GP privatisation: Judicial review awaiting verdict

The legal battle comes after a takeover by Operose Health Limited (OHL), a UK subsidiary of US giant Centene, was finalised in February 2021.

This was when ownership of AT Medics Ltd (ATM), which runs 37 GP practices across London, moved from six GPs to OHL.

The North Central London (NCL) Clinical Commissioning Group (CCG), in charge of eight surgeries involved, was one of the 13 CCGs that granted approval.

Anjna Khurana, a patient of one of the practices affected and Labour councillor for Tollington ward, is challenging the NCL decision in court saying it was unlawful on three grounds: misdirection, the failure to investigate into the financial stability of the new companies and lack of transparency and public involvement.

Cllr Khurana said: “Fundamentally for me as a patient, I need to know that I am represented in this process and that my care is paramount.

“If the judge doesn’t rule it in my favour, the implication is going to be huge. I think this is actually calling into question a lot around how these decisions are made and what need to be taken into account and what kind of due diligence there is,” she added.

The CCG has statutory powers to authorise a change of control (that is ownership) of its contractors. It should do so “unless there are specific ground that the change of control would impact on the performance of the contract, especially with regards to patient experience”.

Adam Straw QC submitted, on behalf of the claimant, that the NCL arbitrarily took into account limited information obtained in the due diligence process and failed to consider other relevant circumstances.

“It is problematic because this is very limited. It does not say anything about Centene and the financial problematic it is in,” he stated.

Allegations are that Centene and its subsidiaries have a long history of fines and Centene had to settle lawsuit for hundreds of millions of dollars for overcharging US health authorities.

There are also concerns alleged on the financial stability of OHL.

The claims are disputed by the defence, saying that “appropriate and proportionate” due diligence checks were undertaken and assurances were sought from ATM.

It also claims Centene “is six steps removed from AT Medics”, which would continue to be responsible for providing services. Although they accept Centene ultimately control ATM.

Fenella Morris QC, speaking on behalf of the NCL, said that “no concerns arose” from the checks and that it “had minimal ground to refuse” the change considering there was no impact on services.

The NCL failed to involve patients and stakeholders, including the health leads of the five LA interested, especially considering the “great public interest”, according to the claimant.

This claim is also dismissed by the NCL. Ms Morris said “the public were given advance notice of the decision” and opportunity to ask questions. She said lay members, the Healthwatch and local Health and Wellbeing Board were involved as public representation.

Similar concerns were raised by 191 councillors, MPs, including the Labour party leader Keir Starmer, mayors and assembly members.

AT a February 2021 NCL meeting, councillors asked to revoke the authorisation but this was not agreed.

Cllr Khurana said: “The thing that made me furious is there was a lot of talk about rational decision making, but they looked at Centene and they didn’t actually factor it in the due diligence.”

A spokesperson for NCL CCG said: “We are committed to offering residents high quality, safe and accessible care. Our commissioning practices in relation to AT Medics have followed the same rules and guidance we apply to all our GP contracts, with decisions informed by legal and national guidance.

“The CCG is defending its decision and the process and will not comment further while a judicial review is under way.”

Among the surgeries run by ATM are centres in Camden, Islington, Hackney, Brent, Newham, Tower Hamlets and Redbridge. The dispute is with the NCL CCG and includes Islington only.