Lucrative Patients

Since the introduction of private companies to provide healthcare on behalf of the NHS there has been much concern from the public that these companies will only be interested in ‘cherry picking’ the most profitable patients in conflict with the NHS ethos of equal access to all patients.

In 2006, Virgin requested that an external company, who had worked with Virgin on other projects before produce an assessment of the market for their plans.

At this time Virgin Healthcare carried a code-name of Project Cocktail.

Extract from report on  “Project Cocktail” examining which patients should be ‘targeted’ by Virgin:

"…. there is a third audience which is of particular interest: the young male professionals. Whilst this group have not been identified specifically by the research as a regular frequenter of healthcare services they are open to the proposition. From a business point of view, this audience are the most lucrative to recruit – they help fulfil a quota without putting a great strain on resources.

To announce the opening of the centre Virgin should produce an 8 page booklet outlining in a greater level of detail (than previous leaflets) the new services and introducing the practitioners. This should be used to create awareness in the local area and as an acquisition tool to recruit new patients. Distribution via door to door to an 8 minute drive time in order to generate awareness and up to 30 minute drive time to ‘hot spot’ areas of young male professionals for acquisition."

 

So the reader should first be aware that Virgin did not produce this document themselves - they commissioned it but nonetheless it is of interest.

In the UK NHS GPs get a fixed amount of money ('capitation') for a patient whether they are well or ill, young or old. This money is received in full whether a patient ever becomes ‘active’ or not.

This report argues that the most ‘lucrative’ patients are those who are least likely to need NHS healthcare:

“From a business point of view, this audience are the most lucrative to recruit – they help fulfil a quota without putting a great strain on resources.”

...and goes on to argue that they should be ‘recruited’ in order to produce maximum profits.

The idea was that as the patient list at a VHC clinic grows so ‘salaried’ GPs could be employed on a fixed wage and the income from capitation can be accessed by Virgin as profit.

That Virgin responded to the advice of this external document is suggested by the demographics of the first VHC clinic in Swindon. 

75% of the local population were aged under 40. Only 4% were ‘elderly’.

In a presentation to the Virgin Board on 22^nd February 2008 the importance of such demographics was made clear, as was the potential to grow the patient list.

The attitude of the Virgin Group towards such behaviour is illustrated in a conversation I had (and taped) with Josh Bayliss, their Chief lawyer who was nominated to deal with my Protected Disclosures and other grievances:

Me: “The big concern that GPs and the general public have is that commercial organisations moving into private healthcare will profiteer, profiteer by looking at is as a market where they need to source the most lucrative patients and that’s not what healthcare is about is it?”

Josh Bayliss: “err..It depends on whether you are talking about healthcare as a business or healthcare as an altruistic…umm”

Me: “If you are going to admit… that you are looking on it as a business, we are not particularly altruistic about this we are looking to make money out of this and if that means not treating the people that most need healthcare – can you see how that is going to look?”

Josh Bayliss: To the extent that people do (need healthcare) and are able to pay for it – we could end up like the American system.

Me: I think the American system is wrong in principle and poor in practice – the British system is absolutely right in principle but poor in practice – and because it’s poor in practice that leaves a loophole for commercial organisations to come in and say:

“These are the lucrative patients that we need to make money out of, this is how we should shape our business and Swindon is the perfect example of how to shape that business.”

Now what that means is that to those people who need healthcare the most, Virgin are really saying we don’t want to treat them because they are not ‘lucrative’ for us.

If you defend that from a business point of view you might be able to – your commercial friends might be able to say, “Well, that is fine” but the British public will completely freak and you know they will do…GPs, British Medical Association, all the newspapers will say:

“So what they are saying is, their commercial argument is that they are not going to treat the ill people because this is a business after all’

You can see the point Josh?

Josh Bayliss – “I can see the point – I’m just not sure that it is unethical or illegal.”

Me: “Oh, no – not illegal – I wouldn’t accuse you of that – but unethical? – Yes.

Where are you from – originally?

Josh Bayliss: “New Zealand”

Me: “ I don’t know what it’s like in New Zealand but in this country the NHS is a secular sacred cow – people are more concerned about the NHS than anything else and all I’m saying is that they have been worried for years about commercial companies and Virgin have come in and say “We won’t profiteer – it’s freedom of access to all” and it’s not.

Really what you are saying is that as a commercial organisation you have the right to make profit if that means siting your clinic in an area where there are people who will bring in more profit for you, even though they don't need healthcare for anything serious - it means that those who do need healthcare don’t get seen to by you”

Josh Bayliss “Uh, Uh, I mean yeh I guess the er, the er idea that you have to start somewhere is important and they selected that site, I’m sure, for all sorts of different reasons”

That this is the attitude that Virgin brings to the provision of NHS healthcare disappoints me as I joined their organisation believing in their publicly espoused principles.

I myself worked for the NHS as did two of my siblings and my Mother who was an NHS GP all her life.

I don't want to see a healthcare system that is paid for by all but prefers treating the wealthy and the well.

Is this why I was called 'unprofessional' and forced into offering my resignation Mr Branson? 

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