Operose Health - a subsidiary of US healthcare giant the Centene Corporation, which provides health insurance to around 25m Americans - is expanding its portfolio of NHS GP practices to 58 through a 'partnership' with major primary care provider AT Medics.
The deal will make Operose almost certainly the largest provider of NHS GP services in England - with nearly 1% of the total 6,658 practices in the country under its control, covering a total patient population in excess of 500,000.
The major expansion of Centene's foothold in NHS primary care has sparked concern among GPs, with the Doctors in Unite union warning the health service was being 'parcelled up and sold off under the radar'. The union has called for the cancellation of APMS contracts held by AT Medics.
Board papers considered by NHS commissioners in one area where AT Medics has notified CCGs of its intention to transfer ownership of the company to Operose Health show that local leaders were recommended to approve the transfer.
Operose already ran 21 NHS GP practices, spread from south-east England to the Midlands and north of England - and will nearly triple this figure through the deal with AT Medics. Its existing practices covered around 120,000 patients.
AT Medics has 37 practices registered with the CQC across 49 sites in London and south-east England serving 390,000 patients - taking the combined population to more than 500,000.
The company will hold more practice contracts and serve more patients than either the Modality or Our Health Partnership 'superpractices', each of which serve around 400,000 patients. It will cover more than five times as many patients as the current population of Babylon's GP at Hand - which operates the largest single patient list.
NHS primary care
A spokesperson for Operose Health said: 'AT Medics and Operose Health have formed a partnership in order to create the leading provider of NHS primary care services in the UK. The new partnership is committed to achieving high quality clinical outcomes and standards of care for our patients and communities.
'Existing AT Medics and Operose Health patients at our 58 practices will continue to receive the same excellent standards of care, while benefitting from further digital access and staff training. We have followed all the required regulatory procedures, including obtaining consent from the CCGs.
'Day-to-day operations of our GP surgeries, the care that we deliver to our patients and the services accessed through our surgeries will not change. Patients will continue to consult with us in the same way that they do today. Our practice teams will be the same and all of the AT Medics leadership team are staying with the organisation as part of our new partnership.'
However, Doctors in Unite chair Dr Jackie Applebee said she had received news of the takeover 'with the deepest disappointment and gravest foreboding'.
Fragmentation of care
She said private sector involvement in NHS services had led to 'fragmentation of care, to the detriment of patients'. Dr Applebee said: 'We have been warning for years that US healthcare firms are circling to swoop on the NHS. Our fears are dismissed by politicians and senior NHS managers.
'The public are constantly told that the NHS is not being privatised. The advent of Centene onto the general practice landscape reveals yet again, that this is a lie. In reality the NHS is being parcelled up and sold off under the radar.'
Londonwide LMCs deputy chief executive Dr Lisa Harrod-Rothwell told GPonline: 'London has a strong track record of practices being led by GPs who live among the communities they care for and are trusted by them, while working as part of the frontline workforce delivering the services they also manage.
'The true value of general practice to patients lies in its ability to use the intrinsic understanding GPs and practice teams have of the health needs of the people they serve, including social factors and other non-medical drivers of ill-health.
'We are relying on commissioners and regulators to ensure that patients and staff see no difference in the way that general practice operates, regardless of who 'owns' the contract, in those affected areas. And that regardless of ownership structure, GP partners and their teams work collaboratively, while maintaining the autonomy to deliver services in the best way to meet the needs of their patients and local communities.'
Liz Wise, director of primary care and public health commissioning for the NHS in London, said: 'The ownership of the holding company of AT Medics Ltd has been transferred after consent was given by the relevant commissioners. Patient Care remains unaffected by this change.'