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. Patients of AT Medics were invited to attend a webinar from 6.30 to 7.30pm on Tuesday 16 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
Question
Is the due diligence process being carried out be legally qualified colleagues and does it have a focus on both the clinical and the corporate structure?
Answer
The due diligence process is being carried out by legally qualified professionals and is a process where we check the company is of good standing, what they look like in terms of their resilience and if they have any history of bankruptcy or anything in their corporation records and that we might have concerns about.
Question
Has the change of control already taken place as it appears that some directors have already resigned?
Answer
They have to seek and they have sought consent for the change of control. We are advised the transfer of ownership hasn't taken place yet, and they're awaiting the outcome of the change of control decision making.
Question
Have they assured us there will be no change to the way the practice operates and no change to the practice team and in particular the GPs as last time all left in our practice within 12 months and we are very concerned about continuity of care?
Answer
Whilst we cannot fix people into positions, as part of the due diligence we are asking about the level of capacity that's committed to the practices, what is their current contingent of staffing, what are they putting in place to support the practices and are there any changes planned.
We do have to accept that at some point, some staff might make their own decisions to leave, and that is entirely their prerogative and you can't stop them from doing that.
Question
They have a complex organisational structure. How does it fit together?
Answer
The corporate structure is complicated but the due diligence will clarify this. For instance, the structure we have at the moment shows T20 Osprey Ltd with HCRG in brackets. We need to clarify all this.
Question
Is the change of control process the same as other changes that occur in GP practices? For example, when a practice is merging where there is a requirement for extensive engagement. Is this different in some way to that process, and if so, how?
Answer
In this case the contract holder is remaining the same. It is AT Medics Ltd who are then owned by Operose Health Ltd. Further up the corporate ladder you have the ultimate owner of the businesses.
Because there's no actual change to services being proposed and the contract holder is the same it limits in in essence the type of engagement and the type of due diligence that we can do. Its why the due diligence is focused on the change of control to make sure that the ultimate owners of the business are of good standing.
So it's just worth bringing that that clarity as to why we're not going through a process where there's a merger or a practice closure where we would proactively engage with patients in a more detailed way.
Question
How do you ensure that are delivering services to the required standard?
Answer
There's are different standards and requirements under the contracts that they need to achieve. We check to see if the practice achieves these or as we call them key performance indicators (KPIs). For instance, their rate of vaccinations and screening
We also look at patient feedback whether that is through the national GP patient survey or other local surveys that we do and complaints and general patient feedback.
Taken together it helps us to build a picture on whether a practice is doing ok. If a practice is not doing ok and we need to take action. If it is a smaller concern, we might issue and agreed action plan for them to follow. If it’s a more serious concern such as on patient safety, we would take more immediate urgent action.
Question
Why do we have to let private businesses or hedge funds run our GP practices?
Answer
We operate under a national legislative and national contractual framework that allows private providers to bid and run GP practice and that's what we have to abide by. If we depart from that it opens us up to legal challenge as well.
Question
Are you following the same process as last time?
Answer
The due diligence process that we're following is largely the same as we undertook last time. What we have said is that we will learn from last time and that we needed to give patients and members of the public more opportunity to provide comments and ask questions.
When we move to considering the request for a change of control we can we can take into account all that feedback which is why we've set up this webinar and we've made sure that we communicated to all the patients. The information we collect in the comments will go into a go into a report that we will produce this feed into the information which goes to forward to the primary care executive groups where they will consider whether to consent to the change of control.
Question
There are a lot of concerns that people have about service provision and a lot of aspiration to see improvements to services. Do you have the ability to let the potential new controllers of the practices aware of this level of concern and aspiration from their patients?
Answer
We've asked them for a lot of information as part of the change of control process but we need to be able to build in a feedback loop, particularly if the change of control goes ahead.