Six weeks ago, I was working as a cover receptionist at Operose Health's largest GP chain in the UK. Most practices in England are owned privately by GP partners. However, a 2007 rule change allowed larger companies to purchase partner-led practices.
Operose Health has seen rapid growth in recent years. It has spent millions to buy GP practices. It has 70 offices and nearly 600,000. This makes it the largest GP provider to NHS.
There is a shortage in GPs across the UK and general practice is under extreme pressure. Panorama spoke with former Operose employees, including pharmacists, doctors, and nurses. They believed that patient safety was at risk.
Our investigation revealed that the company allowed less qualified employees to see patients rather than doctors without proper supervision.
Operose claims that profit is not being prioritized over patient care, and it has a clear supervision process.
This is my diary from my time in a busy Operose GP clinic in London.
Thursday 7 April - 'We run on locums'
This is my second shift and I already have a serious complaint. One patient called me to tell me that his GP was absent due to his mental health issues. He had last year spoken to his GP, but he didn't receive any engagement from the practice after that appointment.
He claimed that he had not been able get his new prescription or to make a mental health plan together with his GP. He felt totally abandoned.
Other receptionists told me that this practice is "run on locums", which means that many of the GPs working here are freelancers, only working a few shifts.
Monday, April 11th - The cheapest physician associates
Today, I had the opportunity to meet a physician associate (PA), one of the lesser-qualified physicians. She was rushing to her next appointment so I only had a few minutes to speak with her, but she quickly shared how she felt like a GP.
She seemed stressed and said that she felt like she was a GP from the first day on the job, despite it being her first job after training.
Before this, I had never heard of a PA. My manager told me that they could prescribe, but they were similar to GPs. My managers explained to me why there weren't more doctors. They also said that PAs cost half as much as a GP, so they were cheaper.
Panorama's Undercover: Britain’s Biggest GP Chain, 20:00 GMT on BBC One Monday 13 June
Wednesday, 20 April - The "skim-reading" team
My practice has a team that processes documents for approximately 30 Operose GPs. Non-medical staff are often required to handle reports, test results, and letters from hospitals. However, the team does not have easy access to a doctor if they need help. They must decide which documents should be filed and which ones need to be handled by a pharmacist or GP.
The central admin team staff claim they are sometimes told to process complicated medical documents. They told me that they are worried about making mistakes but that management has instructed them to reach their goals.
I have heard from them that they read the documents even though they don't fully understand what they are reading. This team is the first to read these documents. If something is not done correctly, it can lead to delays or even risk to vital patient care.
Tuesday 26 April - Squeezing GPs
I was able to spend some time with one the regular locum doctors at the practice. I inquire about the PAs. He explained that PAs are not the same as GPs, and that they need supervision and help.
I was informed by the doctor that it is a problem at the practice. He said that he had requested time from his shifts to discuss cases and provide support for the PAs' official supervisor, also known as the clinical leader. In the interests of "squeezing as many appointments as possible for patients", he claims that this request was turned down by management.
Friday, 29 April - The GP Director is 'always there'
A patient complained today that he couldn't see his GP. He was also the director of the GP. When I explained that the doctor didn't visit the practice and that I hadn't seen him before, and that other staff had said that he came in very rarely, the front desk manager swept me away.
Another receptionist told me not to tell patients that the doctor was not available at the practice. I called the practice manager to inform them of my "mistake." I was informed that the doctor was always available via phone.
Tuesday, 3 May - A day without appointments
Today, there was no doctor or physician assistant at the practice who could help patients with appointments. My coworkers and me panicked. We noticed calls starting to pile up, from 40 calls at 08:00 to many more shortly thereafter.
One of the receptionists shouted out from the back, asking why there weren’t any doctors. My colleague next to I said that it was a joke, and that we shouldn't be open.
We were surprised to hear that we could book patients for the next day. This had a knock-on impact. People calling in from 08:00 on the next day expecting to be able to book appointments the next day were also disappointed. We were unable to tell them that they could try again the following day.
Friday, 6 May - The End of a Bad Week
This week, we didn't have more than two doctors available to see patients in a practice that has 20,000. I noticed that patients calling me every day and sometimes multiple times per day became more desperate for any kind of help.
Once again, I had to tell them that they would try again at 08:00 on the next day. All GP practices are under severe pressure. However, NHS data shows that my surgery has about half of the full-time equivalent doctors to what you would find at an average NHS hospital of this size.
As the first point of contact for the practice, we had to deal with hours of frustration from patients every morning. I could not have been more prepared to turn away patients. Many of these problems could have been solved with a few more doctors.
Monday, 9 May - Documents unseen for six months
Workers from the central admin team who process medical records for approximately 30 Operose surgeries told me that there was more than 1,000 documents in backlog and needed doctors' attention. I was told by the central admin team that although the paperwork has been flagged to the computer system for action, they have not yet been seen by a pharmacist or doctor.
Although the documents are electronically sent to local practices, the central team can still view which requests have not yet been fulfilled. Some of the correspondence was not seen for six months, according to me.
These were vital documents, staff told me - they included prescription changes, diagnoses and other urgent information that GPs should be aware of.
I was told by the admin team that they are concerned about patient safety. I was shown an example of a request to modify the medication for a patient. The patient may have been prescribed the wrong medication if it hadn't been reviewed in five months.
Wednesday, 11 May - Last day
As I answered the morning calls, it felt good to know that this was the last time I would have to call frustrated patients. However, I felt like I was abandoning them. I wanted to do my best to help when I could.
Six weeks of working undercover I felt that the patients at the practice were being treated unfairly.
BBC Panorama reached out to Operose Health regarding the things that I witnessed and was told undercover.
The company stated in writing that profit was not being prioritized over patient care. It claims that it has raised the GP staff to their highest ever level at the practice where they work.
Operose stated that there were five GPs at the practice on Tuesday, 3 May - the day without appointments - and one providing additional remote coverage. We asked Operose if these doctors were available for appointments. The company did not respond.
Operose claims that it has hired 38 GPs across all its practices in the last 12 months, and is currently looking to recruit 14 more.
Operose claims that its document workflow ensures clinicians receive timely, accurate and well-coded information. The process is also audited every month for safety and quality.
Operose claims it is the largest employer for salaried General Practitioners in England. It invests heavily to recruit, train and reward GPs as well as other clinical and non-clinical staff.
Operose, the clinical lead at my practice, said that there was a physician assistant (PA) available to answer questions from PAs. It also stated that there was a clear supervision process and invested heavily in PA training.
Operose claims it doesn't rely too heavily on physician associates, and that its use of PAs is consistent with the long-term NHS plan.
According to it, 97% of its practices have been rated as "good" or outstanding by the Care Quality Commission. It also claims that it acts "in the best interest of patients and provides the highest quality care."
Follow BBC Panorama on Twitter
Are you affected by any of these issues? You can get in touch by emailing haveyoursay@bbc.co.uk.
If you would like to speak with a BBC journalist, please include a contact phone number. These are the ways you can get in touch with us:
If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your question or comment or you can email us at HaveYourSay@bbc.co.uk. Any submission should include your name, address, and age.
