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Half of GPs on clinical commissioning groups have financial links with private providers

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2431 (Published 29 March 2012) Cite this as: BMJ 2012;344:e2431
  1. Matthew Limb
  1. 1London

An analysis of clinical commissioning groups showing the financial links many GP board members have with non-NHS providers has raised fresh fears around potential conflicts of interest.

The False Economy research group, which is funded by the Trades Union Congress, examined details covering 50 clinical commissioning groups.

It identified 22 groups whose boards have a substantial proportion of GPs with an external financial interest in a private company or other non-NHS provider.

Concerns have been raised that once they are put in charge of NHS budgets doctors who have a stake in other companies that provide healthcare might be able to profit from commissioning their own services.

A spokesman for False Economy said the government had not resolved such complications and so would create confusion among patients and ensure doubt would be cast on the motives behind some GPs’ commissioning decisions.

The spokesman told the BMJ, “The government has given no thought whatsoever to this situation. Clinical commissioning groups have been left on their own to clear up the mess.”

False Economy has highlighted that many GP board members on 10 of the clinical commissioning groups have links with Virgin Care companies, which provide services to the NHS including urgent care, physiotherapy, psychological therapies, and screening.

The report lists eight GPs on Barnet Clinical Commissioning Group as shareholders in Barndoc Healthcare Limited, “the profit-making company that is owned by local GPs and holds the out-of-hours contract in Barnet.”

False Economy says seven of the 11 board members (and five out of seven GPs) on South Worcestershire clinical commissioning group are shareholders in Elgar Healthcare, which runs a walk-in health centre tendered by Worcestershire Primary Care Trust.

The report says, “Given that the clinical commissioning group will take over the primary care trust’s duties, the group will have the responsibility of deciding whether to extend the contract or re-tender at the end of the existing contract, and if the latter, whom to award the tender to.”

Johnny Marshall is a GP who chairs Buckinghamshire based United Commissioning and is also a shareholder—along with five GP board colleagues—in Vale Health Ltd, which provides services to the NHS.

He told the BMJ that clinical commissioning groups would need to develop strong governance arrangements over the next 12 months as they began to take on shadow status from 1 April 2012.

He said, “It is vitally important that we don’t find ourselves with either the perception or reality that clinical commissioning decisions are unduly influenced by any financial interests. Interests have to be declared and clinical commissioning groups will need to have the right mechanisms in place to manage potential conflicts of interest.”

In February 2012, health minister Earl Howe accepted amendments to the Health and Social Care Bill tabled by Liberal Democrat peer Baroness Barker because of concern over conflicts of interest between GPs’ commissioner and provider roles and the need to protect the “integrity” of decision-making.

Clinical commissioning groups will have to maintain and publish members’ registers of interests, and the NHS Commissioning Board will have to publish guidance for groups on how to manage potential conflicts of interest.

The False Economy spokesman said that there were concerns about how this would work in practice and that the uncertainty would be damaging.

He said it would harm those GPs who were following earlier government advice to forge worthwhile partnerships, including non-profit making cooperatives, for the benefit of patients.

“By accepting the Barker amendment, the government has washed its hands and left it to others to sort out,” he said.

Notes

Cite this as: BMJ 2012;344:e2431