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Operose Health: UK’s biggest GP chain explained - are they replacing doctors with less qualified staff?

According to an undercover BBC Panorama investigation, the UK’s largest chain of GP clinics allows less qualified personnel to treat patients without proper supervision.

According to a prominent GP, Operose Health is putting people at danger by prioritising profit.

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Undercover reporter Jacqui Wakefield was sent to work as a receptionist at one of the UK company’s 51 London surgeries by Panorama. The practice or the people who work there aren’t being named by the BBC.

The practice was short of eight doctors, according to a GP who works there.

Here is everything you need to know about it.

What is Operose Health?

Centene Corporation, a US healthcare giant, owns Operose Health, which has nearly 600,000 NHS patients.

Operose Health has spent tens of millions of pounds on GP surgeries since 2016.

It paid £50 million for 32 practises from London-based AT Medics in 2020, and now operates 70 GP practises across England, making it the NHS’s largest provider of primary care services.

A councillor who challenged the US-backed takeover of London GP surgeries lost her High Court case in February.

Anjna Khurana, a Labour councillor in north London’s Islington, made the claim, which was backed up by protesters who said patients were not properly consulted about the takeover.

Doctor Judah Eastwell a GP at St Johns Medical Centre, consults a patient via a video link to their home (Photo: Christopher Furlong/Getty Images)

Khurana’s lawyers said concerns over Operose’s parent company Centene include it being sued by US states “for allegedly failing to provide adequate medical care under insurance contracts” and “for overcharging the states’ Medicaid programmes”.

It has also been “fined for not providing enough clinicians under Obamacare contracts”, it was alleged.

Since the NHS’s foundation, GP practices have been run as private enterprises, owned and managed by doctors known as "partners," who provide services to the health service rather than being directly hired by it.

In an effort to boost competition and innovation, the then-Labour government amended the laws in 2007, allowing larger firms to buy up practices in England.

All NHS GP services are subject to the same regulation and standards, according to the Department of Health, and patients should always receive high-quality treatment.

What are physician associates?

Physician associates (PAs) are less qualified medical employees who are “cheaper” than general practitioners, according to the practice manager.

The NHS first introduced physician associates in 2003 to help doctors deal with more complex patient demands. Their implementation was based on a US model, and it has since been replicated in a number of other nations.

PAs are healthcare professionals who have finished two years of post-graduate courses in addition to a scientific degree, compared to GPs who have completed ten years of school and training.

They assist GPs in patient diagnosis and management, but they should be overseen by a doctor.

Panorama found evidence that PAs at the Operose practice were not being properly supervised.

The PAs told the undercover reporter that they saw a wide range of patients, sometimes without clinical oversight, and that the practice treated them as though they were GPs.

Operose Health claims it is not overly reliant on PAs and that its usage of them is consistent with NHS England’s long-term strategy. A clinical lead is said to be on site the most of the time to assist PAs with their inquiries.

What else has Operose been accused of?

Administrative personnel also revealed a backlog of thousands of medical test results and hospital letters on Operose computer systems during the undercover Panorama probe.

According to one employee, they were entrusted with going through 200 documents every day and selecting which ones were essential enough to be seen by a doctor or pharmacist, and which would be filed away with the patient’s records.

Concerned about making mistakes, one member of staff admitted that they occasionally used Google to help them figure out what to do with the documents.

Operose Health claims NHS England has praised its document process, which "helps to ensure that clinicians receive accurate and well coded documentation in a timely manner".

It also says that its methods are "audited monthly for quality and safety".

The corporation denies prioritising profit before patient care and claims to have hired 38 GPs in the last year, and is on the lookout for another 14.

It claims that the Care Quality Commission has rated 97% of its practises as "good" or "outstanding," and that it works "in the best interests of patients, providing access to the highest quality of care".