Private commissioning plan raises question over conflicts of interest

BMJ 2005; 331 doi: (Published 17 November 2005) Cite this as: BMJ 2005;331:1164
  1. Adrian O'Dowd
  1. London

    A strategic health authority has postponed its plans to make one of its primary care trusts subcontract its commissioning function to an outside body, possibly in the private sector.

    Following widespread protest, it has now said that the change will not occur until next summer.

    The proposal, made by Thames Valley Strategic Health Authority last month, was part of the authority's submission to the Department of Health on how it plans to reconfigure primary care—something that all health authorities have had to do.

    What is different about Thames Valley's case is its suggestion that it would create a new, larger version of Oxfordshire Primary Care Trust and tender for the management of its commissioning role among the private and voluntary sectors as well as the NHS.

    This caused alarm among several organisations in the NHS and the BMA, which wrote to the House of Commons health select committee earlier this month to say that doctors were feeling confused and frustrated about proposed changes to primary care.

    Helen Groom, a GP member of Oxford Primary Care Trust's professional executive committee, gave evidence to the select committee recently as part of its current inquiry into changes to primary care trusts.

    Speaking in a personal capacity, Dr Groom voiced her concerns about the Thames Valley authority's reconfiguration plans.

    “What they are saying is that a private sector company would come and hold the purse strings to the £600m [$1bn; €900m] worth of money that is spent on healthcare services in Oxfordshire,” she said.

    “The private companies that are interested… are not just interested in commissioning. They are providers. I think there is quite a large conflict of interests there.”

    When asked where she thought the idea had come from, she replied “Number 10” and that the idea was a result of talks between the prime minister's office and private companies such as UnitedHealthcare.

    John Appleby, chief economist at the health policy think tank the King's Fund, told the BMJ, “This is a significant proposal. It is the only one I have heard of its kind to tender out the commissioning part of a new PCT [primary care trust].

    “It will be a hard thing to do. I wonder how they will draw such a contract up and how they will specify what they want. If you were a private company, you might not be interested at first in making a lot of money but want to get your foot in the door.

    “There is potential for a conflict of interests. Even in the US, doctors who have a financial interest in a hospital have limits on their ability to refer patients to that hospital.”

    Speaking at a session last week of the health select committee's primary care inquiry, the health minister Norman Warner said it was up to the new primary care trust to decide on its management organisation. “I am not an advocate for this. That is a matter for them, but going along that path doesn't in any way remove their statutory obligations, their accountabilities, their responsibilities for the appropriate expenditure of public monies,”he said.

    Lord Warner said such a move could not take place until next summer, when the new primary care trust configuration was settled.

    Health authorities' proposals need government approval before they are subject to a public consultation next year.

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