One of the most vociferous critics of the Government's health reforms has a financial interest in a partnership of GPs that could lose out if private providers are given greater freedom to compete with doctors offering NHS services.
Clare Gerada, the head of the Royal College of GPs (RCGP), has been at the forefront of opposition to the Government's controversial Health Bill, which she says will open up the NHS to multiple private organisations leading to a "fragmented, expensive and bureaucratic" health service.
But Dr Gerada is also one of four partners in the Hurley Group – a rapidly expanding chain of London GP surgeries and clinics that now has 13 practices, 250 employees and provides a host of NHS services across the capital.
The group could face substantial competition from private providers if they are allowed to compete equally to provide NHS services.
There is no suggestion that the Hurley Group would lose NHS contracts in the face of greater competition, or that they do not provide effective and reasonably priced services. But senior Government sources have been keen to point out what they say is the irony of Dr Gerada's position. Some of her colleagues within the Royal College have also questioned whether she is "practising what she preaches" against competition but are reluctant to criticise her openly.
"She seems to be using her role as chair of the college in a very political way in opposing the Bill," said one. "That seems odd to some of us as she must have made a fortune through the expansion of the Hurley Group." In a statement on behalf of Dr Gerada the Hurley Group say they support competition, in an appropriate setting, but disagree with forcing competition, for the sake of it, into all parts of the NHS. Under the present rules, private companies cannot normally compete to provide NHS services. But GP partnerships – who are themselves private providers of services that can make significant profits from the NHS – can.
Over the past five years the Hurley Group has worked under the current system to expand from one surgery in Kennington to run practices and walk-in centres across London. Apart from Dr Gerada and her three other partners, the other employees of Hurley are salaried. A fully qualified GP there receives a starting salary of £72,600. While this is above the national average for salaried GPs, it is still below the £100,000 average earned by partner GPs.
Hurley has also caused controversy by taking over a service in south London which other local GPs claimed could fragment the local NHS and damage continuity of care – similar criticisms that Dr Gerada has been making about the Government's reforms.
Hurley Group won the contract to take over the urgent care centre at the Queen Elizabeth Hospital in Greenwich following a tendering decision by NHS South East London at the end of last year. But the move sparked opposition from local practices which said patients had not been adequately consulted, and that the new centre would threaten the viability of local out-of-hours services.
Dr David Wheeler, a GP in Greenwich who works out-of-hours shifts, told the medical magazine Pulse at the time that there was a "feeling of dismay" among local GPs at the decision: "It's a paradox that the chair of the college is all for collaboration and federating, but is also a partner at the Hurley Group, which is swooping in and taking over in areas where it normally has no business."
In a statement, the Hurley Group, on behalf of Dr Gerada, said it did not think it would lose out from the NHS reforms: "In competition with a range of providers [the Hurley Group have] taken over failing or new practices, supported and developed them and kept them open for patients. In a competitive, denationalised NHS the Hurley Group, with its successful track record, may stand to gain from a market free-for-all. So it is important to put that in the context of The RCGP's opposition to the Bill.
"The best way to deliver care is through high-quality, evidence-based integrated services delivered in partnership with patients and public. Competition, in the appropriate setting, can support this. However, the prospect of forcing competition, for the sake of it, into all parts of the NHS is not. This is a view shared by members of the RCGP, the BMA, the RCN, the RCM and other health groups and the majority of workers and organisations within the family of the NHS."
The Hurley Group: What it runs
8 GP practices spread across South London. Five years ago they ran a single GP surgery in Kennington. Many of the practices have on-site pharmacy services run by the group.
* A contract to run the urgent care centre at the Queen Elizabeth Hospital in Greenwich.
* A contract with the Department of Health to provide confidential health consultations and services for doctors and dentists in London.
* A substance misuse service for homeless patients in Westminster and a GP service to those in homeless shelters and asylum seekers in East London.
4 NHS Walk in centres (some included within surgeries) including a minor Injury Unit with X-ray, scans and blood tests on site. Many of their surgeries have expanded to carry out diagnostic tests such as X-ray and ultrasound normally provided in hospitals. They also have visiting hospital consultants in the areas of gastroenterology and cardiology.
* Mental Health professionals in practices, so patients can access advice and support for mental health issues at any of the surgeries.
* An open access, self-referral physiotherapy service run out of its Docklands Practice.
140 bed hostel for refugees and asylum seekers in south London.
UPDATE: The article was corrected at 4pm on 8 February 2011 to add Dr Gerada's title.