Author: TonyGosling
Posted: Fri Jun 07, 2013 1:03 pm (GMT 0)
GPs who hit the 111 jackpot: It's the helpline that's meant to save patients like baby Axel. But as this devastating dossier reveals, the biggest beneficiaries are the fat cat doctors who made millions from a firm that runs it
Harmoni, Britain’s largest urgent care provider, has been sold for £25 million
The GPs’ co-operative was formed in Harrow, North London in 1996
All of the five doctors who founded it are now millionaires
Firm is expanding massively despite claims it is stretched to breaking point
Last year, it was sent out 'Mayday' texts to doctors, begging them to work
http://www.dailymail.co.uk/news/article-2336000/GPs-hit-111-jackpot-Its-helpline-thats-meant-save-patients-like-baby-Axel-But-devastating-dossier-reveals-biggest-beneficiaries-fat-cat-doctors-millions-firm-runs-it.html
By Zoe Brennan
PUBLISHED: 23:28, 4 June 2013 | UPDATED: 07:41, 5 June 2013
So what is Harmoni? And how have ordinary GPs managed to pocket so much money, at the same time as horror stories about out-of-hours care have spiralled out-of-control?
In order to answer those questions, we must go back to 1996, when a group of doctors founded a GPs’ co-operative in Harrow, North London.
When, in 2004, the New Labour government negotiated controversial new contracts with GPs, allowing them to opt out of evening and weekend care for a pay cut of just £6,000, this co-operative stepped into the gap.
Harmoni became a pioneer in what is termed ‘telehealth’ — an umbrella term used to describe treating patients with the help of telecommunications technology. The company acquired private equity backing, and went from strength to strength.
Devastated: Axel's mother Linda Peanberg was placed in a queue with her dying son in her arms
In particular it has won the lucrative contracts for more than a quarter of the nation’s new 111 non-emergency medical call-lines, which are the centre of a growing scandal over the quality of patient care.
As we shall see, however, this is not just an issue of service: it is also about the huge profits these changes to the NHS are generating for certain individuals.
Some of Harmoni’s 111 contracts have already begun, others are being rolled out. One contract alone — for providing 111 cover for Sussex, Kent and Medway — is worth £28 million. This contract was awarded to Harmoni in partnership with the South-East Coast Ambulance Service (SECAmb).
In total, Harmoni makes £100 million a year from NHS contracts, and will soon care for 15 million patients outside opening hours.
Yet although Harmoni is being paid huge amounts to provide this service, it does not seem to translate to a high standard of care. A whistleblower who had worked as a Harmoni GP recently revealed that the company was using one nurse to cover 250,000 patients.
The whistleblower also said that doctors are being paid £1,350 a shift — £150 an hour — to plug gaps in the service, and European locums with poor English were flying in on easyJet to cover shifts.
In Saturday’s Mail, another whistleblower who works for the 111 helpline revealed that call-centre workers were being told to keep patients in the dark about how long they would have to wait to see a doctor, saying that ‘a doctor will be with you as soon as he can’ when they know it won’t be for up to 14 hours.
Last year, it emerged that Harmoni was regularly critically understaffed to the point of being unsafe, and was sending out ‘Mayday’ texts to doctors, begging them to work.
Little wonder the whistleblowing GP said that working for Harmoni was like sitting with a loaded gun about to go off, adding: ‘Everything is secondary to meeting budget.’
For some patients, this catastrophe has already happened.
Patients like Axel Peanberg King — a seven-week-old baby with pneumonia — whose case was downgraded from ‘urgent’ to ‘routine’ after a telephone consultation with an out-of-hours GP unit run by Harmoni. He was made to wait for four hours at home before an appointment at a clinic was arranged.
When his mother finally arrived at the emergency clinic with her dying son in her arms, she was placed in a queue, and her desperate pleas for help ignored.
Axel’s deteriorating condition was eventually spotted by an off-duty paediatric nurse — but it was too late to save him.
The coroner said he died as a result of ‘wholly inadequate’ decisions made by the out-of-hours doctor, but added that it was impossible to say whether earlier intervention would have averted the family’s tragedy.
The fact that blame was not laid squarely at the door of Harmoni in this case is legally important, of course — but of little consequence to the grieving family left feeling that their baby was let down.
Despite accusations that Harmoni is already stretched to breaking point, the organisation continues to expand at a rate of knots.
Last November — just after Axel died — Harmoni was sold to a company called Care UK for £48 million. It was at this point that the GPs who founded the company involved cashed in.
Harmoni’s finances are complex, but the Mail has established that the five doctors who founded the company in 1996 are all now millionaires, after a deal with a private equity company saw turn-over increase from £3 million in 2004 to £100 million last year.
As a result of the sale to Care UK, one Harmoni founder, Harrow-based Dr David Lloyd, is estimated to have made at least £2.8 million. A father of three, he still works at the Ridgeway GP practice in Harrow, yet seems to enjoy the fruits of his labour.
On a break in Arles, France, he enthusiastically tweeted about the beautiful ‘light’ and exclaimed ‘What a nice villa!’
Another Harmoni founder, Kenyan-born Dr Nizar Merali, also received an estimated £2.8 million from the deal.
He lives in a £2 million detached house in North London. Tellingly, when asked why he decided to sell the company, Dr Merali cites the case of a German locum, working for a provider taken over by Harmoni, who gave a pensioner a fatally high dose of morphine in 2008.
Dr Merali, 60, told the Mail: ‘Just like that incident, any out-of-hours provider at any time, in any part of the world can be unlucky, and incidents can occur such as those.
‘There was a degree of responsibility resting with me at the top end, as the only clinical doctor on the board. And really, the responsibility was too much.’
Pointedly, he added: ‘I have not regretted it; all those things you hear in the news are absolutely valid.’ However, Dr Merali insisted that he and his fellow founders did not make outlandish sums of money.
‘There are lots of costs involved before the money is in your pocket,’ he said.
Nor are the Harmoni founders the only ones to benefit from the company’s sale.
In addition, some 500 GPs working as out-of-hours doctors for Harmoni gained £25,000 each, received in February. As Dr Merali joked: ‘Hopefully, they will all be able to buy BMWs for their spouses.’
Of course, some may question whether the health budget should end up lining the pockets of individuals wealthy enough to splash out on luxury cars.
It doesn’t seem to be something which troubles former directors of Harmoni, such as Drs Adrian Richardson and Thomas Davies, who were reported to have earned £1 million each from the sale.
Dr Richardson still works as a GP in Willesden, North-West London. He lives in fashionable Hampstead Garden Suburb, on a leafy street of houses worth £2-3 million apiece, with his wife, Alison, and their two teenage children.
Dr Davies now lives in an attractive £2 million property set in extensive grounds in Northamptonshire. The five-bedroom farmhouse has commanding views of the countryside and a bespoke gym. Dr Davies also owns a stable of racehorses.
On a website for his GP practice in Hillingdon, he says: ‘Away from the practice, hobbies include breeding thoroughbred horses, gardening and messing about on boats.’
Harmoni's website boasts of the firms 15 years experience in delivering out of hours service
Obviously not short of a few pennies, in 2006 Davies and his racing partner turned down an offer of £1 million for Speciosa, their winning thoroughbred — which they had bought for just £30,000.
Another Harmoni director, Dr Ian Goodman, is also believed to have made more than £2 million from the sale, and now lives in a £1 million home in Stanmore, Middlesex, with his wife, Elizabeth, and their teenage son.
Dr Goodman chairs the Hillingdon Clinical Commissioning Group (CCG), which is responsible for buying health services for local people using public funding, and was recently accused by an MP of trying to put so many NHS operations out to tender to private companies that it ‘would have destabilised the whole hospital’.
But this is not simply about Dr Goodman and a few other doctors who, like him, got ‘lucky’ selling Harmoni.
It reflects the murky connections and conflicts of interest which define in this new Wild West landscape of privatised medical care.
The British Medical Journal has revealed that more than a third of GPs on the boards of Clinical Commissioning Groups in England have a conflict of interest resulting from directorships or shares held in private companies such as Harmoni.
Andy Slaughter, Labour MP for Hammersmith, says: ‘The people who are making decisions on closing A&E units are the same people who, in many cases, have shares in the possible eventual providers for the services they are replacing.
‘This is the bulk of NHS spending they have in their hands. It is either a touching naivety in the system, or worse.’
Private equity firms ‘see it as a massive opportunity’, he adds. He says he believes some of the figures reported after the Harmoni sale were ‘low estimates’ of the profits made by individual GPs, and the situation was ‘very opaque’.
Nor is that the only murky issue. The former chairman of Care UK, which owns Harmoni, is venture capitalist and Conservative Party donor John Nash, who donated £21,000 to the personal office of Health Secretary Andrew Lansley in 2009.
It’s certainly a booming business. The operating profits of Care UK soared by several millions of pounds last year, which fed back to the firm’s ultimate owners, a private equity firm called Bridgepoint Capital.
Expanding: In total, Harmoni makes £100 million a year from NHS contracts, and will soon care for 15 million patients outside opening hours
And who is the chairman of the advisory committee at Bridgepoint? Why, none other than former Health Secretary Alan Milburn — the same man who was at the helm up to 2003 when negotiations were going on with GPs prior to their contracts being changed so they no longer had to work at nights and weekends, effectively ushering in the era of private firms operating the NHS’s out-of-hours services.
His secretary confirmed his role at the equity company, though a spokesperson for Harmoni insisted that ‘Alan Milburn does not work with Harmoni’. No, he just advises the company that owns it.
There are further intriguing links which are only now emerging.
A man named Jim Easton was on the NHS Commissioning Board, which oversees England’s NHS budget (£95.6 billion for 2013-14).
It was responsible for the procurement process for the new NHS 111 services, in which Harmoni was so very successful.
In October last year — after enjoying an exotic holiday in Egypt, which he documented on his Twitter page — Easton resigned from the NHS Commissioning Board to become the healthcare managing director of . . . Care UK, the company that took over Harmoni just a month later.
He said the new role was an opportunity ‘too good to miss’. Little wonder, given Care UK’s turnover is projected to hit £700 million.
Yet the company makes so much money by keeping its costs terrifyingly low. Its subsidiary, Harmoni, is recruiting call operators in the London area, offering a rate of £9 an hour. Alarmingly, candidates for the post of ‘health adviser’ — working on the 111 lines — do not need prior medical knowledge, and are given basic four-week training.
Harmoni protests that it provides a robust system, yet the company’s stock response will offer little consolation to those who believe their loved ones have died as a result of the chaotic out-of-hours system.
A spokesman for the firm says: ‘We would like to express our deepest sympathy to those families who lose a loved one in any circumstances.
‘Sadly, any large health care provider like Harmoni will be involved over time in the care of some patients who then die, making it essential to understand the causes of death and any lessons for the service.
Harmoni always undertakes a detailed review of the circumstances surrounding such deaths to see what, if any, lessons can be learned. ‘However, we firmly believe we have the right underlying systems, policies and procedures to ensure a safe and robust out-of-hours service.’
As we have seen, many families who have used their services take a very different view. The mother of little Axel Peanberg King, who died of pneumonia, says: ‘It all feels very sinister when you begin piecing it together — there are so many vested interests in healthcare now.
‘A lot of decisions are made with financial interests in mind.
‘I am not surprised there is a whole fracas over 111. You speak to call handlers who are not medically trained. I don’t understand how they think they can get untrained people to tick boxes — that is not medicine.’
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