UK’s biggest GP chain replacing doctors with less qualified staff

Jacqui Wakefield was told of a backlog of more than 1,000 documents needing doctors' attention

The UK's biggest chain of GP practices lets less qualified staff see patients without adequate supervision, an undercover BBC Panorama investigation has found.

Operose Health is putting patients at risk by prioritising profit, says a senior GP.

The company, with almost 600,000 NHS patients, is owned by US healthcare giant Centene Corporation.

Operose says it's not short-staffed and operates in patients' best interests.

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.

A GP working at the practice said they were short of eight doctors. The practice manager said they hired less qualified medical staff called physician associates (PAs), because they were "cheaper" than GPs.

• What I saw working undercover at a GP surgery

Physician associates were first introduced by the NHS in 2003, so that doctors could deal with more complex patient needs. Their introduction was based on a US model and has been adopted in various other countries.

PAs are healthcare professionals who have completed two years of post-graduate studies on top of a science degree, as opposed to 10 years education and training for GPs. They support GPs in the diagnosis and management of patients, but should have oversight from a doctor.

Panorama reporter Jacqui Wakefield worked undercover in a GP surgery in London

Panorama gathered evidence that PAs were not being properly supervised at the Operose practice. The PAs told the undercover reporter they saw all sorts of patients, sometimes without any clinical supervision. They said the practice treated them as equivalent to GPs.

There is a UK-wide shortage of GPs and general practice is under unprecedented pressure.

Panorama analysed NHS data for 6,500 practices across England. It found:

• For every 2,000 registered patients, there are on average the equivalent of 1.2 full-time GPs

• But at Operose practices the average is half that, at a little 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 the NHS's inception, GP practices have been run as private businesses, owned and managed by doctors known as "partners", providing services to the NHS, rather than being directly employed by it.

But in 2007, the then-Labour government changed the rules, allowing larger businesses to buy up practices in England, in an effort to drive competition and innovation.

Since 2016, Operose Health has spent tens of millions of pounds buying GP surgeries. In 2020, it bought 32 practices from London-based AT Medics for a reported £50m. It now runs 70 in total across England, making it the largest supplier of GP services to the NHS.

Operose Health denies being over-reliant on PAs and says its use of PAs is in line with NHS England's long-term plan. It says a clinical lead is on site most of the time to help answer questions from PAs.

Panorama has also spoken to a dozen former employees from across the Operose group.

One GP, who wished to remain anonymous, said she had witnessed the way PAs had been used where she worked. "They were fantastic colleagues and trained to do certain roles, but not trained to basically do as much work as a GP. They were doing the same job as us, with less experience, less qualifications and earning less money," she said.

• Watch Panorama's Undercover: Britain's Biggest GP Chain at 20:00 on BBC One on Monday 13 June

Prof Sir Sam Everington, a senior practising GP at an unconnected partner-run practice, reviewed BBC Panorama's undercover footage and said he was concerned for patient safety.

He said at his own practice, PAs would debrief with him every day, discussing every patient they had seen. He said he was worried to see physician associates at the Operose practice saying they were not receiving the supervision they needed. "They're clearly articulating it, but they're not getting it. And that's a problem."

During the undercover investigation at the London practice, administrative workers also revealed a backlog of thousands of medical test results and hospital letters on Operose computer systems. An office at the site processed documents for about 30 Operose GP practices.

One worker said they were tasked with getting through 200 documents a day, deciding which were important enough to be seen by a GP or pharmacist and which would be filed to the patient's records. One member of staff, worried about making mistakes said they sometimes used Google to help them work out what to do with the documents.

Admin workers also said some correspondence had been waiting to be seen by a GP or pharmacist for up to six months.

Prof Everington told Panorama this was not safe. "If a letter destined for the GP is not being acted on for six months, that is a massive risk to patients, both in terms of the development of a more serious disease and them dying earlier." He said the government needed to send in the independent regulator, the Care Quality Commission. Operose Health is "putting profits, money ahead of quality of care. And that will have an impact," he said.

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Operose Health says that its document workflow has been commended by NHS England and that it "helps to ensure that clinicians receive accurate and well-coded documentation in a timely manner".

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

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 are 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".

The Department of Health says all NHS GP services are subject to the same regulation and standards - and that patients should always receive high-quality care.

The Care Quality Commission says that it takes all concerns seriously and will be following up as appropriate.

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