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 ( www.thebureauinvestigates.com) 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. "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," she said. "And if you're in a position to commission... and you could potentially buy care from yourself, then I would be very concerned."
The investigation found that more than 60 per cent had potential conflicts resulting from their involvement in an expanding healthcare company controlled by Richard Branson's Virgin Group. Assura Medical has set up 25 joint enterprises with groups of GPs around the country. Under the terms of their deals, these ventures 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.
But there are broad crossovers between the Assura partnerships and the new commissioning boards. At the Sutton Consortium in Surrey, 19 out of 25 commissioning board members are listed at Companies House as having a financial interest in their local Assura Medical partnership. In the South Reading Consortium, three out of five board members are GPs who have involvement in an Assura venture 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 spokesman 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". Nineteen of the 52 first-wave pathfinder consortiums have board members with interests in commercial providers – 69 board members in total, including 47 with links to Assura.
British Medical Association (BMA) guidance suggests where the majority of board members have a potential conflict of interest, an "appropriate independent body" should oversee decisions. Dr Laurence Buckman, chairman of the BMA's GPs committee, said: "The rule should be if it looks strange, it is strange. It doesn't matter if it's legal or not. If there are a few GPs on a board with a vested interest, they should absent themselves. Or if it's the majority, then clearly you need an outside body to make that decision. We would also like each consortium to have an independent audit board to oversee all decisions."
Health economist Kieran Walshe, professor of health policy and management at Manchester Business School, said: "It's a very obvious conflict of interest if a GP is on the commissioning board, and they're really at the centre of making decisions about what services to buy, and yet they still have a financial interest in Assura Medical, a business from which they would be buying services."
NHS Alliance chairman 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.
The Sutton Consortium said it would be "developing our governance arrangements over the coming months to ensure we continue to be transparent and accountable". The issue was addressed at a recent board meeting, it added.
NHS South West London said none of its board members was a member of Assura Wandle LLP clinical management board.
A spokesman for Assura Medical said: "GPs remain what they have always been: providers of patient care first and foremost. The potential conflicts of interest that may arise in the new world of GP commissioning are relevant to all GPs and must be managed in an open and transparent way.
"Our own guidance to our GP partners reflects best practice, and should the Department of Health publish new guidance when commissioning consortiums become statutory bodies, we will update ours accordingly."
A Department of Health spokesperson said: "Our plans to modernise the NHS will improve the current system of accountability in the health service, ensuring that any potential conflicts of interest are dealt with in an open and transparent way. All clinical commissioning groups will have to have a governing body, with powers to ensure that decisions about patient services and use of taxpayers' money are made in an open and accountable way."