The Practice Group Ltd
Founded in 2005 by Dr Ajit Kadirgamar and Dr Jeremy Rose, both GPs, plus Peter Watts, a businessman.
The Practice Group (TPG) works in primary care and community care. The business is private with the major investor being the US healthcare company Centene Corporation. Centene has a 75% share in The Practice and sits on its board of directors.
The company's primary focus for many years was in primary care, plus walk-in centres, but it also has some contracts to run community services in the area of ophthalmology and dermatology. In April 2016, TPG added a new division, TPG Complex Care, focused on care at home for patients with complex needs.
The company's March 2016 financial statement shows that the group had 517 staff - 188 clinical and 331 in administration. That compares to 544 overall in 2015, 208 clinical staff and 336 admin. The loss of 30 clinical staff comes at a time of a general shortage of GPs.
In the outset, TPG's strategy was to offer to take over the running of the infrastructure of existing GP practices including the premises. It offered 100% purchase or a partial equity release scheme for GP premises and then employed the GPs as medical staff with the possibility of share options in The Practice. The company targeted GPs selling their premises, down-sizing for retirement or needing expansion funding (3,4). By mid-2010 The Practice had 16 contracts with GP surgeries. The Practice then underwent a phase of rapid expansion through the acquisition of other companies. In November 2010, it acquired the surgery business of Chilvers McCrea (over 30 surgeries), in April 2011 the surgery business of United Health UK (six surgeries). More recently in May 2016 The Practice acquired Phoenix Primary Care Limited (12 GP surgeries.). At the time of the acquisition, Phoenix had 58,000 registered patients.
In other areas The Practice has tendered for contracts with CCGs. In March 2010, the acquisition of the company Drummonds expanded the company’s business in the area of secure health, adding contracts in two immigration removal centres. However, in 2017 there was no record of prison services on TPG's website and the company Drummonds is listed as dormant in the company's accounts to March 2016.
In mid-2017 The Practice listed 37 surgeries on its website. In addition the company lists 15 ophthalmology services and four dermatology clinics (three in Blackpool and one in Kent).
An interesting strategic move for the company came in April 2017 with the launch of a new complex care division to provide home-based complex healthcare services to people with significant health conditions, long-term illnesses or disabilities. The division is known as TPG Complex Care. In May 2017 it launched its opening at headquarters in Telford.
The Practice is now angling for a slice of the hospital-at-home market. With the primary strategic direction of the NHS being for more care to be administered at home in preference to more expensive hospital care, then The Practice Group has targeted what it believes to be a massive growth market. The company highlights that its new division "is based on enabling people to make their own choices and to be able to live their life comfortably at home independently." The division is marketed as a company that can potentially reduce hospital stays, eliminate hospital admissions and support relatives. The thrust of the website and marketing is of a company working for the NHS, rather than targeting the private home care market.
The company is targeting its services at a wide variety of specialist healthcare conditions, including acquired brain injuries, spinal injuries, learning disabilities, mental health conditions, neurological disorders, dementia and those with ventilator dependencies.
Information provided through companies house shows that in the year ending March 2016, The Practice Group recorded revenue of almost £29.5 million, however it recorded a loss of almost £1.3 million, compared to a loss of £710,248 the previous year.
The group is a private company limited by share capital and incorporated in the United Kingdom.
The 2016 accounts show that the group derives all its revenue from NHS contracts for iGP surgeries and community healthcare services.
According to the company's annual report for the financial year to March 2016, The Practice Group Ltd is majority owned by the US company Centene Corporation; its share of TPG was increased from 49% to 75%. Centene Corporation is a Fortune 500 company listed on the New York Stock Exchange. TPG describes Centene Corporation as "a diversified multinational healthcare enterprise that provides services to government-sponsored healthcare programmes."
Centene Corporation has taken "an active role in strategic and management oversight of the group" according to documents filed with Companies House by The Practice Group.
Centene is a publicaly-traded company that acts as a major intermediary for both US government-sponsored and privately-insured health care programs. Centene works with Medicare, Medicaid, and The Health Insurance Marketplace System, as well as traditional commercial insurance. The company has over 30,000 employees across the USA and operates health plans that serve 2.9 million members in 24 US states.
TPG has struggled financially since its beginnings and, according to accounts filed with Companies House, TPG has never made a profit. The company has been shored up with money from venture funds and investors, the latest being Centene Corporation in 2016. The company's first major investor was the venture capital fund MMC Ventures Ltd. The initial investment of £865,000 was in 2006. This was followed by a further £1.4 million in October 2007 and £1.1 million in July 2007. According to ex-CEO Peter Watts in 2010 The Practice has only just begun to break even.
TPG has contracts to run GP surgeries, with 37 listed on its website. Recent contract awards include:
A GP services contract published in August 2015, to run for 3 years in Doncaster for an unknown sum of money.
In October 2015, TPG was awarded a contract to run the North Kent Community Ophthalmology service by NHS Medway and two other CCGs. The contract is worth £4 million and will run for 3 years.
In May 2016 a £4.8 million contract to run primary medical GP Services for Northumberland Avenue (and Luker Road Branch) Practice in Southend-on-Sea, Essex. This is a ten year APMS contract, with an option to extend for a further five years.
Quality of care
Through its acquisition strategy The Practice Group (TPG) has grown substantially. In the main, TPG does not have a policy of ownership or partnerships for GPs, but employs salaried GPs at its practices. Of the problems that have been reported in the media, a major component has been the excessive use of locums because the company is unable to find permanent salaried GPs with potential for a reduction in quality of care for patients. Indeed, the number of clinical staff employed by the group has fallen.
In June 2012 TPG relinquished a contract to run the Brandon Street surgery (also known as Belgrave Health Centre) in Leicester. TPG had failed to recruit permanent GPs for the surgery and a succession of locums was used. Patient complaints noted difficulties in getting through on the phone and making appointments, rude staff, and the use of locums which meant medical history had to be gone over again and again in the limited appointment time allowed. TPG took over the running of this surgery and three others in Leicester in 2010 for five years under a £5 million contract.
In April 2012 TPG closed its Camden Road surgery in London, which it had bought from United Health, when its lease ran out. There was an outcry from patients who had been given very little notice of the decision. Both United Health and TPG were accused of running down the surgery and there was considerable use of locums. The closure triggered a public enquiry by Camden Council. Neither UnitedHealth nor TPG produced any evidence at the public enquiry. The process by which The Practice acquired United Health’s surgeries was severely criticised by the enquiry, which noted that a loophole in APMS contracts needed to be closed. A third scrutiny committee meeting to discuss the closure of the surgery had to be abandoned when both United Health and The Practice, refused to attend
In 2011 The Practice was given notice to terminate its contract for the St James medical practice in Handsworth, Birmingham, in December 2011. The Practice Plc noted that “The type of contract we have is a ten-year fixed term and the PCT have the option to terminate at the mid-point which they have chosen to do. This coincides with the unexpected termination of our lease by Vitality which means we will have no premises to practice from after December 31.” The Vitality Partnership is a GP partnership across five practices in Birmingham.
There was further controversy in January 2016 when TPG announced its intention to terminate its contract for five surgeries in Brighton and Hove following a funding dispute. This left the future care of 11,400 people in doubt. Patients have since been dispersed to other practices and only one practice, the one serving the homeless community, has been recommissioned.