Practice Plus Group services include treatment centres, GP practices, walk-in centres, out-of-hours GP support, diagnostics facilities, ophthalmology and prison healthcare.
In 2020, Care UK divided its business into two separate companies - the care home business remained as Care UK, but the healthcare business was rebranded in October 2020 as Practice Plus Group. Both Care UK and Practice Plus Group are owned by the investment company Bridgepoint, but are now separately managed and financed. Care UK's business is covered in a separate profile.
Last updated: April 2024
Strategy
Practice Plus Group is a private hospital and primary care healthcare company formed in 2020 when Bridgepoint, the owners of Care UK, split the company into two - putting the care home business in a separate company (see separate profile). Practice Plus has 10 hospitals and surgical centres and specialises in orthopaedics, such as hip and knee replacements, general surgery, and ophthalmology. The company also has several contracts with the NHS for primary care, urgent care, 111 services, and healthcare in prisons.
Formation of Practice Plus Group
In October 2019, Care UK split its business into two separate companies, one covering care homes and the other covering all its healthcare businesses.
On 25 October 2019, Care UK Health & Social Care Holdings Ltd (the parent company) sold its shares in Care UK Healthcare Holdings Ltd to a new company Care UK Healthcare Bidco Ltd, which is outside the Care UK Group structure but still managed by Bridgepoint. Care UK Health & Social Care Holdings Ltd changed its name to Care UK Holdings Ltd.
In October 2020, Care UK Healthcare was rebranded as Practice Plus Group, containing primary care services, urgent care, prison healthcare, diagnostics, ophthalmology, hospital-based services and private healthcare.
For more information on Care UK and its history see the separate Care UK profile
Financials
The most recent financial reports available are for the year ending 30 September 2022.
Practice Plus Group Topco Ltd, the parent company for Practice Plus Group Ltd, reported finances for the year ending September 2022. Revenue was reported as £460.6 million (2021: £410.9 million). Secondary care reported revenue of £186.6 million, the Health in Justice area revenue of £186.4 million and integrated urgent care revenue of just over £88 million. Profit for 2022 was £14.2 million (2021: £13.9 million.)
Practice Plus Group receives a high proportion of its annual revenue from the NHS. All income in the area of integrated urgent care (over £88m in 2022 and health in justice (£186.4m in 2022) are from NHS contracts, and a certain proportion of income in secondary care is from NHS work. In integrated urgent care, the company estimates that it has 15% of the NHS 111 market and 15% of the out-of-hours market.
Investors
In March 2010 Care UK was acquired by Bridgepoint in a deal worth £432 million and Care UK was removed from the public markets.
After the formation of the two companies - Care UK and Practice Plus Group - Bridgepoint continues to be the ultimate parent company and controlling party of both companies.
Contracts
NHS contracts
Practice Plus Group has a large number of contracts with NHS commissioners and local councils.
Data collected by the NHS Support Federation estimated that as Care UK it was awarded £187.4 million in contract awards from 2010 to April 2016, then from April 2016 to April 2018, the company was awarded a further £709.8 million in contracts.
In April 2015, Care UK terminated a contract for an out-of-hours service. The contract was to provide OOH care in conjunction with Portsmouth Health Limited (a group of local GPs), however the contract, which began in 2012, proved to be loss-making and so Care UK terminated its involvement before the end of the contract.
Prison Healthcare Contracts
According to the Practice Plus Group website the company delivers healthcare to more than 41,000 patients at 41 prisons and immigration removal centres of all categories. It notes that the company is the leading independent provider of healthcare services in prisons and youth offender establishments. The company provides the following services to prisoners: primary care; substance misuse services; mental health services; dentistry; occupational therapy; physiotherapy; podiatry; and optometry.
The most recent award was in February 2024 for integrated prison healthcare services for Leicestershire & Rutland Prison Cluster and Derbyshire Prison Cluster. The contract is worth £96 million over six years.
In March 2023 Practice Plus was listed on the contract for provision of Integrated Prison Healthcare Services, along with Oxleas NHS FT, for HMP Belmarsh, HMP Thameside, HMP Pentonville, HMP Wormwood Scrubs, and HMP/YOI Isis. The maximum annual contract value for the contract is just over £43.3 million per annum. Over the 7 years, if all contracts are extended to their full duration, the total maximum contract value will be £302.8 million.
In April 2022, PPG lost its contract for prison healthcare in the south west; the new 10 year contract was awarded to Oxleas NHS Foundation Trust. PPG only retained the contract for HMP Eastwood Park. worth £42.4 million.
PPG is taking legal action against NHS England over the procurement in the South West. The contract was divided into four lots, runs for seven years from October 2022, and collectively is worth a total of more than £273m.
PPG had the contract at six of the sites. The legal challenge claims the NHSE was “manifestly wrong” in how it scored different sections of its bid, claiming it broke principles of equal treatment by apparently evaluating its bid in comparison to Oxleas FT.
In the 2016/17 year Care UK won a contract worth £135.6 million to provide healthcare at prisons and detention centres across the Thames Valley, Bristol, South Gloucestershire, Wiltshire and Gloucestershire. In the same year, Care UK was also awarded contracts for prisons in Devon and Dorset, worth £79.8 million, and Sudbury and Foston Hall, worth over £18.5 million.
In the 2017/18 year Care UK was awarded a £23 million contract for "Healthcare Provision for Women in Prisons across Yorkshire & Humber". It also received a £4.6 million contract for healthcare services at HMPYOI Feltham.
Hospitals and surgical centres
Practice Plus Group runs ten hospitals and surgical centres. Work is carried out for private patients and those funded by the NHS.
Practice Plus Group, as Care UK, is listed on the framework contracts for outsourcing services listed on the Shared Business Services website and as Practice Plus on the award in 2021.
Many of the contracts awarded to Care UK covering elective surgery prior to the Covid-19 pandemic where superseded by the contract awards as part of the pandemic response.
In September 2019, Care UK was awarded a place on a framework to provide elective surgery services to NHS trusts in the north of England.
In October 2018, the HSJ reported that the University Hospitals Plymouth Trust had entered an agreement with Care UK for the company to take over all elective orthopaedic surgery for 18 months. Surgeons and anaesthetists at the NHS trust will move to Care UK's Peninsula Treatment Centre to operate on around 200 patients per month. The staff will remain trust employees but be managed jointly by Care UK. The trust hoped that this will free up space over the coming winter.
This agreement was termed a 'partnership' by the trust and was not awarded via a tender process.
Barking and Dagenham, Havering, Redbridge and Waltham Forest CCGs awarded a £70 million contract to Care UK to provide elective care services.
Shepton Mallet Health and Wellbeing Centre
The contract for the Shepton Mallet Health and Wellbeing centre is worth £120 million over eight years. Under the contract, which began in January 2017, Care UK, and now Practice Plus Group, will work with the Somerset Partnership NHS Foundation Trust, which currently runs the community hospital and the minor injuries unit (MIU) on the site. However, as this is a prime-provider contract, PPG is able to subcontract work to other firms and organisations. At the moment, PPG runs its Shepton Mallet hospital on the same site delivering a range of private and NHS services.
Integrated Urgent Care and NHS 111
Practice Plus Group runs a large number of NHS 111 services. The company states that it has designed and is delivering a new model of Integrated Urgent Healthcare. The model brings together out-of-hospital services and a hub of clinicians behind the existing NHS 111 number. This model is now being implemented in the West Midlands, for several CCGs and in an alliance with other local out of hours care providers.
The company has two urgent care centres, one in Southampton and one in Portsmouth.
In early 2024, PPG reports that it has eight NHS 111 contracts across England which serve a total population of over 6.7 million residents. The company's main 111 call centres are based in Southall, Dorking, Bristol, Ipswich, Exeter and Plymouth with two satellite centres in Worcester and Chippenham. The company's OOH services are delivered through eight contracts over 45 different facilities, provide a total population cover of over 8 million patients.
In the West country, the company runs Bristol, North Somerset and South Gloucestershire (BNSSG) 111, Gloucester 111 and Bath, North East Somerset, Swindon Wiltshire (BSW) 111, and Exeter and Plymouth IUC.
Out-of-hours services
Practice Plus Group provides OOH services through eight contracts over 45 different facilities for a total population cover of over 8 million patients. The areas covered are in North West London, South West London, North East Essex, Surrey, Warwickshire, Worcestershire, Coventry, Rugby, Gloucester, and Devon.
Recent contracts begun in 2022 include one with South West Integrated Urgent Care services in May 2022 and Devon Integrated Urgent Care services in September 2022.
GP services
The company has two walk-in clinics, one in Brighton and the other in Clapham Junction.
Practice Assist is a service provided by Practice Plus to GP surgeries designed to improve access for patients by providing additional remote capacity for practices. It provides registered patients with a full consultation by telephone or video on the same day with a GP, with full read and wrote access to the patient’s notes.
Patients call their local GP surgery as normal. Any patients with a clear requirement for a face-to-face appointment are booked in directly. Other calling for a GP appointment that can be managed over the phone are given a timed slot for a call back with a qualified Practice Assist GP, who will try to resolve their problems remotely. If required, the GP will then make any necessary onward referrals, either to the patient’s practice, or to other services.
Diagnostics and Musculoskeletal Assessment & Treatment
Practice Plus Group has four clinical assessment and treatment services (CATS) around the UK:
- Greater Manchester the service consists of two mobile clinics that rotate between seven sites around the city and provide fast access care in multiple specialties.
- Practice Plus Group MSK & Spinal Service, in Lincolnshire provides lifestyle advice and management, soft tissue and joint injections, initial physiotherapy treatment and diagnostics (MRI scans, ultrasounds and X-ray)
- Practice Plus Group MSK, Buckinghamshire specialises in physiotherapy, women’s health advice, acupuncture, multi-disciplinary management of MSK pain and diagnostics (MRI scans, ultrasounds and X-ray)
- Practice Plus Group Ophthalmology provides a glaucoma service, pre-operative assessments prior to cataract surgery and minor eye surgery, and specialises in the treatment of suspected Wet AMD (age-related macular degeneration).
There are also other locations, including the company's hospitals. The company states that each year it delivers more than 75,000 community-based scans at over 60 locations across the country on behalf of the NHS. Scans range from MRI to ultrasound, X-ray and echocardiography to CT and DXA (bone density testing).
Covid-19 contract
In March 2020, Practice Plus Group (as Care UK) was part of the deal with the government for using all its premises and staff for NHS patients during the Covid-19 pandemic. NHS England block booked almost the entirety of the private hospital sector’s services, facilities and nearly 20,000 clinical staff for the foreseeable future to help cope with the surge of covid-19 patients. The agreement only covers England and added around 8,000 hospital beds, nearly 1,200 more ventilators, more than 10,000 nurses, 700 doctors and 8,000 other clinical staff. This deal, which means the NHS is paying all operating costs for the hospitals, has been a lifeline for the company, as the lockdown meant that no private work was possible.
In June 2020, a £5 billion deal to extend the March deal to help the NHS clear the backlog of work was agreed by NHS England and the private hospital companies, however this was blocked by the Treasury. The Treasury did not believe the deal represented good value for money and that the evidence was not substantial. The block-contract basis of contracts with private providers continued, however, as NHS England prepared a new four-year framework contract for increasing capacity. In November 2020, ContractFinder, the government tendering database, reported that Practice Plus Group was one of 67 suppliers awarded a place on the NHS framework contract NHS Increasing Capacity worth in total £10 billion. The framework runs until November 2024.
In October 2020, the HSJ reported that Practice Plus Group (as Care UK) was the recipient of the sixth largest contract for staff and capacity from NHS England, according to a series of contract award notices, however the time period of 2020 this covered is unclear. The contract with Care UK published in October 2020 amounted to £76.3 million. An similar earlier contract award published in June 2020 awarded Care UK £1.3 million.
These block contracts have been criticised after leaks revealed that the capacity paid for by NHS England at companies, such as Care UK, was very under-utilised. HSJ reported that two-thirds of the private sector capacity that was block-purchased by the NHS at a cost of an estimated £400 million a month went unused by the NHS over the summer, despite long waits for operations.
In January 2022, Practice Plus Group became one of ten independent providers which signed a contract to provide extra capacity for the NHS under a three-month deal if Omicron leads to unsustainable levels of hospitalisations or staff absences. The deal, agreed by Sajid Javid, the then health secretary, meant that the providers are paid to be on standby, with the NHS ordered to pay the private hospitals up to £270m, even though they may not treat any NHS patients in return. Leaked letters showed that Amanda Pritchard, head of NHS England, raised grave doubts over the contract, which instructed the NHS to pay private hospitals £75m to £90m a month from NHS England funds for the next three months. The deal could have meant that the NHS had to pay independent hospitals up to £525m if they did end up treating any NHS patients.
The agreement also includes Circle Health, Nuffield Health, Spire Healthcare, Ramsay Health Care UK, Healthcare Management Trust, One Healthcare, Horder Healthcare, Aspen Healthcare and KIMS Hospital.
Concerns
Enforcement actions and Violation Tracker
Using the website Violation Tracker, a UK wide database of enforcement actions brought against companies by government regulators in England, Scotland, Wales and Northern Ireland, as of January 2023, Bridgepoint Group Plc has 13 enforcement actions from 2016-2022. This includes actions brought by the CQC against Care UK and Practice Plus Group, and well as by other organisations, such as the Health and Safety Executive. The database is readily accessible and can be searched by the public for up to date information on enforcement actions.
Care Quality
In February 2023, the CQC found that the PPG-run out-of-hours service needed to improve its staffing to meet its legal obligations. The service was rated 'requires improvement' due to rota gaps.
The CQC also found that 73 patients who were classed as urgent over the weekend of its inspection were still waiting to speak to a clinician the following Monday morning.
Gloucestershire County Council's scrutiny committee has noted that the service had required improvement for more than five years.
Since 2009, there have been a number of high profile cases in the national media in which very poor standards of practice by Care UK have been exposed. This included a BBC Panorama investigation which uncovered instances of gross negligence in care homes operated by Care UK. Other incidents include in 2011 the 84 year old woman who was not visited by carers for four days as Care UK thought she was in hospital and in 2012 the lack of processing of 6,000 X-rays at a Care UK-run urgent care centre.
In Suffolk Harmoni’s OOH service was heavily criticised in 2011 then again in 2012, for excessive waiting times and cuts to the service. In 2012 Harmoni reorganised its Suffolk OOH service, including the closure of several bases, including in Newmarket and Aldeburgh. The closure of the bases was reported to be without any consultation with local people.
At the end of 2012, it became evident that things were going badly wrong in Harmoni's out-of-hours business in London. In December 2012, The Guardian exposed a catalogue of failings, noting that senior doctors have complained that the service is so short-staffed that it is routinely unsafe. Harmoni is also reported to have manipulated its performance data to cover up for delays in seeing patients and missed targets.
One of the most high profile cases was that of a seven-week-old baby boy who died while in the care of Harmoni's out-of-hours GP service. Harmoni's service was described as "wholly inadequate" by a coroner in February 2013. The coroner noted that Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence". When the baby's mother attended the Harmoni clinic three and a half hours later, she was made to wait with her baby in a queue with six patients ahead of her. The baby died shortly afterwards in the NHS A&E department next door to the clinic.
In May 2013, the Care Quality Commission produced a report on Harmoni noting that cost-cutting at the company may be harming patient care. The routine inspection by the CQC, which was carried out in March 2013, found that Harmoni did not respond quickly enough to calls from patients in north central London because it did not have enough doctors, putting patients “at risk”. The CQC report was highlighted by The Independent, which in its article noted that Harmoni won the contract to provide the out-of-hours service against rival bidder LCWUCC, a non-profit GP organisation in west London, by beating it on price despite scoring worse on quality.
In September 2016, Veritas produced a critical report on Care UK's urgent care contract in Ealing. The contract awarded by Ealing Primary Care Trust in 2011 was worth £3.9 million to run an urgent care centre in Ealing Hospital. The independent report by Veritas was triggered following complaints of poor care made to ITV reporters. The report noted that there was a gap in the assurance process carried out by the CCG as well as problems with the staffing model used by Care UK, which “took no account of predictable peaks in demand”.
The contract ran at a loss for Care UK, but when the company requested more funding from Ealing CCG in May 2013 it was refused. Furthermore, Ealing CCG would not allow Care UK to terminate the contract. The contract finally ended in April 2016, when Greenbrook Healthcare took over.
Other concerns
In July 2015, Care UK complained to Monitor about the loss of its contract to run the North East London Treatment Centre; Care UK had run it for three years since 2011. In 2015 the new £55 million five year contract for the centre was awarded to Barking, Havering and Redbridge Hospital Trust. Care UK has questioned the procurement process and Monitor investigated. At the end of January 2016 Monitor found in favour of Care UK in the first part of the competition case; Monitor reported that it had identified “potential issues” with the procurement process. As a result, the CCGs extended Care UK’s contract by 15 months, then retendered the contract. Eventually, in September 2017, Care UK won the contract.
In December 2017 local press in the Bristol area reported that Care UK was sending hundreds of letters to local GPs outlining the costs of operations at Care UK's treatment centres in a marketing exercise for its self-pay services. Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide self-pay procedures.
The company is trialling the scheme at two treatment centres in the west of England, the Emersons Green treatment centre near Bristol and a second centre in Devizes in Wiltshire. The list of treatments on offer ranges from earwax removal (£160) to hip replacements at just under £9,000. Other procedures being offered include cataract surgery, tonsillectomies and vasectomies.
There is currently a six to 20-week wait for NHS patients seeking operations at Emersons Green treatment centre – the NHS says this wait time “under-performs against national and/or local standards”.
