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NHS: Primary Care Surgeries

Volume 816: debated on Wednesday 24 November 2021


Asked by

To ask Her Majesty’s Government what steps they are taking to prevent the takeover of National Health Service primary care surgeries in the United Kingdom by American health insurance companies.

The Government are clear that the NHS is not and never will be for sale to the private sector, whether overseas or domestic. Regardless of whether a service is run by an individual, a partnership or any other organisation, all providers of NHS core medical services are subject to the same requirements, regulations and standards. Patients will continue to receive high-quality care, free at the point of use.

I thank the noble Lord for that Answer. I have two points to make. Once they know what is happening, NHS staff and the public increasingly oppose this move. A group action by Islington patients is going to court to challenge the change of control to an American profit-making company. First, will the Minister respond to such a groundswell and urge the Government to stop the encroaching control of the NHS by American health insurance companies? Secondly—

Centene has a bad reputation across America. Since 2000, it has paid many millions of dollars in fines for 174 contract-related offences across the States, so will Her Majesty’s Government forbid the appointment of Centene-related staff and former staff to NHS CCG boards and their sub-committees?

I thank the noble Baroness for her speech. In answering, as this is for judicial review, I am sure she understands that I cannot comment on it. But I saw an interesting documentary over the weekend, so let me just read some words from it:

“Yes the NHS is a public service but how it spends its vast procurement budget, how it uses IT, how it fashions new processes and pathways for patients, plainly benefit from private sector experience.”

I admit I have plagiarised these words from Tony Blair, the last Labour Prime Minister to win an election.

Is the Minister familiar with the research that shows that the longer the relationship between a patient and a GP, the less likely the patient is to need out-of-hours care or emergency hospital treatment, or to die, within 12 months? Are patients not right to be afraid that profit-making will interfere with those important relationships?

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

My Lords, one of the concerns is the transparency of agreements between clinical commissioning groups and these private companies. Are CCGs required to make absolutely transparent any arrangements they have made with these private companies?

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

My Lords, I entirely welcome the Minister’s assertion that much of what is great about the NHS is the collaboration with international partners and the private sector. During the pandemic, many things that went well, including the vaccine, relied on that. With a special session of the World Health Assembly next week to discuss new global agreements on pandemic preparedness, what steps will the department be taking to foster international and business collaboration?

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?

I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.

My Lords, my local GP, who has been extraordinarily busy during this pandemic, tells me that he just wants to get on with treating people who are ill and preventing others from becoming ill. He is not interested in fighting off unwanted backdoor interference from Americans or any other predators. Will the Government give proper support to our NHS, without which some of us might not be around to pass on these views from the front line?

We all understand the importance of the role that GPs play in our NHS. I remind noble Lords that, when the NHS was created, once the state had seized the voluntary hospitals and hospitals from churches, it left GPs independent. It has been left up to them how to run their services. What is important is that we expect all GP services to offer the best-quality care, despite the business model they use.

My Lords, I commend the Minister for congratulating Tony Blair, who, of course, led the best Government of modern times in this country. The Blair Government trebled health spending in real terms—three times the rate of growth under this Government. I encourage the Minister to learn further lessons from Tony Blair, in particular to significantly increase health spending and leave the National Health Service in a better condition than he found it, rather than, as is now happening, in a worse condition.

I pay tribute to the noble Lord on his contributions to the Blair-Brown documentary, which I am sure a number of noble Lords enjoyed watching and learning from. It is important that we learn the right lessons from whichever political party, so when Tony Blair, a former Labour Prime Minister, says that we should encourage the private sector to be more involved in partnership with the public sector, we will take that advice.

My Lords, I have great respect for GPs, but with general practices paid for the number of patients registered with the practice, profit-driven services might carry the risk of some GPs choosing to register younger and fitter patients, who will need to be seen less often than older patients. Would the Minister really be comfortable if that situation played out?

I am sure that noble Lords agree that it is appropriate that GPs register as many patients as they are able to see, and that their patients, whatever their needs, can access our great system of healthcare in this country. I would indeed be concerned if there were barriers to accessing GP services.

My Lords, the cost of locum doctors to the NHS is £6 billion a year, much of it in primary care surgeries. Does the Minister feel that this is good value? What are the Government doing to try to get back to having regular doctors?

The Government recognise that it is important that people can see GPs and, as much as possible, invest in making sure that there are more full-time equivalent GPs. We have done that and we will continue to do so.