GP chain ‘hiring cheaper, less qualified workers to replace family doctors’

THE country’s biggest chain of GP practices has been caught using cheaper and less qualified staff in place of family doctors.

Operose Health, which has almost 600,000 NHS patients on its books, was last night accused of putting profit before safety.

The company is owned by US healthcare giant Centene and runs 70 surgeries across England, including 51 in London.

A GP working at one practice told an undercover BBC reporter posing as a receptionist that they were short of eight doctors.

And the practice manager admitted hiring less qualified medical staff, called physician associates (PAs), because they are ‘cheaper’ than GPs.

Family doctors in England earn an average salary of £100,000 but Operose is currently advertising for a PA on £42,000. PAs have only completed two years of postgraduate studies on top of a science degree, rather than the ten years’ education and training required of GPs.

They were first introduced by the NHS in 2003, so doctors could be freed up to deal with more complex patient needs. They can support GPs in the diagnosis and management of patients as long as they have the oversight of a doctor. However, the BBC Panorama investigation found that PAs were not being properly supervised at the Operose practice, which is in London but has not been identified.

The PAs told the undercover reporter they saw all sorts of patients, sometimes without any clinical supervision, and that the practice treated them as equivalent to GPs.

It comes amid a nationwide shortage of GPs, which is piling pressure on doctors and has left patients struggling to secure appointments.

Analysis of NHS data on 6,500 practices across England reveals Operose operates with half the number of GPs per patient than the average. They also employ six times as many physician associates.

One GP, who wished to remain anonymous, said of PAs: ‘They were doing the same job as us, with less experience, less qualifications and earning less money.’

While undercover, Panorama was also told about a backlog of important patient referral documents, often unread by doctors or pharmacists for months.

One worker said they were given the task of 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.

Professor Sir Sam Everington, a senior GP at an unconnected practice, accused Operose Health of ‘putting profits, money, ahead of quality of care’ and added: ‘That will have an impact.’

Referring to the document backlog, he said: ‘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.’

GP practices have always been run as private businesses, owned and managed by doctors, to provide services to the NHS. But in 2007, the then Labour Government changed the rules, allowing larger businesses to buy up practices in England.

Since 2016, Operose Health has spent tens of millions of pounds buying GP surgeries. In 2020, it bought 32 practices from Londonbased AT Medics for a reported £50million and is now the largest supplier of GP services to the NHS.

Professor Martin Marshall, chairman of the Royal College of GPs, said it is normal for GPs to work alongside other healthcare professionals, such as PAs.

But he added: ‘It is essential that all healthcare professionals working in general practice receive appropriate training, support and supervision, and that no healthcare professional is asked to work outside of their clinical competence. This would both be unfair on them and a risk to patient safety.’

Operose Health denied being over reliant on PAs and said that a clinical lead is on site most of the time to help answer questions. It added that its document workflow has been commended by NHS England and allows clinicians to receive correspondence ‘in a timely manner’.

It also said its processes are ‘audited monthly for quality and safety’ and denied putting profit before patient care. The firm added it has recruited 38 GPs in the past 12 months and is in the process of recruiting 14 more.

NHS regulator the Care Quality Commission said it takes all concerns seriously and will be following up as appropriate.