An ICB has denied that its decision to replace a GP-led out-of-hours (OOH) provider with a private company was a ‘cost-cutting exercise’, despite its financial reports suggesting otherwise.
Shropshire, Telford and Wrekin (STW) ICB sought to address claims from local campaigners that it had awarded the private provider – Medvivo – a contract worth far less than the GP cooperative Shropdoc is currently paid.
A Pulse analysis of the ICB’s publicly available financial information has revealed that in 2024/25 Shropdoc is set to be paid almost £1m more than the proposed annual value of Medvivo’s contract award.
Shropdoc had challenged the decision in February, leading to an extension of the usual procurement ‘standstill period’. And Pulse has now learned that the challenge was accepted for review by NHS England’s independent patient choice and procurement panel.
At the end of January, STW ICB announced its intention to award the new five-year GP-led OOH contract, worth over £32.5m, to the Wiltshire-based company Medvivo.
This prompted immediate criticism from residents, with a petition opposing the decision reaching almost 13,000 signatures in just two weeks.
Campaigners said residents ‘know and trust’ Shropdoc, a not-for-profit company with over 200 GP members which has been running OOH services in the area since 1996.
They also claimed that Medvivo had been awarded the contract on a ‘rock-bottom bid that will mean massive service cuts’.
Shropshire councillor Bernie Bentick made similar claims at a council meeting last month, arguing that the ICB’s own website suggested that Shropdoc was paid over £8m in 2024/25, meaning the Medvivo contract will ‘drop the value by £1.5m each year’.
In response to these concerns, the ICB has repeatedly denied that there will be a cut to funding and has argued that these claims are unfounded. The ICB also told Pulse that all bids are highly confidential.
A message on its website said ‘the financial value of this procurement process remains consistent with the current services provided’, while its chief medical officer Dr Lorna Clarson told councillors that the ‘envelope around what we wanted to spend is unchanged’.
STW ICB put out its ‘invitation to tender’ for the GP-led OOH contract in October last year and at that stage set its five-year budget for the contract at £36m, or £7.2m per year.
The ICB told Pulse that this ‘indicative contract value has remained consistent’ throughout the procurement process, and that ‘no bids were excluded’ based on being above or below this figure.
As part of its statutory duty, STW ICB is required to publish details of all expenditure over £25,000 on its website on a monthly basis.
Expenditure in March 2025 has not yet been published, but over the first 11 months of 2024/25, contract payments made to Shropdoc equalled £6.87m.
When estimating the full-year effect – on the assumption that Shropdoc will be paid the same in March as in February – the total value of Shropdoc’s contract will be just under £7.5m for 2024/25 (see table below).
As such, Medvivo’s winning bid, at around £6.5m per year, appears to represent a saving for the ICB of around £1m annually.
This calculation includes only contract payments made for OOH, care coordination and single point of access – all of which appear to form part of the specification for Medvivo’s contract award.
It does not include other payments made to Shropdoc under ‘CMDU’ or ‘acute services’, as these do not form part of the core contract.
In response to Pulse’s analysis of these payments, the ICB argued that the payment schedule ‘does not reflect the core contract value for the GP Out of Hours service’.
Director of commissioning Gemma Smith told Pulse: ‘Additional payments have been made to Shropdoc outside of the main contract to support operational and ad-hoc requirements across the county.
‘These have included assistance with outbreak management and the piloting of new approaches within Urgent and Emergency Care.’
She continued: ‘To clarify, the indicative contract value has remained consistent throughout the procurement process.
‘Bidders were invited to propose their own costings based on their capacity to meet the service specification, and to put forward innovative models for service delivery. No bids were excluded based on whether they were above or below the indicative value.’
Ms Smith also reiterated that the decision to go out to procurement for the OOH contract ‘was driven by legislation in this area, given the size and duration of the contract’.
She added: ‘It was not a financial decision, and the procurement is not a cost-cutting exercise. Instead, it is about ensuring value for money alongside high-quality service provision, whilst meeting legislative obligations within the Provider Selection Regime (PSR).’
Shropdoc and Medvivo are not able to comment on the procurement process during the standstill period.
Seen this before.
Anyone want to run a sweepstake on how long before the service quality declines or the OOH provider is looking for an extra handout?
The existing GP Co-op will have disappeared so the ICB will be over the barrel.
With the benefits of hindsight from Harmoni, Serco and others, nothing has changed. Private sector created artificial savings to win bids, resulting in demonstrably unsafe cuts to OOH GP numbers and provision, and evidence of corrupt practices at both. Along with the clear lessons of failure following Hinchingbrooke and the Mid-Staffs Inquiry, the artifice of private sector offering cheaper, better quality care, continues to be promulgated by McKinsey consultancies, and vested politicians/advisors. The clear and open record of failed privatisation of 40yrs of social care has destroyed a generation of good care for our older people. The crucial problems still evident from political strategy are the harnessing of truth and critical analysis.
Difficult for a ‘Not for Profit’ Doctors Co-Operative to compete with the complex hierarchical structures used by private companies such as Medtop International and Medtop Group Ltd, the parent and ultimate parent companies of Medvivo and HealthHero, who can use such structures for intra company loans and tax exemptions transactions between group members.
OOHs services shouldn’t be called GP OOHs anymore as in some more than 80% clinicians are non-GPs just like many walk in centres.
DOI: I work for Shropdoc. It is an excellent service and still in the main GP led and delivered across STW and Powys by local GPs who know the area and resources. It is a not for profit service.
Medvivo has a terrible reputation amongst colleagues who have worked for it.
They reduce GP staffing to the bare minimum, they employ non-GPs to do the bulk of the assessments and these are supervised often remotely from a call centre in Wiltshire by a medvivo GP who may have never lived or worked in the area.
As a result, admissions rise, A&E and ambulance use rises, and increased risk by employing staff without the appropriate skills of local support.
Medvivo and the ICB is careful to state ‘delivered by local clinicians’ but this isn’t doctors. I understand but cannot confirm that Medvivo has tried to approach local UCPs to recruit to them, but not a single GP has been approached to ask if we would wish to work for them
For the avoidance of doubt – I will continue to work for Shropdoc. It is extremely well led and managed, and puts patients first. I will never work for Medvivo, a for profit organisation that puts profits first.
The board of STW ICB should be thoroughly ashamed of themselves. I hope they read this.
top down efforts to remove anything GP led still alive and well I see
DOH has never forgiven GPs for the OOH opt out in 2004
Shocking really and Of likely to be in the best interests of the residents
unlikely to be in best interests of local residents
Why are ICBs so stupid?
it’s something many GPs and frontline clinicians have been quietly (and sometimes not-so-quietly) frustrated about for years now. The shift away from having GPs in OOHs (out-of-hours) services toward ECPs, ANPs, and other non-GP clinicians under the banner of “skill mix” and “cost efficiency” has had significant and, in many cases, worrying consequences.
Short-term savings take priority over long-term resilience or outcomes. It’s especially maddening when these savings are often false economies—patients bounce back into EDs, or suffer complications due to suboptimal OOHs management.
Many are too afraid or exhausted to say out loud: this was not an accident. It has been systematic. The deskilling of GP services—OOHs and in-hours—is a direct result of policy choices prioritising short-term numbers over care quality.
What’s particularly concerning is how this model often overlooks the complexity of presentations that land in OOHs. These aren’t always minor ailments—these are patients who didn’t or couldn’t wait until their own surgery opened, often with vague, high-risk, or time-sensitive problems. And without the breadth and depth of GP training, these nuances are more likely to be missed.
Well said.Muhammad!