- Internal report says GP provider’s relationship with CCG had “deteriorated to the point where mutual confidence is low and new business contracts become unlikely”
- Trajectory against an NHS England contract at the start of September would “lead to around a £434,000 deficit”
- Community interest company says situation has changed and it expects to meet its obligations
- Provider received £4.4m from the prime minister’s challenge fund
Concerns have been raised over the local relationships and finances of a GP provider that has received significant backing from national health leaders.
An internal report for Warrington Health Plus, which stated the company’s position at 1 September, has been leaked to HSJ. It noted how its relationship with Warrington Clinical Commissioning Group had “deteriorated to the point where mutual confidence is low and new business contracts [have] become unlikely”.
The community interest company’s main business activity appears to be running three GP practices, under a contract with NHS England, and the report said the trajectory against the contract would “lead to around a £434,000 deficit” by March 2017.
It added: “The degree of cumulative loss will mean that the organisation will not be able to meet its financial obligations before the end of this contract.”
When contacted by HSJ, WHP said the situation had now changed and it expects to meet its obligations, but it did not provide a detailed explanation.
A company report published online suggested its total income for the year to July 2015 was just over £3m. A report for the year to July 2016 is not yet available.
The internal board report was written by chief executive John South, who took over after the departure in August of Alison Holbourn, who has been appointed deputy chief inspector of general practice at the Care Quality Commission.
He said there was a need for WHP to review its “present business status” and “take a step back” from strategic partnership meetings across the Warrington health economy.
On the contract for the GP surgeries, known as the CCA practices, he said there should be a renegotiation with NHS England, and he was “not convinced” that WHP should bid for the contract in an imminent tender process.
He added: “I am aware that this is not in line with present thinking. However, my feeling is that the financial risks will be unsustainable, especially when a salaried model is used versus one of GP partners… and there may be better solutions for patients and Warrington practices as a collective.”
The report also set out plans to enhance relationships with stakeholder organisations and review the organisational structure.
Warrington has been highlighted nationally for its work and efforts to improve primary care, and WHP was set up in 2014 to administer around £4.4m of transformation cash awarded through the prime minister’s challenge fund.
This money was to deliver various time limited projects to improve access to primary care and ensure better coordination of services. Mr South’s report did not refer to these schemes.
Earlier this month, the WHP website prominently featured a quote from chair, Catherine Doyle, which described the company as a “last ditch attempt to save primary care – to preserve the NHS free to the public at point of use, to keep general practice sustainable”. The site has since been updated and the quote replaced.
In a statement to HSJ, Dr Doyle said of the internal report: “Like many businesses, such reviews are an important part of what they do and would normally include focus on those contracts that may be temporarily overheating.”
She did not respond directly to questions about the trajectory of the CCA contract, but said the report was written more than seven weeks ago, and “our financial plans and strategies are such that WHP as a CIC will achieve financial balance at year end with all obligations met”.
She said a renegotiation of the CCA practices is ongoing, and WHP will decide whether to bid for the new contract when procurement information is available.
She added that the PM’s challenge fund was a time limited project and “it was therefore right that the board take the opportunity to re-evaluate its position and the contracts we are presently involved with”.
Ivan Camphor, medical secretary of the Mid Mersey Local Medical Committee, told HSJ there had been questions over the success of the schemes, adding: “It’s my understanding that on the ground very little seems to have changed for general practice in Warrington.”
He said like many other areas of the country, there is a “general feeling of apathy and despair” among the borough’s GPs, and there are currently 20 vacancies at 28 practices.
A spokesman for NHS England said a final evaluation report on all the pilot projects supported by the fund is “expected soon”, and there are no concerns about the quality of services being delivered at the WHP practices.
Warrington CCG said it “works collaboratively” with WHP but did not expand on why there had been a poor relationship.
It would not comment on the schemes funded under the PM’s challenge fund, saying NHS England held the contract.
Leaked board report