is assumed that benefits will trickle down to patients, but this isn’t how hedge funds work. They are there to make a profit for investors 

Privatisation has long been held up as a panacea to the NHS’s problems. The first ‘PFI’ (Private Finance Initiative) schemes in the 90s were hailed as a possible solution to the NHS’s difficulties in funding large capital projects, like new hospital buildings, under the Major and Blair governments. Since then, it’s been estimated that taxpayers’ money will be used to pay more than five times over what those PFI assets are worth, at £57bn. Private money into the NHS meant public liability, many times over, for no private risk.

But far from taking the lesson that private money to fund the NHS causes it greater problems, the NHS leadership’s most recent move to meet its under-funding is to approach City hedge funds to borrow £10 billion. This marks a quantum leap in privatising our more


Private provider beats GP federation to NHS contract (HSJ: 18 April 2017)

Commissioners in north London have awarded an extended primary care services contract to a private provider over the GP federation that was already providing the service, HSJ has learned.

Camden Clinical Commissioning Group has appointed AT Medics, a private provider of primary care services, as its extended GP access provider following a procurement process. It is a GP led provider of various primary care services in London, including core GP services and urgent care.

This was despite a receiving bid from the Haverstock Healthcare, a GP federation operating in the borough, and which currently provides the service. It covers 200,000 patients across 26 GP practices in Camden.

HSJ understands that the contract has been awarded as part of a joint procurement process for extended GP services accross five North central London CCG areas – Camden, Haringay, Islington, Barnet and Enfield – related to the national GP access fund.

In a message to local GPs, Rebecca Thornley, assistant director of primary care at Camden CCG, said: “AT Medics, who run King’s Cross Surgery, demonstrated their understanding of the local health system and the needs of Camden patients through the bidding more


Virgin Care and CCG in dispute over changes to £270m contract (HSJ: 11 April 2017)

A Midlands clinical commissioning group is locked in a contract dispute with Virgin Care over a controversial “prime provider” contract awarded last year, HSJ has learned.

East Staffordshire CCG disagrees with “contractual claims” made by the independent provider to make changes to the £270m “prime provider” deal that began in May 2016.

Burton Hospitals FT is unable to sign a subcontract with Virgin while the dispute continues

The fixed price, seven year contract covers community services, with Virgin Care coordinating services for frail elderly patients, people with long term conditions and intermediate care. Last year, the CCG said it had used the prime provider contract model as it did not have the capacity to deliver the required integration of services.

However, in governing body papers published on 30 March, the CCG said there have been “a number of contractual claims made by Virgin Care for variations to the contract… these continue to be managed through the prescribed contract management and dispute resolution processes”. It is not clear what the nature of these claims are.

The documents also said the CCG is utilising a number of “contractual actions” in relation to Virgin Care in its prime contractor role, and the outcome of “contractual claims made by Virgin Care” present a “potential risk” to the group’s more


Flagship £690m cancer procurement abandoned over financial fears (HSJ: 10 April 2017)

A controversial tender for cancer services in Staffordshire worth £687m has been abandoned after a consortium led by a private provider failed to convince commissioners its offer was financially viable.

The tender process for the 10 year, prime provider contract has been running since 2013 and HSJ understands the procurement has cost the four Staffordshire CCGs more than £840,000.

Only one bidder, a consortium led by Interserve, remained in the running for the contract. The consortium also included University Hospitals North Midlands Trust and The Royal Wolverhampton Trust.

The decision by commissioners not to award the contract on financial grounds follows the collapse of the £800m UnitingCare Partnership contract, which was abandoned in December 2015 eight months after going live.

As a result, procurement of the Staffordshire cancer contract and a separate £535m end of life care contract were paused for several months while a review was carried out. The process resumed in November. 

Andy Donald, chief officer at Stafford and Cannock Chase CCGs, who was leading on the project, told HSJ today that he was “disappointed” commissioners had not been able to award the contract.

He said: “The remaining bidder couldn’t convince us they could deliver with the resources available. They couldn’t meet the required evaluation criteria.”

He said the work that had been done, including setting out clear outcome measures for cancer care in the county, would be used to hold individual providers of cancer services to account for improvements.

The contract was designed to deliver service integration through a single prime provider that would be responsible for commissioning services measured against outcomes agreed by commissioners, including full recovery, longer life expectancy or pain free dignified more


Biggest ever NHS tender launched as £6bn contract put on market (HSJ: 7 April 2017)

Manchester health leaders have kicked off the search for providers of “out of hospital” health and care services across the city under a contract worth nearly £6bn – the largest ever NHS services tender.

A tender document, published by NHS Shared Business Services, sets out for the first time the contract value and other details of the ambitious plan to set up a “local care organisation” to provide all non-acute services – including social care – across the city.

The LCO will hold a single 10 year contract to provide services for a population of around 600,000 across the city – but not the entire Greater Manchester devolution region. The contract will be let by Manchester Health and Care Commissioning, a partnership between the city council and a newly formed single clinical commissioning group.

The notice, which calls for expressions of interest by the end of April, said: “Commissioners seek responses from interested providers who wish to deliver… a local care organisation for the population of Manchester with the aim of bringing together a range of health, social care and public health services to be delivered in the community.”

“The LCO is envisaged [to have] an emphasis upon: local population health and prevention of ill health; connecting to community assets and building upon people’s strengths and self-management skills; and targeted care support people’s needs particularly as needs change and become more complex. The estimated total contract value for the 10 year contract term is £5.9bn.” more


CCG pays ambulance staff wages following private provider dispute (HSJ: 22 March 2017)

Commissioners in Sussex paid a total of £642,000 in wages to former NHS staff after their private company employer ceased trading, HSJ can reveal.

Alan Beasley, the chief finance officer for High Weald and Lewes Clinical Commissioning Group, said he would be “exploring all avenues” to recover the cash from Docklands Medical Services, which provided patient transport services in Sussex until it ceased trading last summer.

He insisted that the payment will not set a precedent for other private providers to expect a bail out.

The circumstances of the payment were “unique”, Mr Beasley told HSJ. “We are not setting a precedent in terms of other private sector contracts that we might have. Those were ex gratia payments, not contractual payments.”

The 71 former South East Coast Ambulance Service Foundation Trust workers at the centre of the dispute twice lost their jobs when two private patient transport companies – VM Langfords and Docklands Medical Services – ceased trading in rapid succession last more


Deer Park Medical Centre: Campaigners to fight on after closure (BBC: 24 March 2017)

Campaigners have said they will fight to reopen an Oxfordshire doctor's surgery forced to close.

Witney's Deer Park practice will close later, leaving 4,000 people to look for new doctors. Oxfordshire Clinical Commissioning Group said it had not found a new provider to run the practice after its contract with Virgin Care ended.

Health secretary Jeremy Hunt ruled it would not be safe to keep it open with no provider in place.

Campaigner Yvonne De Burgo said: "We intend to fight on, to get it back open and running as good as it was before, either with Virgin Care or not.

"We have all had to go elsewhere and we haven't wanted to, and we are not getting as good a service as at Deer Park.

"That's not the fault of the other practices, they are just overwhelmed, they could only barely cope before."

Witney MP Robert Courts had said the "vital community asset" needed to stay open.

The decision to shut the practice has been referred to an independent reconfiguration panel, but it is not due to report back until 11 April.


Circle contract win means trust 'risks going in special measures' (HSJ: 14 March 2017)

A struggling NHS trust could lose up to £6.6m of income and risk being put into financial special measures after losing a £73m contract, a report has found.

Lewisham and Greenwich Trust stands to lose up to £6.6m of revenue over five years unless Circle Health, the winner of a musculoskeletal contract for Greenwich, contracts it to deliver community based services and “other orthopaedic activity”, the PwC report said.

Loss of activity would make Queen Elizabeth Hospital ‘the smallest site delivering both trauma and orthopaedic services in the country’

The report also highlighted possible risks to the safety of care if Circle subcontracts MSK services currently provided by Lewisham and Greenwich to another provider.

The London trust already has a forecast deficit of £34.6m for 2016-17, which puts the trust’s finances £14.4m behind plan, the PwC study said.

The loss of £1.6m of income in the first year of the three year contract could “add additional financial pressures to the trust”, and lead to “potential intervention, for example being placed into the financial special measure regime”, the report more


Virgin Care starts legal proceedings against NHS (HSJ: 13 March 2017)

A private provider has launched legal proceedings against eight NHS commissioners after losing a bid for a £82m children’s community services contract.

Virgin Care Services Limited issued court proceedings in the High Court against NHS England, Surrey County Council and the county’s six clinical commissioning groups one month after commissioners awarded the three year contract to Surrey Healthy Children and Families Services Limited Liability Partnership.

The winning bidder is an alliance between Surrey and Borders Partnership Foundation Trust and two social enterprises, CSH Surrey and First Community Health.

A spokesman for Virgin Care Services told HSJ that concerns about “serious flaws in the procurement process” prompted the company to launch proceedings.

“Never before have we been so concerned with the whole process that we have needed to make a challenge of this nature,” the spokesman more


Revealed: millions paid to social care companies amid crisis in standards (The Guardian: 3 December 2016)

An investigation into the five biggest firms providing homecare services in the UK has found millions of pounds has been paid to some owners amid a crisis in standards of care.

An analysis of published reports from the Care Quality Commission, the care regulator for England, reveals that of the 192 domiciliary care services run by major companies, and inspected over the last two years, 80 were found to “require improvement”, with eight found to be “inadequate” and placed into special measures.

In services rated inadequate, people were found to be unwashed, unfed, unable to get out of bed and left at risk of harm. In some cases, medicine was not given on time or safely and services were described as unsafe and short-staffed. Yet, in the past five years, an analysis of care records and company accounts by Corporate Watch reveals evidence of £36m being paid to owners, with a further £34m in liabilities being stacked up in company accounts.

The revelation follows an announcement last week by the Competition and Markets Authority that it was launching an investigation into the sector, after concerns were raised about unfair practices and high more


NHS outsourcing contract collapses due to 'catalogue of failures' (The Independent: 16 November 2016)

A "catalogue of failures" resulted in the collapse of an £800 million NHS contract to outsource care of older and mentally ill people, the Commons spending watchdog warned.

An influential committee of MPs concluded that the NHS lacked expertise in procurement and it was "worrying" that untested contracting arrangements could form part of the plans being drawn up for further changes to services across England.

The Public Accounts Committee was scathing about the doomed deal between Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) and UnitingCare Partnership, which collapsed after just eight months.

The cash-strapped CCG awarded a five-year contract to UnitingCare, an NHS consortium of Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, but the deal was scrapped in December 2015 after it ran into more


Capita support services remain a 'chaotic mess', warns GPC in new report (Pulse: 7 November 2016)

GP support services remain a 'chaotic mess' despite nearly a year passing since NHS England outsourced the services to Capita, the GPC has warned.

The GPC said that the Government has to 'get a grip' of the situation, which is 'putting patient care and safety at risk', with the warning coming as MPs are due to debate failures in Parliament tomorrow.

A snapshot survey of 281 GP practices carried out by the GPC found that problems with delivering patient notes and customer support persisted last month.

It found:

  • Almost one third (31%) of practices said they had received incorrect patient records;
  • More than one quarter (28%) of practices failed to receive or have records collected from them on the agreed date with Capita;
  • Over half (58%) of practices reported that new patient registrations were not processed within the required three days.
  • Eight in ten (81%) of urgent requests for records were not actioned within three weeks.

Meanwhile, more than one fifth of practices (23%) had not received medical supplies they had ordered on the expected date, like medicines and prescription pads and just over half (51%) of practices reported that customer service support staff were unable to resolve issues within an appropriate more


27,000 patients could lose their GP as chain hands back contract (Pulse: 31 October 2016)

Some 27,000 patients are at risk of losing their GP practice as a provider has decided to hand back a contract it says is 'not fit for purpose'.

Greenbrook Healthcare, which runs five practices in west London under one APMS contract, said it has been in discussions with NHS England since the beginning of the year to ‘address what support could be provided by them'.

But with no extra funding coming through, Greenbrook Healthcare - a private company which runs GP practices and urgent care centres across west and south London - has concluded that the best option is to end its 10-year contract nine months early, to ‘allow NHS England to look at the contract afresh’ more


Trust's radiology information system crashes for nine days (HSJ: 7 October 2016)

A trust has said it has no plans to pull out of its contract for a troubled radiology information system, shortly after its leaders considered terminating the deal early.

A paper to a meeting of the board of Dartford and Gravesham Trust at the end of last month said “in the longer term the trust plans to give notice on the RIS contract” provided by GE Healthcare.

It said the trust planned, as an alternative, to extend another IT system used at its Queen Mary’s Hospital site, to its main site at Darent Valley. The paper, a report by the quality and safety committee, said: “The business case is scheduled to go to the finance committee.”

However, the trust subsequently told HSJ it did not plan to pull out of the contract.

The system suffered a hardware failure, which saw the radiology information system, which serves all of Kent and Medway, out of service from 28 August to 5 September.

The collapse of the system resulted in a “significant reporting backlog developing”, according to a report to the Dartford and Gravesham board meeting on 29 September.

“This has led to complaints from clinics as patients have attended without their imaging report being available.”

The trust’s actions to cope with a significant backlog included triaging investigations for reporting, allocating additional staff to support reporting and outsourcing reporting.

However, when HSJ asked the trust about its proposal to give notice on the GE Healthcare contract, a spokesman said while the failure of the system “was of great concern to the trust and was discussed at board level”, it will not be “pulling out of the GE contract, which is a Kent and Medway wide agreement” more


Nurses forced to clean wards after private company fails to improve (HSJ: 3 October 2016)

Nurses at Nottingham University Hospitals Trust are having to clean wards after cleaners from a private company in order to maintain standards, the trust board has said.

At a meeting of the board last Thursday, the trust said Carillion, which won a £200m, five year estates and facility contract in 2014, had not made sufficient improvements.

The trust warned Carillion in July that it faces having the contract terminated if it does not turn the service around.

After the board meeting a trust spokeswoman said: “Nottingham University Hospitals Trust remains deeply concerned about the cleanliness of our hospitals.

“Following escalation of our concerns to Carillion we have instigated vigorous, additional interventions to focus Carillion on improving cleanliness to the required standards as quickly as possible.


'Gap' in CCG assurance process for Care UK contract (HSJ: 29 September 2016)

There was a “gap” in commissioners’ assurance process for an urgent care contract with Care UK and the provider’s staffing model was flawed, a review has found.

The report by Verita, published last month, also found that the urgent care centre was “often understaffed” and the staffing model “took no account of predictable peaks in demand”.

In 2011, Ealing Primary Care Trust awarded a five year contract to Care UK worth £3.9m to run the centre in Ealing Hospital.

In August 2015, Ealing Clinical Commissioning Group asked Verita to carry out an independent report following an investigation by ITV that accused the service of poor care.

The review identified a “gap” in Ealing CCG’s assurance process as it “failed to recognise deficiencies in a number of UCC audits” more


£380m Coventry hospital built without proper fire protection (NHE: 31 August 2016)

A major hospital in Coventry will need to undergo remedial work after it emerged that it was built without the guaranteed fire safeguards.

University Hospitals Coventry and Warwickshire NHS Trust said that it had carried out an investigation following a review of the fire safety separation at University Hospital, Coventry.

This found that the structures to prevent a fire spreading are not as robust as specified in the original plans.

University Hospital opened in 2006 as part of a £380m private finance initiative (PFI) partnership between the trust and developer Skanska.

The trust and Skanska are now working on a programme of remedial works.

In the meantime, it has taken steps to reduce the risk of a fire by increasing security patrols and rubbish collections and reminding staff of safety procedures. It has also developed an action plan with West Midlands Fire Service.

David Eltringham, chief operating officer at the trust, said: “Following a review of the fire safety separation at University Hospital, we learned of some potential issues with the infrastructure.

“As a result of these issues, we immediately launched an internal investigation to determine if any further steps needed to be taken to make the site safer.

“This investigation appeared to show that, in the unlikely event of a fire, the structures to prevent it spreading were not as robust as those specified in the original plan for the more


Out of hours provider to go into administration (HSJ: 13 May 2016)

An out of hours provider has been forced to end provision of services across the East Midlands after it announced it intends to file for administration.

Central Nottinghamshire Clinical Services said on Thursday it will stop its services in Leicester, Leicestershire, Rutland and north Nottinghamshire. It transferred them to other providers on Friday.

CNCS has stopped running out of hours services at King’s Mill Hospital

The news comes against the backdrop of pressure on general practice and out of hours services across the country. HSJ has been told that services in Leicester, Leicestershire and Rutland have moved to Derbyshire Health United, the out of hours provider for North Derbyshire, South Derbyshire, Hardwick and Erewash clinical commissioning groups.

Nottingham Emergency Medicine Service has taken over running out of hours services at King’s Mill and Newark hospitals in Nottinghamshire.

Care home support services, also provided by CNCS, have been transferred to Nottinghamshire Healthcare more


GPC demands practices be compensated for 'systematic failure' of support services (Pulse: 11 May 2016)

The GPC has told NHS managers that every practice should be compensated for the significant extra workload they have had to take on as a result of the ‘systematic failure’ stemming from the handover of primary care support services to the private provider Capita. 

The GPC sent a letter to NHS England most senior management to highlight the ‘serious and systemic failure’ of the relaunched primary care support service, for which it is ’ultimately responsible’.

Capita has said that they have introduced new procedures in a bid to alleviate the problems for practices.

Pulse has written extensively about the problems with Primary Care Support England, which has seen practices accumulating piles of uncollected patient recordsmissing payments, and left without vital practice supplies.

The GPC has raised these issues with Capita, but the letter states that interim solutions have heaped more workload and costs on practices and things have not improved ‘despite reassurances’ made weeks more


'Meltdown' of £330m outsource contract disrupts primary care (HSJ: 11 May 2016)

Vital primary care support services are in “meltdown” after NHS England contracted them out to Capita last year, prompting anger among providers toward the contractor and the national body.

The outsourcing giant took over primary care support in September following a competitive tender. The contract is worth £330m over seven years.

Capita’s bid depended on saving £21m a year, driven by centralising administration and technology functions.

However, there have been reports of the service getting dramatically worse since the beginning of 2016 as the old localised service centres have been closed and transferred to Capita’s new centres.

HSJ has heard GPs, community pharmacists and optometrists have all been affected. 

Chaand Nagpaul, chair of the British Medical Association’s GP committee, has written to NHS England to highlight “a multitude of serious complaints” from GPs. These have focused on Capita’s failure to supply essential supplies such as syringes and prescription forms, and to deal effectively with paper records moving between practices.

Dr Nagpaul said Capita “appears to have been considerably underprepared”. The poor service has increased practice workload and cost practices money, he said. He called for practices to be compensated.

He told HSJ: “This is a salutary lesson… it is another example of how the idea of outsourcing appears attractive in offering more for less, but that is based on a very simplistic view of how the NHS functions. The NHS has been very efficient and effective. The NHS functions on organisational memory, and you cannot just take a service over and run it better.”

Bob Morley, executive secretary of Birmingham Local Medical Committee, said there had been some instances of practices not being able to release paper records because couriers, subcontracted by Capita, had arrived without appropriate identification. He also said some practices had not been paid properly.

The situation was an “almighty mess”, he more


Is private equity really fit to run care homes? - Graham Ruddick (The Guardian: 4 May 2016)

These are crucial weeks for England’s care home industry. Homes across the country face a cash crisis, and they are about to find out whether the pressure on them is going to ease.

Since George Osborne announced in the autumn statement last year that councils could increase council tax by an extra 2% to pay for social care, care home operators have been eagerly anticipating a rise in the fees they receive from local authorities. The tax increases took effect from April, so the extra money for councils should start flowing to care homes imminently.

Well over 90% of local authorities have chosen to enforce the 2% tax hike. The extra cash is crucial for care homes. The chancellor introduced the “precept”, as it has been described, after warnings from leaders in the care home industry that homes could close because they were running out of cash.

Care homes are being squeezed by a fall in the fees that cash-strapped councils pay for residents, and a rise in staff costs. This squeeze has become more pronounced due to the introduction of the “national living wage”, meaning care homes have to pay all staff over the age of 25 at least £7.20 per hour.

Care home operators made a clear argument to the chancellor – if you want us to increase the amount we pay staff, then you have to help us fund it. This is why councils can increase council tax.

The funding issues for care homes are clear. The number of beds in care homes in the UK fell by 3,000 last year, the first decline for a decade according to research by industry analysts LaingBuisson. In addition, private residents now pay 40% more on average than publicly funded residents for like-for-like services, which critics claim is because care homes are trying to make up the shortfall from state-backed residents. There is also evidence that the quality of care in homes is deteriorating. The Care Quality Commission has found a third of Britain’s 18,000 care homes require improvement and 7% are “inadequate”.

The pressure on the industry was underlined last week when Four Seasons, the biggest care home operator, published its financial results. It has 440 homes, 18,500 residents, and 31,000 staff. It is a behemoth in the care home world. However, its results showed a £264m annual pre-tax loss for 2015.

Four Seasons is at the centre of the storm in the care industry. Not only is it feeling the squeeze from rising costs and falling fees, but it has been in private equity ownership for a decade, which has left it lumbered with interest payments of more than £50m every year and debts of more than £500m.

The situation brings back shocking memories of the collapse of Southern Cross, then Britain’s biggest care home group, five years ago. S&P, the credit ratings agency, warned last year that Four Seasons was going to run out of cash. It begs the question – is private equity really fit to run a care home? more


Ambulance privatisation descends into 'total shambles' (The Guardian: 12 April 2016)

Hundreds of patients including people with cancer and kidney failure have missed important appointments for treatment because ambulances did not arrive to take them to hospital, after privatisation of NHS non-urgent transport services in Sussex this month.

Some elderly patients have had to wait more than five hours for ambulances and been stuck at hospital for long periods after their appointments because the transport service, now run by the private firm Coperforma, has proved so unreliable.

Patients, relatives, NHS bodies and local MPs have severely criticised the service’s performance, and a trade union representing ambulance crews said it was an “absolute shambles”. The NHS organisations that awarded the four-year, £63.5m contract have now launched an investigation.

A host of problems have arisen since Coperforma replaced the NHS’s South East Coast ambulance service (Secamb) as the provider of non-emergency patient transport services on 1 more


NHS paid private provider £165,000 for single home visit under GP Choice scheme (Pulse: 1 April 2016)

NHS England has paid £165,000 for a contract that has seen a private provider carry out just one out-of-area GP patient home visit and 18 phone consultations since last July.

The West Midlands local area team awarded a contract to health and social care provider Primecare in July last year to provide home visits to patients who are registered in practices outside of their area as part of the GP Choice scheme. 

The contract was worth £165,253 upfront, with an extra £80 agreed for each GP visit and £30 for phone consultations, NHS England confirmed.

But Primecare was only required to carry out a single home visit during that time, NHS England admitted, with the contract expiring more


GP practices face £20,000 losses as federation goes bust (Pulse: 15 March 2016)

A GP federation providing APMS services for 37,000 patients has gone into administration after running into financial difficulties leaving local GPs thousands of pounds out of pocket.

Danum Medical Services Ltd (DMSL) is a private limited company set up in Doncaster by the 23 local shareholding practices - which DMSL’s website says ’equates to 63 individual shareholding GPs’ - which holds APMS contracts for six practices in the Midlands and Yorkshire.

The company previously held major contracts for an extended hours hub and GP out-of-hours services in Doncaster, but hadn’t managed to secure them again when the contracts expired and went out to competitive tender last year.As a result, one shareholding practice told Pulse they were facing losses in the region of £20, more


Private health provider goes into administration (Northern Echo: 15 March 2016)

Patients are facing an uncertain future after a private company that runs health care services in east Cleveland revealed it was in financial difficulty.

The future of Marske Medical Centre is in doubt after the private healthcare company which took over less than a year ago went into administration.

The contract to run the centre - which had been under the control of the South Tees NHS Foundation Trust - was awarded to Doncaster-based Danum Medical Services Ltd (DMSL) in April last year.

A spokesman for DMSL said: “I can confirm that DMSL has gone into more


Revealed: Failed Cambridgeshire provider asked for £34m bailout after just one month (HSJ: 10 March 2016)

The controversial Cambridgeshire older people’s services contract collapsed because the provider expected to be paid substantially more than had been agreed in the deal, an audit has found. 

The investigation into one of the largest deals ever awarded for NHS clinical services has also raised serious questions over the quality of advice received by Cambridgeshire and Peterborough Clinical Commissioning Group.

UnitingCare Partnership’s contract was worth £725m over five years. The contract, which was awarded to UnitingCare Partnership in November 2014, was worth £725m over five years, and collapsed after just eight months of operation in December.

UnitingCare was a limited liability partnership jointly owned by two local trusts: Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT.

An audit by West Midlands Ambulance Service Foundation Trust, carried out on behalf of the CCG, found that one month into the contract the provider asked for an extra £34.3m for the year. This would have been worth 23 per cent of the £152m contract value for the first year of the more


‘Grave concerns’ over CCG’s finances following £800m contract failure (HSJ: 18 February 2016)

NHS England has raised “grave concerns” and demanded action on the financial position of the clinical commissioning group reeling from the collapse of the £800m UnitingCare Partnership contract, HSJ has learned.

The national commissioner’s intervention follows Cambridgeshire and Peterborough CCG’s 2015-16 financial forecast plummeting from a £4m surplus to an £11m deficit because of the high profile contract collapse, its latest board papers more


NHS watchdog signed off doomed £750m contract despite doubts (The Guardian: 26 January 2016)

An NHS contract worth £750m that collapsed in December after just eight months was effectively signed off by the regulator and NHS England, despite questions about its viability.

The contract – the biggest in NHS history – was the first designed to bring together hospital, mental health services and community care for adults and older people in Cambridgeshire, introducing a single point of contact for patients.

Signed in November 2014 after a 15-month procurement process that cost more than £1m, it was strongly opposed by local campaigners and trade unionists after several private bidders expressed an interest. Opponents feared it would mean transferring thousands of staff into the private sector.

In the end, the contract went to an NHS partnership called UnitingCare. It launched in April last year, promising to cut emergency admissions to hospital, saving millions of pounds. But by early December, all the partners agreed it was not financially sustainable.

In papers submitted to Cambridgeshire county council’s health scrutiny committee, Monitor revealed it had such grave doubts about the project that it only gave it the go-ahead the day before the launch. There were 34 outstanding issues remaining to be negotiated, a hearing of the committee was told last week. 

The senior GP in the clinical commissioning group (CCG) that awarded the contract, Dr Neil Modha, resigned last Friday, citing personal reasons. At the hearing of the health scrutiny committee the day before, he admitted that the obligations in the contract exceeded its value. “There was not enough money to cover all the services that were to be provided,” he said.

Questions will be asked not only about how the contract came to be approved but why it was not rescued. On some estimates, its collapse will cost the already hard-pressed local hospitals, community care providers and GPs up to £20m. The shortfall that had been identified was £9.3m. NHS England refused to find the extra more


John Lewis arrival sealed the end for GP firm as it walks away from contract and 11,500 patients (The Argus: 18 January 2016)

The long-awaited arrival of John Lewis to Brighton city centre may have the unintended consequence of leaving 11,500 patients looking for a new GP.

The Argus has learned that The Practice Group’s decision to terminate its contract for five GP surgeries in Brighton and Hove is based partly because of a need to relocate two of its surgeries under upcoming redevelopment schemes.

The company, which is set to leave the city at the end of June, currently has a practice based in Boots in North Street – a site which John Lewis bought last year and are set to submit a planning application for in a matter of weeks.

Practice Group bosses added that the move had also been because of rising demand for services, difficulty in recruiting and retaining GPs and a reduction in their funding.

NHS England have moved to reassure residents that the announcement will not affect the care they can receive immediately and that work is underway to find an alternative provider for the surgeries.

The health body has received notice from The Practice Group that it seeks to end its contract which includes The Practice Whitehawk Road, The Practice Hangleton Manor, The Practice North Street, The Practice Willow House in Bevendean and Brighton Homeless Healthcare in Morley Street.

The Practice Hangleton Manor has recently been placed into special measures after a Care Quality Commission report published last month branded the surgery inadequate.


Healthcare group to walk away from five Brighton and Hove surgeries putting care of 11,400 patients in doubt (The Argus: 16 January 2016)

The future care of 11,400 residents has been thrown into doubt after a health group announced it would stop running five GP surgeries.

The Practice Group has announced its intention to terminate its contract for five surgeries in Brighton and Hove following a dispute over funding.

Brighton Pavilion MP Caroline Lucas has urged healthcare bosses to think again and warned other city surgeries could not cope with additional patients if the surgeries did close.

The Practice Group has given notice that they will be pulling out of their contract at the end of June with Brighton and Hove Clinical Commissioning Group expected to take over its running after that if an alternative provider is not more


Lord Hunt calls for NAO probe into collapsed £800m contract (HSJ: 11 January 2016)

A senior Labour politician has called on the government’s spending watchdog to investigate the dramatic collapse of an £800m contract in Cambridgeshire, one of the largest contracts ever tendered by the NHS.

Lord Hunt, deputy leader of the opposition in the House of Lords, told HSJ he would write to the National Audit Office this week to ask it probe why the older people’s services contract had been deemed “no longer financially sustainable” just eight months into a five year contract.

He said the letter, penned with a colleague, would ask comptroller and auditor general Amyas Morse to ”investigate the circumstances of the awarding of the contract and its subsequent failure and the waste of public money as a result”.

“I am dumbfounded by why on earth [Cambridgeshire and Peterborough Clinical Commissioning Group] got themselves into this mess,” he added. “I do not get the sense that anyone is owning up or taking the rap.”

The move follows an announcement last month that UnitingCare Partnership was handing back the five year outcomes based contract to the CCG, which had been awarded to the fully NHS owned company after a lengthy, costly, and controversial procurement process.

According to a procurement document found by HSJ, the final value of the contract between UnitingCare and the CCG was £725.5m – at the lower end of the £700m-£800m range given to bidders during the tender.

The document was published by the CCG on the website in November 2014, a month after UnitingCare was awarded the contract. Neither the CCG or provider disputed the figure in the document when invited to comment byHSJ.

A “memorandum of information” issued to bidders during the procurement in July 2013 said the contract was valued at £140m-£160m a year, giving an overall value over five years of £700m-£800m.

The CCG said its board meeting on 12 January would discuss a stabilisation plan for the contract. A board paper said the CCG would carry out an internal review and that NHS England would carry out an “external review”, as revealed by HSJ last month.

Archive of earlier stories 


see also: 






 In-depth articles on Market Failure

Going for gold: The redistributive agenda behind market-based health care reform - Professor Robert Evans

Market Failure Alive and Well in the English NHS -  Clive Peedell, Member of BMA Council, BMA Political Board

Market Failure in Healthcare Part 1: Market Failure in Theory - Bevans Run

Market Failure in Healthcare Part 2: Market Failure in Practice - Bevans Run

Lessons need to be learnt for the NHS from failure of competition in imperfect markets - Socialist Health association

Can market forces makethe NHS more efficient?  SHA conference 30.11.10   Wendy Savage MBBCh FRCOG  MSc (Public Health) Hon DSc   Co-Chair Keep Our NHS Public


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