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Practice Plus Group

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In 2020, Care UK divided its business into two separate companies - the care home business remained as Care UK, but the healthcare business was rebranded in October 2020 as Practice Plus Group. Both Care UK and Practice Plus Group are owned by Bridgepoint, but are now separately managed and financed. Care UK's business is covered in a separate profile.

Practice Plus Group services include treatment centres, GP practices, walk-in centres, out-of-hours GP support, diagnostics facilities, ophthalmology and prison healthcare.

Strategy

Formation of Practice Plus Group

In October 2019, Care UK split its business into two separate companies, one covering care homes and the other covering all its healthcare businesses.

On 25 October 2019,  Care UK Health & Social Care Holdings Ltd (the parent company) sold its shares in Care UK Healthcare Holdings Ltd to a new company Care UK Healthcare Bidco Ltd, which is outside the Care UK Group structure but still managed by Bridgepoint. Care UK Health & Social Care Holdings Ltd changed its name to Care UK Holdings Ltd.

In October 2020, Care UK Healthcare was rebranded as Practice Plus Group, containing primary care services, urgent care, prison healthcare, diagnostics, ophthalmology, hospital-based services and private healthcare.

Recent history

Care UK grew through a process of acquisition and organic growth to become one of the five leading residential home companies in the UK and the leading independent sector provider to the NHS in England of elective surgical procedures, NHS 111 non-emergency service and out of hours primary care, and healthcare in prisons. It had two business divisions: residential care and healthcare. Until very recently, revenue for the healthcare division has been derived entirely from contracts with the NHS and public bodies.

For many years Care UK's strategy has been to bid for contracts with the NHS in the area of primary and urgent care, it was a major player in the walk-in centres developed in the previous decade, and prison healthcare, as well as contracts to run treatment centres performing a range of elective surgery. By late 2017, its NHS contracts focused on NHS 111 services, prison healthcare, primary care and out-of-hours care, and elective treatment centres.

In 2017, Care UK reported that it is the largest provider of healthcare services in prisons and secure facilities, with services at 42 different sites. It also provides over 60 NHS primary care services, including GP and walk-in services, 11 NHS out of hours services, providing health advice and support for over 10 million people, and 13 NHS 111 services handling on average 240,000 calls a month covering a population of over 11.0 million people.

However, in 2017 the company's strategy took a slightly different direction; for the first time the company began to offer "self-pay" services. In its September 2017 report to bondholders the company notes that the profitability of the primary care (including 111 service, OOH and primary care) is marginal and there are also concerns over the continuing profitability of the elective surgery contracts the company has with the NHS.

The company notes that financial pressures in the NHS are leading commissioners to defer patients needing a range of elective procedures. As a result there will be an increase in the number of patients waiting for treatment. Care UK believes that this increase in waiting list numbers is "unsustainable" and is an opportunity for the company. For the first time Care UK is moving into the self-pay market, offering patients on waiting lists the possibility of paying for their operations at the treatment centres where Care UK carries out the NHS work. Care UK notes it is "exploring partnership structures with NHS Acute Trusts alongside developing the opportunity to give patients choice and control over their treatment through a self-funding alternative currently being trialled."

The first "self-pay" trial began in late 2017 in the West country, where Care UK has two treatment centres one in Bristol and the other in Devises. Care UK wrote to local GPs, who would normally have referred patients to Care UK for NHS work, marketing its self-pay option as a quicker alternative. The mail shot included a list of treatments and prices, ranging from ear wax removal to complete knee replacement. This approach received considerable criticism from GPs and local anti-privatisation campaigners. A report in the Bristol Post noted that the letter to GPs says: “we understand the pressure of growing waiting lists is leading to greater restrictions on NHS access.” and goes on to tell GPs they “will have greater options to discuss with patients” thanks to the self-pay scheme.

The company's strategy to explore partnerships with the NHS bore fruit in late 2018 when the company entered a partnership with the University Hospitals Plymouth Trust to carry out all the trust's elective orthopaedic surgery for 18 months. Surgeons and anaesthetists at the NHS trust will move to Care UK's Peninsula Treatment Centre to operate on around 200 patients per month. The staff will remain trust employees but be managed jointly by Care UK. This agreement has been termed a 'partnership' by the trust and was not awarded via a tender process.

Earlier strategy

Care UK (as Anglia Secure Homes) specialised in retirement homes and sheltered housing, then added nursing homes and homecare support. Then in 1994 after being renamed Care UK, the company began acquiring learning disability support, community care and mental health services. In 2003, Care UK began providing secondary healthcare services after winning contracts to run a number of independent sector NHS treatment centres. Later Care UK entered the primary care market with its first GP out-of-hours contract. In recent years Care UK has won contracts to provide GP practices, walk-in centres, and clinical assessment and treatment services (CATS).

A notable move in November 2012 was the acquisition of Harmoni for £48 million, significantly expanding Care UK’s OOH business, including 12 NHS 111 contracts, and prison healthcare business. Following the deal Care UK is reported to provide unscheduled care to approximately 15 million people across England.

Harmoni has been active in the development of telehealth; in May 2012, Harmoni, the Qatar Science & Technology Park (QSTP), and Corinium Technologies signed an agreement to use RASAD, an ICT telehealth platform developed and owned by Qatar Science & Technology Park (QSTP) and ASPETAR (the Gulf region’s first orthopaedic and sports medicine hospital in Doha), as part of the UK’s long term health care management programme. Harmoni will use RASAD to remotely monitor patients with conditions that require regular medical observation, such as pulmonary vascular disease.

In June 2015, Care UK's mental health services were sold to Partnerships in Care for an undisclosed sum, its learning disability group was sold to Lifeways, and its homecare division was sold to Mears Group for £11.3 million.

Political Connections

Co-founder of Care UK John Nash and his wife have reportedly donated over £300,000 to the Conservative party including £21,000 to the personal office of the former Health Secretary Andrew Lansley. John Nash has gained considerable power within government although unelected. In 2010 he was appointed by the UK chancellor, George Osborne to plan the drive for austerity, then in December 2010 he was appointed non-executive director of the Department of Education board.  In January 2013, John Nash, received a peerage, becoming Baron Nash of Ewelwe, and became a schools minister in the Conservative government. responsible for among other things, academies and free schools and school capital (including playing fields). He continued in this role after the Conservatives won the May 2015 UK general elections, but has now left this position. He sits in the House of Lords.

In October 2012 Jim Easton resigned from the NHS Commissioning Board to become Managing Director of Care UK. Jim Easton was responsible for the procurement process for the NHS 111 services, 12 of which were won by Harmoni. Care UK acquired Harmoni a few weeks after Jim Easton joined Care UK. Jim Easton is now Care UK's managing director for healthcare.

Financials

The most recent financial reports available are for the year ending 30 September 2020.

Practice Plus Group Topco Ltd, the parent company for Practice Plus Group Ltd, reported finances from 8 October 2019 to 30 September 2020. Revenue was reported as £343.5 million. Secondary care reported revenue of £130.5 million, the Health in Justice area revenue of £143.6 million and integrated urgent care revenue of £69.6 million.

Secondary care was reported to have had a strong October 2019 to February 2020 due to a rise in self-pay and new NHS contracts, however as the Covid-19 pandemic began, Practice Plus was signed up to the block-contract with the NHS.

Practice Plus Group receives a high proportion of its annual revenue from the NHS. All income in the area of integrated urgent care (£69.6 mn in 2020) and health in justice (£143.6 mn in 2020) are from NHS contracts, and a certain proportion of income in secondary care is from NHS work. In 2020 over 62% of the company's income came from NHS contracts. In integrated urgent care, the company estimates that it has 15% of the NHS 111 market and 10% of the out-of-hours market.

Investors

In March 2010 Care UK was acquired by Bridgepoint in a deal worth £432 million and Care UK was removed from the public markets.

After the formation of the two companies - Care UK and Practice Plus Group - Bridgepoint continues to be the ultimate parent company and controlling party of both companies.

As of September 2020, Bridgepoint Europe IV (Nominees) Limited held 78.2% share of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited. The remaining 21.8% of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited is held by Mike Parish, other members of Care UK’s senior management and a number of Care UK’s employees including the group’s Employee Benefit Trust, who together hold 20.9% of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited, as well as the group’s former Chairman, whose trustees hold 0.9% of the issued ordinary share capital.

In February 2018, Reuters reported that Bridgepoint planned to sell Care UK and in April 2018 the first bids were reported to have been made for the company. However, in December 2020 Care UK  and Practice Plus Group was still listed as owned by Bridgepoint on its website.

Contracts

Covid-19 contract

In March 2020, Practice Plus Group (as Care UK) was part of the deal with the government for using all its premises and staff for NHS patients during the Covid-19 pandemic. NHS England  block booked almost the entirety of the private hospital sector’s services, facilities and nearly 20,000 clinical staff for the foreseeable future to help cope with the surge of covid-19 patients. The agreement only covers England and added around 8,000 hospital beds, nearly 1,200 more ventilators, more than 10,000 nurses, 700 doctors and 8,000 other clinical staff. This deal, which means the NHS is paying all operating costs for the hospitals, has been a lifeline for the company, as the lockdown meant that no private work was possible.

In June 2020, a £5 billion deal to extend the March deal to help the NHS clear the backlog of work was agreed by NHS England and the private hospital companies, however this was blocked by the Treasury.  The Treasury did not believe the deal represented good value for money and that the evidence was not substantial. The block-contract basis of contracts with private providers continued, however, as NHS England prepared a new four-year framework contract for increasing capacity. In November 2020, ContractFinder, the government tendering database, reported that Practice Plus Group was one of 67 suppliers awarded a place on the NHS framework contract NHS Increasing Capacity worth in total £10 billion. The framework runs until November 2024.

In October 2020, the HSJ reported that Practice Plus Group (as Care UK) was the recipient of the sixth largest contract for staff and capacity from NHS England, according to a series of contract award notices, however the time period of 2020 this covered is unclear. The contract with Care UK published in October 2020 amounted to £76.3 million. An similar earlier contract award published in June 2020 awarded Care UK £1.3 million.

These block contracts have been criticised after leaks revealed that the capacity paid for by NHS England at companies, such as Care UK, was very under-utilised. HSJ reported that two-thirds of the private sector capacity that was block-purchased by the NHS at a cost of an estimated £400 million a month went unused by the NHS over the summer, despite long waits for operations.

NHS contracts

Practice Plus Group has a large number of contracts with CCGs and local councils.

Data collected by the NHS Support Federation estimated that as Care UK it was awarded £187.4 million in contract awards from 2010 to April 2016, then from April 2016 to April 2018, the company was awarded a further £709.8 million in contracts. However this is certainly a significant underestimate of the amount of income Care UK derives each year from work for the NHS.

In April 2015, Care UK terminated a contract for an out-of-hours service. The contract was to provide OOH care in conjunction with Portsmouth Health Limited (a group of local GPs), however the contract, which began in 2012, proved to be loss-making and so Care UK terminated its involvement before the end of the contract.

Prison Healthcare Contracts

According to the Practice Plus Group website, in December 2020, the company delivered healthcare to more than 40,000 patients at over 45 prisons of all categories. It notes that the company is the leading independent provider of healthcare services in prisons and youth offender establishments. The company provides the following services to prisoners: primary care; substance misuse services; mental health services; dentistry; occupational therapy; physiotherapy; podiatry;  and optometry.

In the 2016/17 year Care UK won a contract worth £135.6 million to provide healthcare at prisons and detention centres across the Thames Valley, Bristol, South Gloucestershire, Wiltshire and Gloucestershire. In the same year, Care UK was also awarded contracts for prisons in Devon and Dorset, worth £79.8 million, and Sudbury and Foston Hall, worth over £18.5 million.

In the 2017/18 year Care UK was awarded  a £23 million contract for "Healthcare Provision for Women in Prisons across Yorkshire & Humber". It also received a £4.6 million contract for healthcare services at HMPYOI Feltham.

Hospitals and surgical centres

Practice Plus Group runs six hospitals and three surgical centres. Work is carried out for private patients and those funded by the NHS.

Care UK was awarded contracts under the government's response to the pandemic for "The provision of inpatient and outpatient healthcare services and hospital capacity, as part of the response to the Covid-19 Pandemic in England." See above for details.

Many of the contracts awarded to Care UK covering elective surgery prior to the pandemic where superseded by the contract awards as part of the pandemic response.

In September 2019, Care UK was awarded a place on a framework to provide elective surgery services to NHS trusts in the north of England.

In October 2018, the HSJ reported that the University Hospitals Plymouth Trust had entered an agreement with Care UK for the company to take over all elective orthopaedic surgery for 18 months. Surgeons and anaesthetists at the NHS trust will move to Care UK's Peninsula Treatment Centre to operate on around 200 patients per month. The staff will remain trust employees but be managed jointly by Care UK. The trust is hoping that this will free up space over the coming winter.

This agreement has been termed a 'partnership' by the trust and was not awarded via a tender process.

Barking and Dagenham, Havering, Redbridge and Waltham Forest CCGs awarded a £70 million contract to Care UK to provide elective care services.

Shepton Mallet Health and Wellbeing Centre

The contract for the Shepton Mallet Health and Wellbeing centre is worth £120 million over eight years. Under the contract, which began in January 2017, Care UK will work with the Somerset Partnership NHS Foundation Trust, which currently runs the community hospital and the minor injuries unit (MIU) on the site. However, as this is a prime-provider contract, Care UK is able to subcontract work to other firms and organisations. At the moment, Care UK runs the Shepton Mallet NHS Treatment Centre on the same site delivering a range of NHS services for people living in the Shepton Mallet area. Care UK and the trust will develop the Shepton Mallet Health and Wellbeing centre to encompass: a treatment centre; the community hospital and services that go beyond being a hospital, providing a base for the community, including voluntary and third sector organisations; diagnostics; and the minor injury unit (MIU).

Integrated Urgent Care and NHS 111

Practice Plus Group runs a large number of NHS 111 services. The company states that it has designed and is delivering a new model of Integrated Urgent Healthcare. The model brings together out-of-hospital services and a hub of clinicians behind the existing NHS 111 number. This model is now being implemented in the West Midlands, for several CCGs and in an alliance with other local out of hours care providers.

This six year contract, awarded in 2016 for an integrated out-of-hours GP service and NHS 111 service for 16 CCGs in the midlands was shared between Care UK and other private companies, Nestor Primecare Services Ltd; £6 million goes to Badger Healthcare Limited, a social enterprise; and £690,000 goes to Coventry and Warwickshire Partnership NHS Trust. Care UK received the lion’s share of the contract, however, with almost £140 million.

Other NHS 111 contracts include:

  • In June 2018, Care UK was awarded a five year contract to run the NHS 111 helpline and out-of-hour services across Suffolk and north-east Essex. From 1 November 2018, the company took on the “enhanced integrated urgent care service”. These services will be delivered to the 950,000 population across the STP area.
  • Care UK was commissioned in April 2017 to run a 111 service in the London Boroughs of Hounslow, Ealing and Harrow.
  • Somerset 111
  • Bristol, North Somerset and South Gloucestershire 111
  • Gloucestershire 111
  • Surrey Integrated Urgent Care

Out-of-hours services

Practice Plus Group provides over 20 out-of-hours services across England. Some of out-of-hours services are provided in joint venture partnerships with local GPs.

GP services

The company has two walk-in clinics, one in Brighton and the other in Clapham Junction.

The company also runs around 30 GP surgeries.

Practice Assist is a service provided by Practice Plus to GP surgeries designed to improve access for patients by providing additional remote capacity for practices. It provides registered patients with a full consultation by telephone or video on the same day with a GP, with full read and wrote access to the patient’s notes.

Patients call their local GP surgery as normal. Any patients with a clear requirement for a face-to-face appointment are booked in directly. Other calling for a GP appointment that can be managed over the phone are given a timed slot for a call back with a qualified Practice Assist GP, who will try to resolve their problems remotely. If required, the GP will then make any necessary onward referrals, either to the patient’s practice, or to other services.

Diagnostics and Musculoskeletal Assessment & Treatment

Practice Plus Group has four clinical assessment and treatment services (CATS) around the UK:

  • Greater Manchester the service consists of two mobile clinics that rotate between seven sites around the city and provide fast access care in multiple specialties.
  • Practice Plus Group MSK & Spinal Service, in Lincolnshire provides lifestyle advice and management, soft tissue and joint injections, initial physiotherapy treatment and diagnostics (MRI scans, ultrasounds and X-ray)
  • Practice Plus Group MSK, Buckinghamshire specialises in physiotherapy, women’s health advice, acupuncture, multi-disciplinary management of MSK pain and diagnostics (MRI scans, ultrasounds and X-ray)
  • Practice Plus Group Ophthalmology provides a glaucoma service, pre-operative assessments prior to cataract surgery and minor eye surgery, and specialises in the treatment of suspected Wet AMD (age-related macular degeneration).

There are also other locations, including the company's hospitals. The company states that each year it delivers more than 75,000 community-based scans at over 60 locations across the country on behalf of the NHS. Scans range from MRI to ultrasound, X-ray and echocardiography to CT and DXA (bone density testing).

Ophthalmology

Practice Plus Group runs an ophthalmology  service on behalf of Heywood, Middleton and Rochdale CCG.

Concerns

Care Quality

Since 2009, there have been a number of high profile cases in the national media in which very poor standards of practice by Care UK have been exposed. This included a BBC Panorama investigation which uncovered instances of gross negligence in care homes operated by Care UK. Other incidents include in 2011 the 84 year old woman who was not visited by carers for four days as Care UK thought she was in hospital and in 2012 the lack of processing of 6,000 X-rays at a Care UK-run urgent care centre.

In Suffolk Harmoni’s OOH service was heavily criticised in 2011 then again in 2012, for excessive waiting times and cuts to the service. In 2012 Harmoni reorganised its Suffolk OOH service, including the closure of several bases, including in Newmarket and Aldeburgh. The closure of the bases was reported to be without any consultation with local people.

At the end of 2012, it became evident that things were going badly wrong in Harmoni's out-of-hours business in London. In December 2012, The Guardian exposed a catalogue of failings, noting that senior doctors have complained that the service is so short-staffed that it is routinely unsafe. Harmoni is also reported to have manipulated its performance data to cover up for delays in seeing patients and missed targets.

One of the most high profile cases was that of a seven-week-old baby boy who died while in the care of Harmoni's out-of-hours GP service. Harmoni's service was described as "wholly inadequate" by a coroner in February 2013. The coroner noted that Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence". When the baby's mother attended the Harmoni clinic three and a half hours later, she was made to wait with her baby in a queue with six patients ahead of her. The baby died shortly afterwards in the NHS A&E department next door to the clinic.

In May 2013, the Care Quality Commission produced a report on Harmoni noting that cost-cutting at the company may be harming patient care. The routine inspection by the CQC, which was carried out in March 2013, found that Harmoni did not respond quickly enough to calls from patients in north central London because it did not have enough doctors, putting patients “at risk”. The CQC report was highlighted by The Independent, which in its article noted that Harmoni won the contract to provide the out-of-hours service against rival bidder LCWUCC, a non-profit GP organisation in west London, by beating it on price despite scoring worse on quality.

In September 2016, Veritas produced a critical report on Care UK's urgent care contract in Ealing. The contract awarded by Ealing Primary Care Trust in 2011 was worth £3.9 million to run an urgent care centre in Ealing Hospital. The independent report by Veritas was triggered following complaints of poor care made to ITV reporters. The report noted that there was a gap in the assurance process carried out by the CCG as well as problems with the staffing model used by Care UK, which “took no account of predictable peaks in demand”.

The contract ran at a loss for Care UK, but when the company requested more funding from Ealing CCG in May 2013 it was refused. Furthermore, Ealing CCG would not allow Care UK to terminate the contract. The contract finally ended in April 2016, when Greenbrook Healthcare took over.

Other concerns

In July 2015, Care UK complained to Monitor about the loss of its contract to run the North East London Treatment Centre; Care UK had run it for three years since 2011. In 2015 the new £55 million five year contract for the centre was awarded to Barking, Havering and Redbridge Hospital Trust. Care UK has questioned the procurement process and Monitor investigated. At the end of January 2016 Monitor found in favour of Care UK in the first part of the competition case; Monitor reported that it had identified “potential issues” with the procurement process.  As a result, the CCGs extended Care UK’s contract by 15 months, then retendered the contract. Eventually, in September 2017, Care UK won the contract.

In December 2017 local press in the Bristol area reported that Care UK was sending hundreds of letters to local GPs outlining the costs of operations at Care UK's treatment centres in a marketing exercise for its self-pay services. Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide self-pay procedures.

The company is trialling the scheme at two treatment centres in the west of England, the Emersons Green treatment centre near Bristol and a second centre in Devizes in Wiltshire. The list of treatments on offer ranges from earwax removal (£160) to hip replacements at just under £9,000. Other procedures being offered include cataract surgery, tonsillectomies and vasectomies.

There is currently a six to 20-week wait for NHS patients seeking operations at Emersons Green treatment centre – the NHS says this wait time “under-performs against national and/or local standards”.

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