UK’s biggest GP chain replacing doctors with less qualified staff


UK’s biggest GP chain replacing doctors with less qualified staff: An undercover investigation conducted by BBC Panorama discovered that the largest chain of general practitioner (GP) clinics in the UK allow less qualified employees to visit patients without proper supervision.

A prominent general practitioner claims that Operose Health is putting patients at risk in order to prioritize profit.

The organization, which serves over 600,000 patients in the NHS, is owned by the massive healthcare provider Centene Corporation in the United States.

Operose asserts that it does not have a staffing shortage and that it prioritizes the needs of its patients.

Jacqui Wakefield, an undercover reporter for BBC Panorama, was assigned to work as a receptionist at one of the 51 London surgeries owned by the UK firm. The BBC will not identify either the medical practice or the individuals who are employed there.

A general practitioner who worked at the office mentioned that they were short eight doctors. The practice manager explained that they went with less qualified medical staff known as physician associates (PAs) rather than general practitioners (GPs) since PAs were “cheaper.”

In 2003, the National Health Service (NHS) began employing physician associates so that doctors could better address the increasingly complicated demands of their patients. Their inception was based on a model from the United States, which has since been replicated in a number of other nations.

When compared to the ten years of school and training that are required to become a general practitioner, medical assistants (PAs) just need to have finished two years of post-graduate studies after earning their scientific degrees. They assist general practitioners in the diagnosis and management of patients, although they should be subject to the supervision of a physician.

At the Operose office, Panorama found evidence suggesting that physician assistants were not being adequately supervised. The physician assistants (PAs) said to the undercover reporter that they saw a wide variety of patients, sometimes without any clinical oversight. They said that the clinic treated them in the same manner as general practitioners.

There is a lack of general practitioners (GPs) across the entire United Kingdom, and general practice is currently facing unprecedented pressure.

Panorama conducted an investigation into the NHS data for 6,500 different practices across England. It discovered:


  • On average, there is the equivalent of 1.2 full-time general practitioners for every 2,000 patients who are registered with the practice.
  • However, the average number of full-time equivalent general practitioners at Operose practices is closer to 0.6 than it is to 1.
  • According to data provided by the NHS, Operose employs six times the average number of physician associates found in the NHS.
  • While Panorama was operating undercover, they were informed of a backlog of crucial patient referral records that were frequently left unread by physicians or pharmacists for months at a time.


Since the beginning of the National Health Service (NHS), general practitioner (GP) practices have been operated as private enterprises. These practices are owned and controlled by doctors who are referred to as “partners,” and they provide services to the NHS rather than working for it directly.

However, in 2007, the restrictions were altered by the Labour administration that was in power at the time. These new laws made it possible for larger firms to acquire practises in England. This was done in an effort to increase competition and innovation.

Since 2016, Operose Health has invested tens of millions of pounds in the purchase of general practitioner (GP) practices. It is believed that the company paid £50 million to acquire 32 practices from London-based AT Medics in the year 2020. It is presently the NHS’s largest supplier of general practitioner services across England, where it operates a total of 70 practices across the country.

Operose Health denies that it has an unhealthy reliance on PAs and claims that its usage of PAs is in line with the long-term plan developed by NHS England. It is stated that a clinical lead is present on-site for the majority of the time to assist in answering queries posed by PAs.

In addition, Panorama has talked to a dozen former employees from different departments inside the Operose business.

One general practitioner (GP) who spoke on the condition that her identity be kept private said that she had seen how PAs were utilized at the facility where she worked. “They were wonderful coworkers and had been trained to do specific duties, but they had not been trained to basically do as much work as a general practitioner would. They were doing the same work that we were, but they had less experience, fewer qualifications, and were paid less “— I quote her.

Following his study of the undercover tape obtained by BBC Panorama, Prof. Sir Sam Everington, a senior practicing general practitioner at an independent partner-run practice, expressed his concern for the well-being of patients.

He stated that at his own practice, physician assistants would debrief with him on a daily basis, discussing all of the patients that they had seen. He expressed concern that medical associates at the Operose practice were complaining that they did not receive the necessary level of supervision, and he said this made him apprehensive. “They are really good at articulating things, but that does not mean that they understand it. And it is a challenge.”

During the undercover investigation that was taking place at the London practice, administrative personnel discovered a backlog of thousands of medical test results and hospital letters that were stored on Operose computer systems. Around 30 general practitioner offices in Operose had their paperwork processed at an office located on the site.

According to one employee, they were entrusted with going through 200 documents every day and determining which ones were significant enough to be reviewed by a general practitioner or pharmacist and which ones would be filed away in the patient’s medical records. One member of the team, who was concerned about making mistakes, admitted that they sometimes turned to Google for assistance in determining what they should do with the documents.

Workers in the administrative department also mentioned that some communications had been waiting for up to six months to be reviewed by a general practitioner or a pharmacist.

Professor Everington stated on Panorama that this is not a safe practice. “Patients face a significant threat when a letter addressed to their primary care physician is ignored for a period of six months, which increases the likelihood that they would suffer from a more severe condition and pass away at an earlier age.” He stated that the government ought to involve the independent watchdog organization known as the Care Quality Commission. It’s called Operose Health “placing profits and money before the quality of treatment provided to patients. And that will have some kind of effect “he remarked.

Operose Health claims that its document workflow has been praised by NHS England and that it “helps to guarantee that physicians obtain correct and well-coded documentation in a timely way.” These are the exact words that NHS England used in their praise of Operose Health’s system.

In addition to this, it states that all of its procedures undergo “monthly audits for quality and safety.”

The company disputes the claim that it prioritizes profit over patient care and asserts that it has recruited 38 general practitioners (GPs) during the course of the previous year and is in the process of recruiting 14 more.

It asserts that it operates “in the best interests of patients, offering access to the greatest quality of treatment” and that 97 percent of its practices have received ratings of “excellent” or “outstanding” from the regulatory body known as the Care Quality Commission.

According to the Department of Health, all primary care services provided by the National Health Service (NHS) are subject to the same regulations and standards, and patients should always receive high-quality care.

According to the Care Quality Commission’s statement, the organization takes all concerns seriously and will conduct follow-up investigations if necessary.