There has been a shedload of problem with NHS services in Shropshire. Think of Ockendon report on maternity services in Shropshire. Think of the very delayed Future Fit and the abandoned and forgotten Community Fit. The withdrawal of services from rural areas. The great success of health services in Shropshire has been the resilience of NHS staff and the strength of our GP services. And the out of hours service, ShropDoc.
ShropDoc is run as a co-operative. Shortly, our out of hours provision will be supplied by an American venture capitalist company, Medvivo.
The Integrated Care Board (ICB) is the part of NHS bureaucracy that pays for the health services we receive in Shropshire. After a procurement exercise that had to go to a national panel for examination, the ICB decided to axe ShropDoc and replace it with Medvivo Group, a for profit company based in Chippenham, Wiltshire. Medvivo is owned by Eight Roads, an American venture capital company. Medvivo specialises in telecare. It is rated Outstanding by the Care Quality Commission (CQC).
Shropdoc is a not for profit company. Established in 1996, Shropdoc is organised and governed by GPs for the purpose of providing medically necessary care to the population of Shropshire and surrounding counties out-of-hours (OOH) on behalf of its members. Shropdoc has over 200 GP members comprising GPs from Shropshire and Powys, with a smaller number from adjacent areas. Around 250 members of staff work in a wide variety of roles. It is rated Outstanding by the CQC.
The decision by the Independent Patient Choice and Procurement Panel did not look at which service was best for Shropshire and Telford & Wrekin. It only looked at whether the procurement process was fair. It concluded that there were some limitations in the procurement process, for example, limited information on key performance indicators. But the ICB’s actions met legal and regulatory requirements for transparency, fairness, and proportionality. The review wasn’t about the standard of service to be provided. It was only about whether it complied with procurement rules. The outcome was yes, but only just.
I am appalled by this decision. NHS services work best when they work as a team. ShropDoc is a hugely successful service run by local GPs for local patients. They know about health in Shropshire and Telford. They know about its complex geography and the remoteness of many areas, along with the impacts of isolation.
To save money, the local Integrated Care Board, with national approval, has awarded the out of hours contract to a company owned by American venture capitalists based in Wiltshire. Local involvement will end. A huge reservoir of local and medical knowledge will be unavailable out of hours.
When the NHS was founded, it was local doctors doing their best for local people. We have left that behind. This can only lead to worsening health outcomes at a time when national priorities are to improve health to reduce the need for hospital care and to reduce disability payments.
Why do we want to break something that is working so well?
So NHS pen-pushers who don’t understand the needs of our area have deprived our area of out of hours medical care and are handing the money saved to an American company. Meanwhile A&E will now as a direct result, be busier than ever as the people will still, undoubtedly, need some access to out of hours care. The pen-pushers are not fit for purpose.
More queing ambulances at A&E
Andy
here is the text of an email I sent to the head of the ICB in February following the Town meeting on this matter in Ludlow. There were legal challenges, one I think questioned the way the application by Medvivo had been made. David Sandbach, the ex CEO of Telford Hospital raised a question as to the process and was very critical of the way it had been handled. I am sure you know how to contact him. I also give the response to the email from Simon Whitehouse the head of the ICB – basically “B*gg*r off and don’t bother us.”
The point I make that might not be clear to your readers is that the same people will be providing the service as before. The out of ours service will continue just with a financially stressed provider. Gill George, who I am sure you know also had an email from me about the financials of Medvivo which she can share with you if she wishes,
I attended a meeting in Ludlow recently to discuss the provision of out of hours GP services. This was prompted by the suggestion that the current not for profit Shropdoc service was to be replaced by a privately owned and commercially motivated provider. There was widespread anger shown by those present as to how the review process had been handled. There was genuine amazement that there was a deadline of 14th February when a final decision was to be taken. I take an interest in local health matters – I am a Trustee of the Ludlow Hospital League of Friends – but I was unaware of this proposed change, as were most, if not all of those present at the meeting. At the very least there appears to have been a lack of appropriate communication in how this very significant matter has been handled.
As to the preferred bidder there was widespread disbelief that a commercial organisation could provide a service that was equivalent to that provided by a not for profit organisation. Anecdotally I have been told that the new provider will be paying the doctors working for them the same as currently paid by Shropdoc. How can the service be maintained and the provider make a profit? You will be unsurprised to hear that there was a degree of scepticism in the audience that the new arrangements would work as well as those currently in place. No doubt that any agreement with the new provider will contain performance targets etc. However once Shropdoc is gone it is gone for good. By definition it can’t find other customers. If the new provider doesn’t perform where do you go from there?
The meeting was told that there were two potential legal challenges to how the process has been handled. If this is correct it would be very rash for a decision to be taken on 14th February. If the claims of illegality are shown to have merit unscrambling a hastily taken decision could be disastrous for the people of Shropshire.
If the decision goes ahead you will be faced with a barrage of bad publicity. For a Trust whose performance was recently rated 118th out of 118 I would have thought this is something you would want to avoid. Imagine The Telegraph follow up articles.
People are very angry. The only reason that I think you have not been inundated with protests is the very low key way in which the matter has been handled. There has been little time to mobilise protest up to now, if the decision goes ahead you will be hearing from a lot of very angry people.
There may be assertions in this email that are inaccurate – it is not possible in the short time we have left to check things rigorously – but no doubt you will correct any factual errors.
In the interests of democracy and accountability please pause this process now.
RESPONSE
Dear Mr and Mrs Walker
Thank you for your email in relation to the GPOOH procurement.
Following the NHS Shropshire, Telford and Wrekin Board Meeting which took place on Wednesday, 29 January 2025, Board members have approved the recommendation and intent of commissioners to award the GP Out of Hours contract to Medvivo.
Importantly, we remain within the legal procurement process and, whilst the standstill period is active, we cannot officially confirm Medvivo as the new provider or share any further information – only that it is our intention to award the contract at this stage.
In line with statutory and legal duties, we have undertaken a robust, transparent, and fair commissioning and procurement process that commenced in August 2024 to determine the future of the GP Out of Hours service in the county.
This has been undertaken by NHS Shropshire, Telford and Wrekin, through a competitive procurement process in order to continue providing a high-quality, value for money out of hours service that meets the needs of our local people, in accordance with the key principles of the Provider Selection Regime (PSR).
The ICB and any bidders are bound by confidentiality in relation to Procurement. Given this position, the ICB will not be making any further statements in relation to this service or the procurement process.
Simon Whitehouse
Andy,
I notice that you only offer sharing on the appalling techbro platforms of Twitter and FB – there are other more ethical outlets e.g. BlueSky and Substack.
I can’t at the moment change the options. I don’t have the money. But as always, you can cut and paste the link.