NHS North West London Potential change of control at AT Medics Ltd public webinar 22 January 2024

NHS North West London has been notified of a potential change of control of AT Medics Ltd. AT Medics Ltd provides general practice care to patients across North West London. Members of the public and interested stakeholders were invited to attend a webinar from 3 to 4pm on Monday 22 January 2024 to give their feedback and ask questions.

View the presentation

  • During the meeting there was general concern about the type of organisation that was talking control of AT Medics Ltd and their ongoing commitment to investing in providing high quality patient care.
  • Attendees wanted to understand the due diligence process and what it entailed.
  • Detailed below are questions and answers that came out of the meeting. Please note they are not verbatim questions and answers but a summary of the main questions raised and answers given.
  • For a full flavour of the discussion, please view the video above.
  • If anyone has any further comments or feedback please email nhsnwl.communications.nwl@nhs.net

Questions and answers

Please note these are anonymised, collated and edited questions and answer that act as a summary of questions, answers and comments given in the meeting.

I am concerned about the condition of the Earl’s Court Health and Wellbeing Surgery building which has not been upgraded since it opened. Planning permission has been granted for the building but nothing has happened.

When the practice first opened it was meant to be some sort of health and wellbeing centre but it dropped off the agenda.  Dr Fiona Butler does want to bring to this back and this should be encouraged.

Earls Court is not owned by AT Medics and would not be picked up as a result of the change of control process.  Any issues are general estate issues and would need to be picked up as part of the overarching estates strategy for North West London.  We will talk to our estates team to seek clarification on what is happening.

My understanding is in the chain of ownership, that all the practices including the nine of which are in North West London are being sold to this company called T20 Osprey Care limited or HCRG Care Group. In the Health Service Journal, they were saying this is a £35 million purchase by an equity company with a with a single director called Tristan Ramus. And is there anything you can do to stop the change of control?

The change of control is in relation to Operose Health. The sale has not taken place yet as the change of control hasn't so far been confirmed or refused.

Do they have to keep the same opening hours and staffing levels, the same level of qualification of staff and the same services?

The APMS contract sets out the basic core essential services that need to be provided. At time of procurement additional local requirements can be included. For example, longer opening times.

In terms if staffing, they need to provide suitably trained and skilled staff in order to provide those services, whether that's GPs, nurses and other health professionals, and have to have the right skill mix to deliver the services they have been commissioned to provide.

We can't require them to keep the same people because people change jobs and people move on.

Are they allowed to try and attract patients from other GP practices locally?

Any general practice can market themselves and up to a degree so they can put leaflets through local letterboxes or posters outside of practice or whatever it is that that is allowable.  They do need to factual, and cannot say other services are of a lower standard than theirs. They can day they are taking on new patients, please come along and see what we're doing or here's our range of services that we offer.

What is the due diligence process and what questions are you asking?

The due diligence process and assurances that have been requested and responded to will form part of the committee papers and so will be shared at that time.

We know when big companies take on these contracts there are changes to staffing and that they use ARRS contracts where they have been getting alternative sources of funding to pay for these?

There is concern that these new types of staff need to be properly supervised and that physician associates are taking over the role of GP's and that there is financial savings going on that these companies are not taking over GP practices because they want to be benevolent and kind and look after people's health, but because they're there to make profit.

The future of general practice is to have a good skill mix of different clinical staff providing care to patients. This is going to be very important that as sadly NW London is not well off for GPs and it also has a large number range of older GPs. It does mean we need to use the GPs we have wisely and to that end we have encouraged a good use of a wide range of clinicians who have a different skill mix.

Physicians associates do have some very good skills and are able to do some of the things that other clinicians cannot do.  All of these additional roles, such as physios, pharmacists, physician associates all need to be properly supervised by GPs to make sure that they are working in the right way.

All practices have to deliver services against key performance indicators (KPIs). Some of these are around access and some service standards. There is a monitoring regime and we compare and benchmark local data that the GP practices provide against national data. We then look at things like complaints and other anecdotal information.

In terms of whether we extend a contract or not we look at all this information. If there is a reduction in performance against the KPI’s there's a facility for us to and take action depending on the seriousness of that failure.

Anything to do with safety or clinical practice is a red flag immediately. If it's not a safety issue, for instance they are not complying with certain KPI targets we usually implement a recovery or an action plan which is agreed with the provider. That is then monitored to ensure that they come up to standard again within a particular time period.

What are the CQC reports on these practices? Are there any of concern?

All the AT Medic practices are rated good.  You can view the current reviews here.

We are concerned the practices are going to be controlled by a hedge fund, which is an investment vehicle who could decide to sell at any moment.  What promises, undertakings or assurances are they giving you?

The due diligence process is being carried out by legally qualified colleagues and has a focus on both the clinical and the corporate structure.  We go on the internet and check Companies House.  The due diligence is looking at the various levels to the overall corporate structure involved in the change of control so we can really understand it and the different groups involved and the roles they play in the overall hierarchy of the corporate structure.

We will then assess what their roles and responsibilities are with regards to this contracts in terms of delivery of services and the management and all the rest of it.  And part of that is obviously deciding if they are of good standing.

We also ask what are their plans in terms of the services.  Do they propose any changes to services or how things are run? If they do, what are those and what is the impact on the level of services to patients as a result of that?

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