Concerns have been raised that this conflict of interest held by GPs involved in commissioning could influence their decision making. Commissioning GPs are likely to lose the trust of their patients – anyone in charge of deciding how the £60billion earmarked for patient care is to be spent, they must be seen as trustworthy and beyond reproach. However, recent research by False Economy – a research group financed by the TUC – has highlighted some concerns relating to a large number of GPs who sit on Clinical Commissioning Groups. The new Health and Social Care Bill put through earlier this year means that from April 2013 Clinical Commissioning Groups will take over from Primary Care Trusts in deciding which services are commissioned locally to provide health care and GPs make up a significant proportion of those sitting on the board of Clinical Commissioning Groups. The research by False Economy has identified that many of these GPs have a conflict of interest, as they have personal financial involvement in non-NHS providers.
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After analysis of information available about 50 Clinical Commissioning Groups, their members and their outside financial interests, False Economy found that in 22 Clinical Commissioning Groups over half of the GPs and in some cases all of them sitting on the boards have a stake in non-NHS providers of health care. In 10 Clinical Commissioning Groups it was shown that the majority of GP members were in partnership with Virgin Care to provide services ranging from physiotherapy to dermatology. For another 7 Clinical Commissioning Groups many of the GPs earned extra money through their work providing evening and weekend services for patients as part of “not for profit family doctor collectives”.
spicious of their motives for choosing the care that they have for them, damaging previously good doctor-patient relationships. Care will become more fragmented, delivered by a range of different private providers, which will ultimately increase costs and mean less money is available for spending on clinical treatment, so patients could suffer. The issue has also been raised that many GPs don’t possess the necessary skills to run the Clinical Commissioning Groups.
Preventing potential problems
As it can’t be seen to be that the decisions made by commissioning GPs are related to financial gains they could personally make, it is essential that steps are taken to put strategies in place to prevent this arising, ensuring that above all patient care is still the number one priority. During the months that remain before the takeover by Clinical Commissioning Groups rigorous principles need to be developed that all members of these groups agree to abide by. Polices developed by the Department of Health, Royal College of General Practitioners and British Medical Association will help to manage any conflicts of interest. GPs that are part of Clinical Commissioning Groups will have to declare any conflicts of interest and they will not be the only ones casting the vote, other members such as nurses and consultants will also have their say.
The 6 GPs that sit on the Clinical Commissioning Group in NHS Bath and North East Somerset are from practices that are part of Assura Minerva, the GP-Virgin Care partnership within the local area, which provides services such as fracture clinics and minor surgery. It has already been laid down that these GPs would not be involved in bidding on any services that they could be seen to benefit financially from, in other words any contracts that Assura Minerva were in the running for. Although their exclusion might possibly mean a decision would be more difficult to pass due to the smaller number voting, it has already been suggested that members from neighbouring Clinical Commissioning Groups could provide help in casting votes in such instances.