NHS in London

Barry Gardiner Excerpts

Thursday 24th March 2016 Westminster Hall

[Barry Gardiner (Brent North) (Lab)]

It is a great pleasure to serve under your chairmanship, Ms Buck, but it is an even greater pleasure for all of us to see our hon. Friend the Member for Ilford South (Mike Gapes) back in his proper place in the House, doing what he does so well: representing his constituents.

I wish to make two points in this debate, and I am grateful for your indulgence, Ms Buck, in letting me come in at the end of the debate; I had other engagements. First, I wish to mention the case of Dr Chris Day v. NHS and Health Education England, which has exposed a particular lacuna in the protection for whistleblowers in the NHS. HEE oversees the training placement of doctors, and I understand that its role will increase under the new contracts. If a junior doctor blows the whistle, HEE will be able to terminate the doctor’s training as a punishment with absolute impunity. I know that the Minister would not wish to see that and that she is keen to ensure that whistleblowers get appropriate protection. I simply ask that she looks at that issue and takes the necessary action to remedy it.

The main focus of my remarks is the recruitment process for GP surgeries in north-west London. Specifically, I refer to Integrated Health CIC, which is known locally as the Sudbury surgery, and the number of problems that have arisen with that and the commissioning thereof. In 2013, the surgery was given to two doctors, Dr Omodu and Dr Akumabor, until March 2016. In fact, the contract on the surgery expires in precisely seven days’ time. I have been in correspondence with NHS England and Dr Anne Rainsberry, and the local council’s health scrutiny committee has been in correspondence with Monitor, to try to ensure that the concerns of local people are respected in relation to the surgery and the procurement process, and that is what I want to bring to the Minister’s attention.

There has been a lack of clarity in the handling of conflicts of interest in relation to the procurement. According to Brent CCG’s website, in February this year, five of the seven local GPs who have declared interests in relation to their Brent CCG activity have interests in Harness, which is the name of another surgery. They include the chair and vice-chair of the CCG.

It is noted that the practices that have been removed from the commissioning timetable are also associated with Harness, and that in October, Harness Harlesden and Harness Acton Lane surgeries were withdrawn from the timetable. It was reported that they were to merge and procure a service from either current Harness Harlesden premises or from primary care hub. In March 2016, it was confirmed that Brent GP Access Centre, run by Harness, was also removed from the timetable to align it with the service start of the walk-in service contract, also run by Harness, that is provided on the same site, but is being procured and commissioned by the CCG. This is to reduce the chance of any confusion about accessing the services and to avoid any unnecessary disruption to either service. It would appear that Harness Locality, representing 21 of the 69 GP practices in Brent, has disproportionate representation on the CCG governing body. It is the belief of members of the scrutiny committee, and a concern of mine and of residents, that there needs to be clarity on commissioner-provider interrelationships to ensure a fair procurement process and the retention of public confidence in that process.

GP practice leaders have expressed misgivings about the ability of local practices to meet the demands of the London key performance indicators. It has been suggested to Members that the London KPI regime is intended to favour larger bidders with the infrastructure to offer economies of scale. If that is the case, it puts NHS England and Brent CCG in direct conflict with residents in my constituency, especially in relation to the Sudbury surgery.

It is the clearly expressed opinion of local residents that the practice has served the community incredibly well, and they are extremely distressed, angry and puzzled by NHS England’s treatment of it. To give an example of just how well regarded the surgery is locally, in the three years that the two doctors have been running it, its list has increased from 3,500 to more than 8,000. That is by word of mouth, and that is success in action. People are rightly concerned about how the surgery has been treated.

On 11 March, I received a letter from Dr Anne Rainsberry of NHS England, in which she confirmed to me that

“in undertaking the decision making processes with the local CCG related to this time limited contract, the NHS England standard operating procedure ‘Managing the end of time limited contracts for primary medical services’…was followed.”

She goes on in her letter to talk about key stages 1 and 2, which she says were

“completed to enable a decision on how the services should be provided after the end of the contract and to implement that decision.”

I refer to stages 1 and 2 and the time standards for that contract. Stage 1 lists four requirements to be carried out a minimum of

“9 to 15 months before contract end (all essential)”.

Those requirements are:

“Needs assessment…Value for money…Impact assessment… Consultation proposal.”

The first contact that NHS England had with the surgery is noted in Dr Rainsberry’s letter, in the fourth paragraph from the bottom of the second page, which states:

“NHS England wrote to the current contractors in September 2015 regarding their contract and the proposal to re-procure the contract when it expired.”

On that page, she has outlined the fact that the procedure was not followed within the set time period. Yet on the first page of her letter, she told me that it was followed. That is not good enough.

Procurement does not have the confidence of local people or patients certainly in north-west London. I have enormous respect for the Minister—she is one of the Ministers I respect most across the House. She deals with things in a straightforward, plain-dealing manner. I urge her to look at the process I have outlined, because I do not think it has been done properly. I trust her to get it done right.