Conflict of interest fears in NHS shakeup plans

At least half the board members of some GP consortia, the new bodies that will take over commissioning, have links with a single private healthcare company, an investigation by Bureau of Investigative Journalism, published in the Independent and Pulse Magazine can reveal.

Assura Medical, majority controlled by Sir Richard Branson’s Virgin Group, has links with 50 per cent or more of the board members at three of the 52 first-wave GP pathfinders.

The Department of Health responded to the investigation by saying it planned new guidance on the make-up of consortia and how to deal with potential conflicts of interest following Professor Steve Field’s ‘listening exercise’ report.

One in seven doctors appointed to the new clinical commissioning boards, which will have responsibility for spending £60bn of NHS money every year, could have a significant financial conflict of interest, an investigation has found.

Research by the Bureau of Investigative Journalism revealed that, of the first 52 consortiums established under the Coalition’s NHS reforms, 19 could present concerns about the independence of their boards. The study raises the prospect that GPs could benefit directly from private companies working in the NHS.

The Department of Health has announced new rules to address perceived conflicts of interests within the boards before the boards start taking responsibility for commissioning in 2013. However the research highlights the inherent problem of giving GPs responsibility for spending the bulk of NHS resources when they are themselves increasingly involved in providing many of those services. Unlike most professionals working in the NHS, GPs are effectively self-employed – and so can benefit personally by entering into arrangements with private companies.

Dr Clare Gerada, chairwoman of the Royal College of GPs, said she was concerned about any doctor sitting on the board of a consortium who had an interest in a private company that would be tendering for contracts under the new “Any Qualified Provider” system. She told the bureau: “If you have any system that you can gain financially from making decisions about your patient care, then clearly that is a conflict of interest. And if you’re in a position to commission… and you could potentially buy care from yourself, then I would be very concerned.”

Findings by the Bureau show one in seven board members of first-wave consortia has a link to a private company, defined as an association registered by PCTs, a financial link recorded in Companies House records, employment by a company or employment by a GP practice in partnership with a company. That compares with an earlier Pulse investigation finding one in 10 consortium board members were directors of private providers.

More than 60% of those with private links were associated with Assura Medical. Most were GP members of Assura, meaning their practice had formed a joint company with it. These companies provide community-based services in areas such as dermatology, sexual health and out-of-hours care, with profits split 50:50 between Assura Medical and member practices.

Click here to see our interactive map on NHS consortia board members’ links to private companies.

At the Sutton Consortium in Surrey, 19 out of 25 board members are linked to Assura Medical. In the South Reading Consortium, three out of five board members are GP members of Assura, and two are employees of an Assura member practice. At the Calleva Consortium in Basingstoke, Hampshire, six out of 11 voting members on the consortium board have links with Assura, as does the non-voting board secretary.

An Assura Medical spokesperson said the company was awaiting Department of Health guidance on approaching potential conflicts of interest and would ‘ensure our policies are updated to reflect and reinforce this guidance’. The spokesperson added: ‘Most services will be purchased under any qualified provider, meaning consortia will not be responsible for deciding providers, but in specifying the outcomes required – thus no conflict of interest exists.’

The Department of Health said it would consider creating a new statutory body to oversee commissioning decisions where 50% or more of a consortium board would be prevented from taking part because of other interests: ‘We [will] ensure governance arrangements are robust. The NHS Future Forum is looking at this and will present findings shortly.’

Some 19 of the 52 first-wave pathfinder consortia had board members with interests in commercial providers – 69 board members in total, including 47 with links to Assura.

The Sutton Consortium said it would be ‘developing our governance arrangements over the coming months to ensure we continue to be transparent and accountable’. NHS South West London said none of the board members were members of Assura Wandle LLP clinical management board.

Dr Elizabeth Johnston, chair of South Reading Consortium, said protocols had been ‘transparent’ and would be strengthened by publishing board minutes. No one was a board member of both the consortium and Assura, Reading.

BMA guidance released last week suggested where the majority of board members had a potential conflict of interest, an ‘appropriate independent body’ should oversee decisions, such as ‘a neighbouring consortium or an audit committee’.

GPC chair Dr Laurence Buckman said: ‘Conflict is in the eye of the beholder. People mustn’t think this somehow impugns their integrity – it’s not. It’s saying, if it looks dodgy, it’s dodgy.’

NHS Alliance chair Dr Michael Dixon, a GP in Cullompton, Devon, argued there was ‘a strong case’ for GPs to step down from either their provider company or consortium board if part of a majority with dual interests. ‘Links to private providers should never be a majority,’ he said.