BBC Panorama programme investigates Operose Health, the company that runs Balderton Primary Care Centre, using an Advertiser story as a case study
A Panorama investigation into the company that operates Balderton Primary Care Centre has accused it of putting profit before patients.
The programme, which aired on the BBC on Monday night, used a case study first published by the Advertiser ten months ago to make its case.
The findings of the Panorama programme are disputed by Operose Health.
Panorama's undercover investigation said it had found Operose Health, the UK's biggest chain of GP practices lets less qualified staff see patients without adequate supervision.
The company, with almost 600,000 NHS patients, is owned by US healthcare giant Centene Corporation.
BBC Panorama sent undercover reporter Jacqui Wakefield to work as a receptionist at one of the UK company's 51 London surgeries. The BBC is not naming the practice or the staff who work there — but it wasn't Balderton.
A GP working at the practice featured in the programme said they were short of eight doctors. The practice manager said they hired less qualified medical staff called physician associates because they were cheaper than GPs.
Physician associates were first introduced by the NHS in 2003 so doctors could deal with more complex patient needs. Their introduction was based on a US model and has been adopted in various other countries.
They are healthcare professionals who have completed two years of post-graduate studies on top of a science degree, as opposed to ten years education and training for GPs. They support GPs in the diagnosis and management of patients, but should have oversight from a doctor.
Panorama gathered evidence that physician associates were not being properly supervised at the Operose practice. They said the practice treated them as equivalent to GPs.
Panorama analysed NHS data for 6,500 practices across England. It claimed that for every 2,000 registered patients, there were on average the equivalent of 1.2 full-time GPs. But at Operose practices the average was half that, at just over 0.6 full-time equivalent. GPs Operose employs six times as many physician associates as the NHS average, according to NHS data.
While undercover, Panorama was also told about a backlog of important patient referral documents, often unread by doctors or pharmacists for months.
Since 2016, Operose Health has spent tens of millions of pounds buying GP surgeries. It now runs 70 in total across England, making it the largest supplier of GP services to the NHS.
The company denies putting profit before patient care and says that it has recruited 38 GPs in the past 12 months and is in the process of recruiting 14 more.
It says that 97% of its practices were rated good or outstanding by the Care Quality Commission regulator and that it works in the best interests of patients, providing access to the highest quality of care.
In a statement, Operose Health: "It is deeply disappointing that the BBC decided to deliberately mislead and secretly record our GP practice staff, including junior members of the team, to cover a story they report on almost every day - a national shortage of GPs.
"Like all GP practices around the country, we are facing probably the most challenging period in the NHS’s history. Despite these challenges, we have a strong track record of performance, recruitment and investment in our staff and services. This success is due to our staff, who go above and beyond every day to care for patients.
"The CQC currently rates 97% of our practices as good or outstanding. We are recruiting a new GP at the rate of one every nine days and are investing over £1m this year in sector-leading GP salaries to help recruit and retain GPs in a very competitive market. We are also an accredited Living Wage Employer.
"The issues the BBC has highlighted are not unique to us, but common across primary care in this country. It's a shame the BBC chose to ignore our record and offers for a full and open briefing, opting for sensationalism instead of a more rounded and topical debate on an issue the public deeply cares about."
The Balderton practice was mired in difficulties at the time Operose took over, but has since had its CQC rating upgraded from needs improvement to good.
Significant issues were reported in the Advertiser shortly after the takeover, including failure to diagnose serious conditions, difficulties in getting appointments with doctors, no nurses available and excessive use of locums.
These included baby was diagnosed with leukaemia after her parents struggled to get a doctor’s appointment.
Her father Antony Barson, an emergency medical technician with the ambulance service, tried to get an appointment for his daughter Isla Brown at Balderton Primary Care Centre on two separate occasions but was told there were none available.
Isla was given a diagnosis of blocked bowel.
Not content, Antony, of Newark, who was a case study on Panorama, instead took Isla to Queen’s Medical Centre, Nottingham, where blood tests revealed she had acute myeloid leukaemia.
At the time, Operose said it had inherited a backlog of patient case information that had yet to be computerised by the former owners.
The Advertiser asked the company for the data and staffing levels for Balderton Primary Care Centre as relevant to the Panorama investigation.
It said: "When we took Balderton over, we had one nurse on site and practically no other staff.
"We now have Dr Oke, our regional medical director based there, plus locum support — and we continuing to recruit more GPs to join us permanently in probably the most challenging recruitment situation in the history of the NHS.
"We have also have an advanced nurse practitioner, a practice manager, a practice nurse and equivalent of six receptionists and administrators on site — so we have built the team up considerably.
"We do not understand the BBC point re our use of physician associates as we have 48 nationally, which equates to less than one per practice — so how that can be six times more than the average we are not clear.
"There are no PAs working at Balderton. We are proud of the work our PAs do and they are fully supervised."
The Care Quality Commission said it took all concerns seriously and would be following up as appropriate.