Arun-down former mining village by csgirla


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                                                   Alex Nunns reports
               run-down former mining village      When Dr Elizabeth Barratt put together a
               in the Derbyshire countryside may
               not seem a likely setting for       community-backed bid to take over a GP
               historic events in the health
     service. But Langwith may go down as          surgery in Derbyshire she thought she
     the site of a crucial battle to stop the      was acting out the New Labour rhetoric
     privatisation of NHS primary care.
        When the government’s health white         of ‘patient choice’ and ‘community
     paper, Our Health, Our Care, Our Say,         control’. So it came as a surprise when
     was published recently, the most
     controversial proposal was the plan to        UnitedHealth Europe – a subsidiary of
     get more private sector companies to
     run GP practices in deprived areas.           the biggest health corporation in the US
     Ministers could not utter a sentence          – was selected to run the practice.
     without invoking the ‘inverse care law’ –
     the poorest areas with the greatest health
     needs have the fewest doctors.The
     implication was that the NHS had failed.      and no clinical team in place. But it did      having a ‘proven track record of providing
     The only solution, in their view, was to      have one big advantage – Simon Stevens,        good quality general medical services’, the
     open the door to private companies.           its president, is Tony Blair’s former health   ability to ‘demonstrate leadership by a
     This was even couched in the language         adviser (see page 10).                         clinician’, a ‘record of engagement of
     of community empowerment – patients              The company’s parent, UnitedHealth          public and patients’ and a ‘record of
     were told they could petition their local     Group, is a £16 billion corporation based      involvement and development of the
     primary care trust (PCT) to force it to       in Minneapolis.The chief executive,            primary healthcare team’. In all these
     invite in new providers.                      William McGuire, earned a total income,        categories UHE were among the highest
        Even before the white paper was            including stock gains, of $124.8 million in    or the highest scorers, despite having no
     published, two PCTs in Derbyshire             2004-05, according to Forbes. He was           track record whatsoever of providing GP
     became the first in the country to head       kind enough to donate over $100,000 of         services to the NHS and no clinical team
     down the road to private care when they       that to the Bush election campaign.The         in place. Ironically, given the company
     selected UnitedHealth Europe (UHE) to         money was, we assume, gratefully               president’s previous job, United did not
     take over the running of GP practices last    received, despite the fact that                score so well on ‘awareness of NHS
     December.Yet contrary to the rhetoric, in     UnitedHealth companies have been               policy’.
     one of these cases there was no shortage      involved in multiple fraud cases in the US.       As well as being chosen to run GP
     of local doctors. And as for the patients,    In 2004, for example, UnitedHealthCare         services by two Derbyshire PCTs, UHE
     far from welcoming in their new private       Insurance settled with the US Attorney         already had contracts to provide
     partner they were screaming out against       for $9.7 million after being accused of        information services to 15 PCTs in the
     the choice that had been made for them.       fiddling the books; in 2002 New York           area covered by Trent strategic health
        North East Derbyshire PCT received         State fined UnitedHealthCare $1.5              authority, including north east Derbyshire.
     18 bids when it advertised for interested     million for “cheating patients out of          This raised suspicions among local health
     parties to run two small village surgeries.   money”; and cases have continued right         professionals that UHE had
     One of the bidders was Dr Elizabeth           up to December last year, when                 obtained an unfair advantage in
     Barratt. She has been a GP in north-east      UnitedHealthCare of Georgia was asked          the bidding process through access
     Derbyshire for over 20 years. ‘We took the    to pay more than $2 million to settle          to privileged information –
     rhetoric of the new NHS to heart,’ she        complaints about delayed payments.             something the company denies
     says. ‘I put together a small local team         ‘The choice of UHE for this practice        – and that Trent SHA was
     including one and a bit doctors, a full-      seemed to be absurd,’ says Elizabeth.          operating a policy of favouritism.
     time pharmacist, a nurse and various other    ‘There had been no public consultation.           For UHE, it is clear the
     staff.The vision was for a well functioning   There was no public awareness of the           Derbyshire practices are a foot in
     multi-disciplinary “cell”. Patients would     company, and there was no awareness that       the door of the emerging
     be involved in the planning of the            the private sector was poised to enter         primary care market.The government’s
     building and design of services, and we       primary care in this way.’                     commitment to the private sector has set
     would concentrate on accessibility and           When residents realised their health was    the share prices of likely beneficiaries,
     continuity.We would work closely with         being entrusted to such a company they         such as Care UK, soaring.The Financial
     social care organisations and successful      started asking questions. How had the          Times name-checked Boots, Bupa,
     local projects promoting health and well-     decision been made? Why would a huge           Netcare, BMI, Nuffield, Alliance Medical
     being. In doing this, we could re-engage a    multinational be interested in a remote        and even Virgin as companies looking for
     community that was under-using the            village practice? How would UHE make a         a piece of the action. Early experience of
     health services.’                             profit without reducing services or            running Derbyshire GP practices will give
        She had the support of the local           quality? How much money would flow             United a huge advantage.
     community.The parish council backed the       out of the NHS to shareholders? Would             But there is a further, potentially more
     bid and offered free land for a new           there be any continuity in the doctors         sinister motive – control of health
     building. Local patient groups came on        patients see? What if UHE took over            budgets. Practice-based commissioning is
     board.The bank offered the necessary          other practices in the area and decided to     a key part of the government’s reforms. It
     money.The application went in to the          centralise services?                           allows the commissioning budget for
     PCT. It was not even short-listed. ‘So           Quite how North East Derbyshire PCT         purchasing treatments – including hospital
     much for patient choice,’ she sighs.          selected UHE is unclear.The decision was       operations – to be transferred from PCTs
        Unlike Elizabeth and her team, the         taken by trust chief executive Martin          to GPs. So instead of the money being
     bidder the PCT selected – UnitedHealth        McShane – brother of the Labour MP,            controlled by a public body with
     Europe – had no experience of providing       Dennis – on the basis of set criteria that     responsibility for a geographically defined
     GP services to the NHS, no local support,     Red Pepper has seen.These included             population, it is handed over to practices

22   red pepper march 2006
                             accountable only for their registered

                             patients. And increasingly these will be
                             corporations like UHE.
                                A previous attempt to sell-off the
                             commissioning role has already been
                             stalled. Last year there was a plan to off-

                             load Oxfordshire PCT’s commissioning
                             budget to – you guessed it –
                             UnitedHealth Europe.The deal would
                             have given the company control over
                             £600 million of public funds. But fierce
                             local and national opposition stopped the

private                      scheme. Practice-based commissioning is a
                             more piecemeal way of achieving the
                             same result. It is not difficult to envisage a
                             future where five or six companies run
                             most GP practices, and patients sign up
                             not to doctors but to a corporation that
                             controls what healthcare they receive and
                             who provides it.
                                Back in Langwith, a campaign has been
                             quickly mobilised.The outraged local
                             parish council has arranged meetings and
                             petitions, and the Keep Our NHS Public
                             campaign has brought added muscle. BBC
                             Newsnight ran a feature from the village as
                             their take on the publication of the white
                                In late January Richard Smith, chief
                             executive of UHE, former editor of the
                             British Medical Journal and one-time critic
                             of the ‘irrational’ American healthcare
                             system, was summoned to Langwith by
                             Martin McShane to placate the locals. It
                             didn’t work. In a lively public meeting of
                                        100 residents every speaker
                                         except Smith expressed
                                         opposition to the deal. One local
                                         councillor, Pam Smith, launched
                                         a legal action that has put the
                                        signing of the contract on hold
                                      pending an application for a
                                judicial review.The legal argument is
                             that handing over a GP practice to a
                             multi-billion dollar corporation
                             constitutes a significant change to health
                             services, meaning the PCT has an
                             obligation to consult the community.
                                The implications of what is happening
                             in Derbyshire could be huge. If a judge
                             rules that PCTs do have to consult when
                             transferring practices to corporations, then
                             the primary care market could become
                             less attractive to the big players. If the
                             political campaign succeeds in reversing
                             the decision it will provide a model for
                             other communities.
                                And momentum continues to grow –
                             now the British Medical Association is to
                                   investigate whether there is a level
                                     playing field between private and
                                     NHS bidders. An alliance between
                                   outraged patients, political activists
                             and the professional medical bodies could
                             be a powerful force.
                                In Derbyshire the reality behind New
                             Labour’s soft rhetoric has been exposed.
                             For all the talk of a patient-led NHS, on
Picture courtesy of
                             the ground patients see privatisation, and
Battersea & Wandsworth TUC   they don’t like it.

                                                     march 2006 red pepper    23

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