14 Mar 2013

The new NHS: watch out for conflicts of interest

In March 2011, Channel 4 News broadcast our investigation into a gaping hole in the then health and social care bill.  It was a gap in the proposed legislation that did nothing to prevent doctors putting profit before the care of patients.

Indeed, we had identified that there was just one line in the bill that dealt with conflict of interest.  This meant that GPs, who were about to be put in charge of the majority of the NHS budget, could potentially send their patients to a private healthcare company that they themselves had an interest in.

We were told at the time by the Health Minister Earl Howe that clinical commissioning groups (CCGs) must have it written into their practice constitutions how they would deal with such conflicts.  We were also told that during board meetings any doctors or nurses with a conflict of interest should step outside.

Furthermore, we were assured that Monitor, the regulator, would bear down on any anti-competitive practice.

So now, followng freedom of information requests by the British Medical Journal, we discover that one in three GPs who are running the CCGs, help run or hold shares in a private healthcare firm.

It was found that 426, which is 36 per cent of the 1,179 family doctors on a board on one of the CCGs in England, have an interest in for-profit firms.  These include companies offering diagnostics, minor surgery and out-of-hours care.

The BMJ found that in some CCGs most of the GPs on the board had a financial interest in a local private provider of NHS care.

It is just two weeks until 1 April, which is D Day for the reforms.  CCGs will from that date be totally in charge.

We pointed out in our film that while it is not unusual for GPs to have financial interests in other healthcare firms, there was a safeguard in the system in the form of primary care trusts because it was they and not the GPs who decided how to spend the budget on patient care.

Post 1 April, the GPs make that decision themselves.  So, this raises two interesting scenarios.  The first is that GPs will do the right thing and leave the board meeting when a conflict of interest arises.

But – and this is a very big but – this could leave the board making clinical decisions about patient care and what services to buy without the expertise of the family doctors themselves.

You could, of course, argue that the lay members on the CCGs might make better decisions but that is an untested theory (and we know just how important evidence-based medicine is).

Secondly, if the contract is still awarded to the firm in which the GP has an interest (he or she having stepped out of the room), does that family doctor then say to the patient:  ‘I am sending you to this clinic for your varicose veins or hernia operation, but by the way I have shares in this company.’?

It is to be hoped so but how easily is that going to be policed?  And what effect does it have on the trust that goes to the very heart of the doctor-patient relationship?

Because the whole point of the health service has always been that you do not have the fear that your doctor is putting  profits before your health.

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