Are GPs exploiting NHS markets?
Updated on 03 September 2007
Doctors may be boosting their income by outsourcing treatments to companies they have a stake in.
Their salaries are already at an all-time high. But now there's concern that some GPs could be further boosting their income by taking advantage of the health service's internal market.
Under the NHS's new "practice-based commissioning" scheme, treatments can be outsourced to private companies which doctors are allowed to recommend to patients.
But as Channel 4 News has discovered, in Liverpool more than 70 GPs have a financial stake in one of those companies. It has led to accusations of a conflict of interest and calls for the rules regulating the award of contracts to be tightened.
The unit had to apply to provide healthcare to the city for the first time - and lost. Now most patients will be referred to two private companies - and that'll have a big impact on the funding for the hospital.
Yet many GPs will personally make money from the contracts. Channel 4 News has learnt that 73 local doctors are shareholders of one private company that won.
Nicholas Jones, a dermatology patient with severe psoriasis, will now be treated at the private clinic. Yet he questions whether he can trust any GP with a financial stake in his care.
He says: "I would get the impression that clinical decisions are being driven by financial incentives. So if these companies want to make more money, its in their interests to refer less patients to the consultants.
"And that way they save more money which is more profits for shareholders. And for GPs who have their own interests. So I'm very frightened and very horrified."
'I would get the impression that clinical decisions are being driven by financial incentives.'Nicholas Jones, dermatology patient
The hosptial can't compete with the two companies on cost. They charge the Primary Care Trust (PCT) £90 for each new patient - £25 pound less than the specialist unit here.
"The sum of money they'll receive under payment by results applies to the NHS as well as the private sector. Yes they are paid for each individual patient that is seen as is the NHS. The price they'll be receiving from the PCT is less than NHS hospitals."
In Liverpool the private companies and the hospital had to apply to an official consortium of 19 local GPs - that works under the direction of the PCT.
But was the process fair? And did the hospital have a chance? The woman who monitors the process on behalf of patients was surprised by the revelations.
She said: "There certainly is a conflict of interest. If you walked down town and asked people is that a conflict of interest they would say yes.
"It's a conflict of interest for the GP because they should tell the patient about the financial interest. It's a conflict of interest for the patient because how are they to decide what is the best service for them."
'The procurement method for the service is a matter for the Primary Care Trust and we are satisfied that the highest standards of probity have been followed.'Our Care's statement
The private company, Our Care, is based above a GP practice in Liverpool. One of the GP directors accepted he is in the Commissioning Consortium - but denied having a personal involvement in awarding the contracts. The company refused to do any interviews but issued this statement.
"The procurement method for the service is a matter for the Primary Care Trust and we are satisfied that the highest standards of probity have been followed. As a matter of course we do not comment on individual contracts."
There is an independent scrutiny committee at the City Council, which examines the new services and will make an assessment after 6 months. The chairman says he trusts the PCT - that there is no conflict of interest here. But he was not personally told the GPs linked to Our Care were in the consortium.
The government has rules to protect patients - the process must be transparent and GPs offering a service must exclude themselves from the group making a decision about a service.
But health think tank the Kings Fund says that's not enough and argues conflict of interest is inherent in the policy.
