CONFLICTS OF INTEREST

GPs/Clinical Commissioning Groups

 

 Don’t blame GPs for NHS crisis. Blame chronic cuts to social care (The Guardian: 21st February 2017)

 The ongoing A&E crisis has shifted attention on to GPs. We are being blamed for being less accessible (with appointments hard to get or surgeries not being open for long enough), while A&E is open 24/7 and therefore faces unchecked demand.

But this makes little sense. You only need to take a walk through an A&E department to see why: long trolley queues in corridors and acute admission units exist because of cuts in bed numbers and delayed discharges from a shortfall in social care. These are not patients who can be seen in GP surgeries and sent home on a prescription.

Last year there were about 23m A&E attendances in England of which 65% were at major A&E departments – an increase of 2.2% when compared to 2014-15.Although the number of patients attending A&E is continuing to rise (an average of 1,400 more per day than last year), as a percentage of total hospital patients, admission rates were roughly the same last year (20.2%) as in 2009-10 (21.8%)...Read More

Smokers trying to quit hit by postcode lottery as GPs ration help (The Guardian: 19th February 2017)

 

Smokers in England wanting to quit face a postcode lottery as cash-strapped councils and GPs restrict access to services that can help them.

 

The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision.

 

Evidence obtained under the Freedom of Information Act shows that an increasing number of clinical commissioning groups – the 200 or so organisations that deliver NHS services in England – have been instructing GPs to stop providing the services. Many of the groups argue that it is no longer their responsibility.

 

In 2012, local authorities were made responsible for improving public health and given £2.8bn of ring-fenced grants to pay for it. But, as the grants have been pared back, councils have pulled their funding for stop smoking services...Read More

 

Climbdown on NHS conflict of interest rules as doctors told they will not have to declare private earnings (The Telegraph : 9 February)

Doctors will not have to declare their private earnings, health officials have ruled, in a climbdown on NHS conflict of interest rules.

Health officials were considering requiring every health service doctor to set out details of all earnings from private work.

But today the board of NHS England agreed that medics will simply have to say when and where they take on such duties – and not on how much they earn from them.

The public rightly expects NHS staff to behave appropriately and use the healthcare budget to achieve the best outcomes for patientsSir Malcolm Grant

The new rules on conflicts of interest also mean all gifts over £50 have to be declared.

The guidance will permit staff, such as nurses, to receive a box of chocolates or other small tokens of gratitude from patients but will require them to decline anything that could be seen to affect their professional judgement, officials said.

NHS England said the new guidance due to take effect in June, followed feedback during a consultation.

It was drawn up by a group including  the Association of the British Pharmaceutical Industry and the National Institute for Health and Care Excellence.

Under the rules, doctors working for the NHS will have to commit to making the health service their priority...(read more)

 

 Crooked doctor facing jail after £150k NHS fake invoice fraud (Birmingham Mail: 14 December 2016)

 AN award-winning mental health GP defrauded the NHS by diverting £153,000 to his private company.

Birmingham Crown Court heard Dr Ian Walton, 59, and senior commissioning manager Lisa Hill, 51, exploited positions of trust for commercial purposes by submitting false invoices.

Walton, of Stourbridge Road, Wombourne, and Hill, of Stourbridge Road, Hagley, Stourbridge, previously admitted a charge of fraud between August 2013 and January 2014.

Judge Paul Farrer QC adjourned sentence until December 20.

Sam Brown, prosecuting, said Walton had a practice in Tipton and was a senior physician concerned with mental health.

Hill was employed as a senior commercial manager for the Sandwell and West Birmingham Clinical Commissioning Group (CCG).

But they were also both involved with Walton Hill Associates, which provided training for GPs.

Mr Brown said they both held positions of trust and added: “They exploited that trust in order to direct and retain amounts of money dishonestly for their commercial purposes.

“A fraud was committed on an organisation that was part of the NHS. In simple terms, it involved them misleading people and lying in documents.”

Mr Brown said the pair received money that should have gone to another sector of the NHS, dealing with treating patients over the busy winter period…(read more)

 

NHS admits it “could have done things better” over Queens Road Medical Centre closure (Leicester Mercury: 2 November 2016)

 Campaigners have won an apology from health bosses over the way the closure of a city GP surgery was handled.

The apology comes in the wake of patients' complaints about the closure of the Queens Road Medical Centre, Clarendon Park, Leicester, earlier this year.

Patients registered at the practice, run by Dr Jonathan Lenten, said their concerns and needs were not addressed by health bosses. Now NHS England has said sorry, and the Leicester City clinical commissioning group (CCG), which managed the closure, has made changes to the way it works.

Katy Wheatley, who was a patient at the centre and a spokesman for the Save the Queens Road Medical Centre campaign, said a key concern was patients not being given any help to find new GPs.

    She said: "The information provided to patients by the CCG was poor. It did not help patients. It was a list of practices, but did not help them find a new practice. It seemed easier for it (the CCG) to close the surgery than to find a solution."

Ms Wheatley said some patients were left with the view that decisions were being made by GPs, who comprise the CCG, in the interests of GPs, rather than in the interests of patients...read more

 

NHS bosses promise crackdown on conflicts of interest following scandals (The Independent: 31 March 2016)

 The NHS promised to crackdown on conflicts of interest as it announced plans to make the health service a "world leader in tackling such issues".

The move follows a series of scandals that included staff being paid £500 a day to attend meetings only to be lobbied by industry representatives to use their products in the NHS, and GPs awarding schemes to private companies in which they have financial ties.

Workers involved in drugs purchasing decisions for NHS bodies have also held advisory roles with drugs companies, while a recent review into productivity in the health service found that 65 sales representatives were on one hospital site in England at the same time.

NHS England chairman, Sir Malcolm Grant, will draw up rules to be adopted across the healthcare system, including proposals to ensure clinicians and procurement staff are free from unmanaged conflicts of interest, including from drugs purchasing.

"In a tax funded health system, the public rightly demand high standards of probity from both NHS staff and health care suppliers," said NHS England chief executive Simon Stevens...read more

 

Conflict of interest confusion 'common' among CCGs (HSJ: 19 February 2016)

Confusion in clinical commissioning groups about how involved GPs should be in designing services is “a common issue” nationwide, senior NHS England figures told investigators.

The report into whistleblower concerns about potential conflicts of interest at Barnet CCG said the governance issues there were likely to be replicated across the country. This view was informed by senior regional staff at the national commissioning body.

The report said ‘it would be surprising if the issues faced in Barnet were not widely replicated across the country’

The investigators from Verita interviewed NHS England London’s director of finance David Slegg and director of primary care commissioning David Sturgeon, who both reportedly said the problems in the north London borough were unlikely to be confined to the area.

The report, obtained by HSJ, said: “Given that CCGs are fledgling organisations it would be surprising if the issues faced in Barnet were not widely replicated across the country. Indeed, our own investigations and conversations with NHS England strongly suggest this is true.”..read more

 

CCG whistleblower sacked days after raising conflicts of interest (HSJ: 19 February 2016)

A whistleblower was dismissed just days after raising concerns about conflicts of interest in a clinical commissioning group, HSJ can reveal. 

A report obtained by HSJ said a manager at Barnet CCG contacted the chief operating officer last year to raise concerns about a “conflict of interest impacting on the CCG’s commissioning of primary care services”. 

The report by consultancy firm Verita said the manager should have been protected by the CCG’s whistleblowing policy and public interest disclosure legislation.

Senior staff at the CCG said they were not aware he was making a whistleblowing complaint and his interim contract was terminated because of sickness absence.

However, the report concluded: “[His] contract was terminated days after he raised a conflict of interest concern. It is impossible to be sure if [it] was terminated because he raised a concern about conflict of interest...read more

 

GP ‘regularly crossed the line’ between commissioner and provider (HSJ: 19 February 2016)

A GP on a clinical commissioning group governing body did not declare outside financial interests, was accused of “lobbying” a manager inappropriately about a contract and was “widely perceived to regularly ‘cross the line’ between commissioner and provider”, investigators have found.

The Verita review into whistleblowing allegations at Barnet CCG also looked at whether GP Jonathan Lubin should have declared an interest in an IT firm operated by his practice manager – a firm the CCG was considering buying services from.

Dr Lubin should have declared an interest in an IT firm run by his practice manager

The concerns were raised in May 2015 by a whistleblower who was later dismissed and investigators were brought in last June. Their report, obtained by HSJ this month, is dated September 2015.

He also alleged that GPs could be paid twice for the same work at care homes – once by the NHS and again by a “retainer” paid to them privately by a care home...read more

 

Virgin legal challenge forces CCG to row back primary care plans (HSJ: 15 February 2016)

A legal challenge from a private provider has forced commissioners to undertake a full procurement process for several GP services in Hull.

As part of a wider plan for primary care services in the city, Hull Clinical Commissioning Group wants to create geographical groups of practices, each operating as larger scale providers.

The legal challenge was discussed by Hull City Council last month

The CCG has been operating under joint commissioning arrangements for primary care with NHS England since last April. However, HSJ understands the initial plan to create the groups, by inviting groups of GPs to take over practices currently run under time limited contracts, was challenged by Virgin Care.

Eight out of about 50 surgeries in Hull are run under alternative provider medical services contracts, which are due to expire in March. Three of these are run by Virgin...read more

 

Monitor finds 'potential issues' with CCG procurement following complaint (HSJ: 30 January 2016)

Monitor has found against NHS commissioners in the first stage of a competition case, HSJ can reveal.

Papers released this week indicate that the regulator, which is responsible for settling complaints about procurement and contracting, has “identified potential issues” with a procurement process run by a group of clinical commissioning groups in north east London.

In minutes released ahead of the board meeting of NHS Improvement – the composite body of Monitor and the NHS Trust Development Authority – Monitor said its cooperation and competition directorate’s initial review of the case had “identified potential issues” with the procurement of elective services, but did not say what these were.

Private healthcare firm Care UK had complained that commissioners had:

  • not followed due process in agreeing to sub-tariff prices;
  • failed to take quality sufficiently into account; and
  • discriminated against it by not running a competitive tender for other services.

The three outer north east London CCGs had initially awarded the five-year, £55m contract to run services at the North East London Treatment Centre to Barking, Havering and Redbridge University Hospitals Trust. The centre is on the site of the King George Hospital run by the trust.

But the decision was challenged by private care firm Care UK and referred to Monitor.

Monitor said it had asked the parties to the case to respond this month and that its “final conclusions” will be published in February.

 

General practice commissioning: in whose interests? (BMJ: 11 November 2015)

An investigation into England’s clinical commissioning groups shows that many are commissioning from organisations in which board members are involved, Gareth Iacobucci reports in the BMJ.

Clinical commissioning groups (CCGs) in England have awarded hundreds of contracts worth at least £2.4bn (€3.4bn; $3.7bn) to organisations in which their board members have a financial interest, a joint investigation by The BMJ and The Times has found.

This new analysis shows the extent to which CCG boards have become conflicted under the health reforms introduced in 2012, which handed general practitioners control of around two thirds of the NHS’s total budget.

The data have reignited calls to ban GPs who are directors of provider organisations from holding board positions on CCGs that could commission them. NHS England has ordered an audit of how CCGs are managing conflicts of interest. Patient representatives, MPs, and doctors’ leaders are also concerned that governance standards are too lax in some areas. NHS England’s current rules allow CCGs the freedom to determine whether conflicted CCG board members should be excluded from relevant parts of meetings or join in discussions but not participate in decision making when commissioning services.1

This guidance was described by the head of the BMA’s GP committee as “too permissive.”The BMJ and The Times examined contracts awarded by a sample of 151 of England’s 209 CCGs between April 2013, when CCGs went live, and July 2015. These were cross referenced with the registered interests of board members that CCGs are required to maintain and keep up to date.

They identified 50 CCGs that have awarded contracts where a conflict was present, with a total of 437 out of 5671 contracts awarded to healthcare providers in which one or more CCG board members had declared an interest. Most of the money went to NHS trusts or other similar organisations providing a range of acute, community, and mental health services (£2.2bn gained from a total of 116 contracts awarded with a conflict present).

Social enterprises were the next highest earners from contracts awarded with a conflict of interest present (£64.6m from 13 contracts), followed by limited companies, (£16.6m from 36 contracts), large commercial companies (£16.6m from four contracts), and confederations or cooperatives (£10.4m from 15 contracts). These contracts ranged from large deals to run general practice out of hours services to small contracts for community based service.

The remaining money earned from contracts awarded with a conflict present went to general practices (£7.4m from 232 contracts awarded to provide services such as screening, anticoagulation clinics, and minor surgery), hospices (£4.6m from nine contracts), councils (£4.1m from four contracts), nursing homes (£440 000 from two contracts), and charities (£260 000 from five contracts).

The findings follow a previous investigation by The BMJ in April 2013 which found that more than a third of GPs on the boards of CCGs had a conflict of interest resulting from directorships or shares held in private companies. For more information see: BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6000

 

GPs at risk of conflict of interest allegations, NAO report finds (Pulse: 11 September 2015)

GPs could be perceived to put ‘personal interests ahead of patients’ interest’ as a result of the move to co-commissioning, a National Audit Offfice (NAO) report has concluded.

The report by the Government auditors found that ‘almost all’ CCGs fulfil key legal requirements for managing conflicts of interest, but only ‘a minority’ have actually reported that they had to manage actual or perceived conflicts of interest. In the instances where they had done so, the NAO found that ‘the adequacy of those controls had varied’.

It also said that NHS England has collected ‘little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements’. But this comes as NHS England’s decision to allow CCGs to choose to co-commission primary care services from GPs as of April 2015 ‘is likely to increase significantly the number and scale of conflicts of interest’.

The report also revealed that some 1,300 GPs sit on CCG governing bodies, accounting for 41% of all CCG board members.

The GPC opposed the introduction of primary care co-commissioning, with members at the LMCs conference 2014 declaring the inherent conflict of interest represented the ‘ultimate poison chalice’ for general practice. NHS England is now reviewing whether CCGs could also take on responsibility for handling patient complaints but the GPC has said CCGs taking on performance management of practies would be ‘inappropriate’. NHS England has approved 151 out of 209 CCGs to take on greater responsibility for commissioning general practice, including 65 which took on full delegated commissioning responsibility in April.

Monitor, the body tasked with investigating CCG conflict allegations, had investigated just one such case since CCGs were introduced in April 2013 up to June 2015, the report said.

 

Exclusive: ‘Bias’ claim over £190m Yorkshire NHS contract (Yorkshire Post: 25 July 2015)

A Yorkshire health trust has called for an official inquiry into how a £190m contract was awarded amid claims of potential bias in the tendering process.

Leeds and York Partnership Foundation Trust (LYPFT), which runs mental health services, has written to health regulator Monitor detailing a series of concerns over how it narrowly lost a five-year contract to run services in the Vale of York - and called for the transfer of services to another trust, due on 1 October, to be suspended. The Trust’s letter, seen by the Yorkshire Post, says Monitor should investigate the role of Louise Barker, a key member of Vale of York Clinical Commissioning Group (CCG), whose partner works for Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Dr Barker, the CCG’s lead on mental health, was directly involved in the decision to award the contract to TEWV in May. The letter, from the Trust’s chief executive Chris Butler, says the CCG breached NHS tendering rules and that the “breaches have undermined the integrity and legality of the Procurement.” It highlights concerns that Dr Barker was a member of the assessment panel judging the rival bids and that her scores for TEWV were significantly higher than her fellow panel members.

 

CCGs consider swapping GPs to avoid conflicts of interest (Local Government Chronicle: 29 January 2015)

Clinical commissioning groups are considering swapping GPs with their neighbouring groups to safeguard against potential conflicts of interest in commissioning primary care.

British Medical Association GP committee chair Chaand Nagpaul told HSJ his “biggest concern” was that “no practice should feel that decisions about their contract, performance management and investment decisions about their practice are being influenced by local colleagues who sit on the CCG board”.

 

CCG leaders complain that they do not have time to fulfil their roles (GP: 26 January 2015)

The Nuffield Trust and The King's Fund argue that NHS England should review the way CCGs attract and develop board members, and must ensure that CCGs have adequate funding to fulfil their new role in primary care.

While the majority of CCG leaders believed that conflicts of interest were being managed adequately, researchers highlighted examples of decisions where there was the potential for, or the perception of, a conflict having occurred.

The research also finds that there has been a significant drop in the numbers of GPs who reported being highly engaged in the work of their CCG, from 19% of respondents in 2013 to 12% in 2014. Within this, there was a 10% drop in the proportion of GP governing body members who reported being highly engaged.

 

New GP 'conflict of interest' fears over financial link to out-of-hours companies (Independent: 12 November 2014)

Public spending watchdogs have warned that GPs could award lucrative to companies providing out-of-hours services in which they have a shareholding. 

The Commons Public Accounts Committee demanded tough safeguards to prevent 'conflicts of interest' arising. Nine out of 10 GPs in England use out-of-hours services when their surgeries are closed at a cost of £400m a year.

Fears of such conflicts have grown since the Government's controversial NHS reforms handed the power to buy healthcare to clinical commissioning groups (CCGs).  

 

GPC set to oppose co-commissioning of primary care (Pulse: 22 May 2014)

GP leaders have rejected plans for CCGs to co-commission primary care, warning that such a move will ‘fatally damage relations’ between practices and commissioners

Delegates at the LMCs Conference expressed their ‘alarm’ at moves by NHS England to give CCGs control of the GP contract, warning it would lead to ‘unacceptable’ conflicts of interest.

The local leaders voted in favour of the motion, which added that the proposals will ‘undermine the credibility of CCGs’ and will now ‘insist that GP core contracts should not be held by CCGs’.

Proposing the motion, Dr Aneel Bikhu of Nottinghamshire LMC told the conference the GPC should petition NHS England and the Department of Health to learn from the problems of PCTs.

 

Legal challenge over NHS spending (BBC News: 2 May 2014)

Campaigners have applied for a judicial review into how Bristol's Clinical Commissioning Group (CCG), which oversees local health services, is spending its £500m budget.

Protect our NHS says the group is failing in its legal duty to consult the public over decisions. But the CCG denies the charge.

Ever since family doctors were put in charge of CCGs a year ago there has been growing concern that decisions are being made behind closed doors. CCGs have the same obligations to consult patients over changes in local health services as the primary care trusts they replaced.

But some health campaigners claim that, with limited resources, CCGs may not fail to do so as much as they could. Now lawyers for the Protect our NHS campaign group have served an application for judicial review on Bristol CCG arguing its draft policy for the procurement of health services is unlawful.

 

NHS consultant Dr Julian Beezhold in row over £1.2m for private clinic Milestones Hospital from cost-cutting trust (The Independent: 17 March 2014)

An NHS mental health trust that is cutting staff and services has spent £1.2m in one year on a private hospital where one of its senior consultants is a director. Anti-privatisation campaigners have called for an investigation into what they believe is the perception of a potential “conflict of interest”. The Norfolk and Suffolk NHS Foundation Trust has been forced to make savings of £40m over four years. In 2013, it referred seven patients to Milestones, a trading name of a company called the Atarrah Project. The company, whose net worth more than doubled between 2011 and 2013, lists Dr Beezhold as a director. There is no evidence that Dr Beezhold’s role with Milestones has had any impact on the trust’s decisions on bed closures or that he has acted inappropriately. The trust said all its placements were audited externally and internally.

Dr Clive Peedell, leader of the National Health Action Party, said the “conflict of interest” should be investigated, adding that he believed private companies were reaping growing rewards from “financially vulnerable trusts laid low by Government cuts”. A spokesman for campaign group Save Mental Health Services in Norfolk and Suffolk said that the trust had made 79 staff redundant in the past month.

 

One in five GPs on CCG boards has financial interests (Pulse: 23 September 2013)

One in five GPs who sits on a CCG board has a financial stake in a provider which currently provides services to their own CCG, a Pulse investigation has found. Figures obtained under the Freedom of Information Act from 76 CCGs reveal that dozens of GPs across the country are juggling commissioner and provider interests, with many being forced to leave board meetings when key decisions come up because of their conflict of interest. There is no suggestion that the GPs concerned have done anything wrong, and CCGs reported that procedures to safeguard against conflicts of interest are being fully followed. But the findings have raised fresh questions over how CCGs should tackle conflicts of interest - and whether GPs’ influence on CCG boards is being diluted as a result of the safeguards currently in place. The figures come as NHS England hinted at a move towards CCGs playing a greater role in commissioning primary care - a move opposed by the BMA due to the potential conflicts of interest.

 

Medical companies sponsor 75% of nurses in ‘stoma’ care across Britain. (BBC News: 23 September 2013)

Some in the NHS are concerned nurses may feel obliged to prescribe the products made by their sponsors NHS England said: "Stoma nurses are bound by a code of professional conduct stating their professional judgment shouldn't be influenced by commercial considerations." Of around 600 stoma nurses working in the health service 450 were sponsored. Stoma patients need a regular supply of colostomy bags, belts, and other products to protect the skin and unlike any other area of care in the NHS, patients can get their products via a supply company owned by the medical manufacturer. The practice has led to complaints of unnecessary equipment being prescribed. George from Essex had his stoma operation two years ago. He said: "You can tell the company you don't need an item this month, some companies abide by that but some companies will send it you." NHS Clinical Commissioning Groups across the country are trying to reduce spending in the area of stoma care. Andrew White, head of medicine management at Greater Manchester's Commissioning Support Unit, said: "While prescription costs for overall prescriptions are down 5% (in the last three years) in the area of Stoma Care it's growing 21%." Jonathan Evans, Conservative MP for Cardiff North said: "It's clear that if you have someone that is a health professional and they advise you about your care and that person is paid for by the manufacturer of a product, big issues around conflicts of interest arise."

 

Conflicts of interest stymie CCG decision making (Health Service Journal: 10 July 2013) 

The governing body of Blackburn with Darwen Clinical Commissioning group was unable to take a decision on its contract for GP out-of-hours services because too many of its GP members had to leave the meeting due to conflicts of interest. In April, the governing body was presented with an options paper on whether to extend or re-tender its contract with East Lancashire Medical Services, which was due to expire in December 2013.

The meeting considered the options and agreed to support a proposal to extend the contract for 21 months, however, minutes state that CCG chairman Joe Slater then “informed the meeting that, due to the number of GP executive members who had left due to their conflict of interest associated with this item, the meeting was no longer quorate and a decision could not be taken”.

The minutes state that in light of the governing body’s inability to take the decision the CCG’s chairman and its clinical chief officer would “act on behalf of the governing body in line with discussions at the meeting and consider the recommendation of the preferred option”.

 

CCG faces £2m funding gap after overnight cut (The Guardian: 22 July 2013)

Bexley CCG chairman Dr Howard Stoate, a GP and former Labour MP for Dartford, Kent, warned that England's 211 CCGs are working on ‘extremely tight running costs’, resulting in a lack of ‘expertise’ and ‘capacity’. Speaking at a meeting of the all-party parliamentary group on primary care and public health on 18 July, Dr Stoate warned his CCG would have to make more cuts than planned because his budget is unexpectedly shrinking. Dr Stoate commented: 'So all of a sudden my best-laid plans of a £12m quality, innovation, productivity and prevention (QIPP) scheme to balance [the budget] this year has been blown out of the water this morning by a £2m gap that wasn’t there last week'.
Dr Stoate called for the government to start investing in primary care and warned that under the reformed NHS in England, there is no mechanism for CCGs to do it.

 

NHS guidance on conflicts of interest should be mandatory (The Guardian: 5 April 2013)

The disclosure that one in three GPs running the new CCGs also help run or hold shares in private healthcare firms has raised concerns about managing widespread conflicts of interest. The NHS Commissioning Board has issued guidance for CCGs, and it is clear that CCG board members should declare all relevant financial interests and exempt themselves from discussion of contracts from which they might benefit personally. However, the article notes that even when procedures are correctly followed, it can be easy to bias the outcome in favour of a particular healthcare supplier - this is a “huge risk” that the government is taking with its reforms. Any suspicion of bias, justified or not, that a private healthcare contract was awarded unfairly could quickly discredit the reforms, which have already raised questions about the quality and consistency of NHS procurement.

 

How GPs responsible for spending Islington’s £302 million NHS budget are linked to private firms (Islington Tribune: 12 April 2013)

The board of doctors now responsible for spending Islington’s £302 million NHS budget are to be summoned to the local Town Hall to explain how they will avoid potential conflicts of interest, after concerns were aired over the potential for the 20 doctors on the board of Islington’s CCG to buy services from companies they are involved with. GPs are now responsible for buying health services for the local population, and are, most crucially, allowed to buy services from private healthcare companies, which many critics fear is the start of the privatisation of the NHS. The CCG has said that it is determined to be as transparent as possible given that the potential for conflict of interests has been recognised by the government. Local councillor Martin Klute, who heads the Health and Scrutiny Committee at the Town Hall, said there were important questions of transparency, and he would be inviting the CCG to explain its processes before the council. Conservative MP Andrew Mitchell and his GP wife have been caught up at the centre of this concern over conflicts of interests, after it was revealed that the Islington CCG’s register of interests showed that Dr Bennett, Andrew Mitchell's wife, owns shares in DictateIT, a company which outsources transcription of medical notes to India. Records held at Companies House, however, suggest that the shares are in fact owned by her husband Andrew Mitchell. With the holding absent from his register of interests, this contradiction leaves the couple open to the suggestion that they have tried to disguise his stake in the company.

 

GP hits back as private firm awarded £70k NHS contract (Manchester Evening News: 1 April 2013)

The boss of a new group set up to run health services in Bury has defended his board’s decision to award a £70,000 contract to a firm where he is medical director. Dr Kiran Patel is the chairman of Bury’s Clinical Commissioning Group, which will design and commission services in the town. The organisation has replaced the disbanded primary care trust – and will have responsibility for the majority of the local health budget. But it has already run into controversy after being revealed as one of a number of boards in England to select companies in which clinicians have a personal interest.

 

GPs' links to private healthcare firms spark fears of conflict of interest (The Guardian: 14 March 2013) 

An investigation by the British Medical Journal has found that one in three GPs who are running new organisations that have been given £65 billion of the NHS’ budget also run or hold shares in a private healthcare firm. The study showed that 426 (36%) of the 1179 family doctors on a board of one of the 211 CCGs in England have an interest in for-profit firms. This disclosure has sparked concern that such widespread conflicts of interest will threaten patients’ trust in GPs, who may be seen as benefiting financially from the privatisation of the NHS. Some GPs are senior directors of major private health companies whilst some own shares in these companies, which already earn hundreds of millions of pounds a year for doing NHS work alongside local doctors.

 

Do you really want them to profit from the pills they prescribe? (Daily Mail: 24 March 2013)

In this article Dr. Ben Goldacre discusses the question "would you feel nervous if you knew that your doctor stood to make money from the treatments they recommend?" The article was prompted by the Government’s new NHS reforms under which GPs will now run local Clinical Commissioning Groups, deciding which NHS services should be commissioned. Dr Goldacre notes that the revelation by the British Medical Journal that one in three GPs on the new local boards has a financial ‘conflict of interest’ is disturbing. Many of these hold shares in large private-sector health firms, which are competing for lucrative contracts from GP commissioning groups. Even more disturbing, notes Dr Goldacre, is that many are senior directors in smaller local companies that have been set up specifically to sell scans, minor surgery, out-of-hours services and blood tests under the new regime.

 

Bucks Urgent Care got £2m NHS contract without a tender process (Bucks Free Press: 21 February 2013)

Health chiefs have defended giving a £2 million contract for Wycombe’s new minor injuries unit to a private company without it going out to tender. Officials have also disputed claims that two of the decision-makers had a ‘potential conflict of interest’ during the commissioning process.

The Minor Injuries and Illnesses Unit [MIIU] opened in October last year after the contract was awarded to a private firm called Bucks Urgent Care, which also runs the county’s GP-out-of-hours service.

 

Revealed: One in five CCG board members have potential conflict of interest (Pulse Today: 21 December 2012) 

An investigation by Pulse has found that more that one in five clinical commissioning group (CCG) board members have financial interests in private healthcare providers, exposing them to multiple possible conflicts of interest when commissioning services from April 2013. In an analysis of nearly 900 CCG board members, 23% were shown to be directors, owners, partners or shareholders in private healthcare providers, or have family member with an interest in a private healthcare provider.

 

'Inherent conflict of interest' in specialised services commissioning (Health service Journal: December 2012)

The Gender Identity Research and Education Society, which shares concerns about the lack of patient engagement in the development of specifications for specialised services, claims there is an “inherent conflict of interest in having clinicians write their own service specifications”. Gender dysphoria services, which range from initial counselling and hormone therapy to transition surgery, are provided at just seven centres around the country. A handful of surgeons carry out transition surgery. Society trustee Terry Reed told HSJ, that patients and stakeholders had been under-represented on clinical reference groups and the practice of holding meetings by conference call rather than face to face had made it more difficult for those involved to get their voices heard. 

 

Drug companies to work with CCGs on care pathways and case finding (Pulse: 28 May 2012)

A new scheme aims to make it easier for pharmaceutical companies to ‘move beyond sponsorship' in working with CCGs and funding NHS case finding projects. The guide to ‘joint working agreements' has been drawn up by the Association of the British Pharmaceutical Industry with the support of the Department of Health. But GP leaders warned the plans were fraught with conflicts of interest and could badly skew the priorities of emerging CCGs – and pile additional work on GPs.

 

Town surgery offering patients controversial private check-ups (West Sussex County Times: 13 February 2012)

A Horsham surgery is opening its doors to a private company offering patients a full heart and stroke screening for £159. Park Surgery in Albion Way has sent its patients a letter offering them private health tests from Health Screen First for discounted prices. The same controversial service was offered four years ago. 

 

PCT found in breach of competition rules (Pulse: 1 February 2012)

A Darzi centre under threat of closure has been given a stay of execution after the NHS competition watchdog ruled that PCT bosses breached conflict of interest rules by enlisting GPs with ‘vested interests' - including the local CCG chair - to lead a consultation on the centre's possible closure. The Cooperation and Competition Panel ruled that NHS Peterborough's consultation recommending the closure of the Alma Road surgery fell foul of conflict of interest rules.

 

CCGs must publish register of all members' and employees' interests after bill amendment  (Pulse: 29 February 2012)

Clinical commissioning groups will have to publish a register of members' and employees' interests under new amendments to the Health and Social Care Bill agreed in the House of Lords. Health minister Earl Howe accepted four amendments from Liberal Democrat peer Baroness Barker aimed at quelling fears of conflicts of interest between GPs commissioner and provider roles but rejected a longer one from Labour.

 

NHS will not fund some operations, patients told, then offered private care  (The Guardian: 4 October 2011)

York GPs offer to carry out minor surgical procedures for a fee in unprecedented step for NHS care. GPs at a health centre in York have written to patients saying the NHS will no longer fund minor operations and instead have offered to carry out the procedures for a fee, an unprecedented step in the health service. In a letter obtained by the website nhsmanagers.net, patients are advised that for a number of minor surgical procedures, such as ingrowing toenails, mole removal and chopping out warts and cysts, they would have to go private.

 

 

See also:

GOVERNMENT / POLITICIANS

MANAGEMENT

ACCOUNTABILITY

MONITOR

Examples of reported conflicts (by company)

BMI/Netcare - GHG Chairman advises Conservatives, which may benefit his company

Care UK - Conservative peer Lord Patten advisor to Bridgepoint Capital, owner of Care UK 

            - Advisor to health secretary has private healthcare links

            - Tory party donors given NHS contracts

Harmoni (Care UK) - Care UK founder and wife donate over £200,000 to Conservative Party

McKesson - NHS fairness tsar urged to quit by doctors over 'conflict of interest'

McKinsey - The firm that hijacked the NHS

Serco - Two Conservative and two Labour peers have shares in Serco

Virgin - Jeremy Hunt personally intervenes to encourage Virgin takeover of NHS hospitals

Spire - Spire employs former Department of Health employee and former Health Secretary

Recent reports:

Private Health Lobbying

How private for-profit healthcare companies have lobbied and influenced government policy, in order to try and gain greater access to the £100bn NHS budget.

MPs and Lords Financial Interests in Healthcare

Analysis of financial interests MPs and Lords may have in private healthcare, these may include business investments, advisory positions and/or monetary donations.

 

"If conflicts of interest in CCGs are not managed effectively, the consequences could badly undermine the confidence of regulators, providers and, most importantly, patients, in the system."

Clare Gerada  Royal College of GPs March 2013

 

Lessons from the US?

Cherry-picking patients leaves sour taste

Medical professionalism in a commercialized health care market

 

Share your examples about the impact of NHS changes


 
 
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