More than a third of GPs on commissioning groups have conflicts of interest

Published on Thursday, 14 March 2013 09:30
Written by Scott Buckler

More than a third of GPs on the boards of the new clinical commissioning groups (CCGs) in England have a conflict of interest resulting from directorships or shares held in private companies, a new analysis by the BMJ has shown

An examination of the registered interests of almost 2500 board members across 176 CCGs provides the clearest evidence to date of the conflicts that many doctors will have to manage from 1 April, when the GP led groups are handed statutory responsibility for commissioning around £60bn (€70bn; $90bn) of NHS healthcare services.

Our investigation shows that conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.

The interests range from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors, such as Harmoni and Circle Health.

In some cases most of the GPs on the CCG governing body have financial interests in the same private healthcare provider.

Some doctors have relinquished interests in private enterprises because of their new roles as commissioners. These include GPs linked to Richard Branson's Virgin Care, which announced in October 2012 that it planned to end its joint venture partnerships with over 300 GPs in England, after admitting that many were becoming "increasingly worried about the perception of potential conflicts of interest."

Leading GPs, including a senior government adviser on commissioning, have called for doctors with conflicts that were “too great” to step down and have urged the NHS Commissioning Board to offer tougher guidance to those with multiple interests. Last week the BMA’s UK consultants’ conference passed a motion expressing concern at “the clear conflict of interest of GP commissioners who run their own private companies” and called on GP commissioners to “be barred from being involved in companies that they are giving contracts to.”

But others have said that conflicts are an inevitable by-product of allowing more clinicians into management positions and said that focusing too much on the issue may prevent commissioners redesigning services effectively.

The BMJ analysed the registered interests of 176 of the 211 commissioning group boards, obtained through requests made under freedom of information legislation and from CCG websites. The remaining groups were not able to disclose their lists, though they must maintain and publish them from 1 April under NHS Commissioning Board rules

Our analysis also showed that 4% of GPs on CCG boards were consultants to or advised private health or pharmaceutical companies, while 5% were employed by a private health company as well as working as a GP.

Some 12% of GPs declared links with not for profit voluntary or social enterprise providers that represented a conflict of interest with their commissioning role, while 9% of GPs declared a conflict of interest through a family member.

See BMJ for full version

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