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Competition panel ruling leaves GPs open to conflict of interest challenge

Exclusive: GPs are being warned they are likely to face a series of challenges to commissioning decisions they make under the Government's NHS reforms after a competition watchdog ruled being a GP partner at a practice was a significant conflict of interest.

The Co-operation and Competition Panel (CCP) found a PCT had breached conflict of interest rules by involving GP commissioners in a consultation on the closure of a Darzi centre – on the grounds their practices and other provider interests stood to benefit from the decision.

The case was brought after 3Well Medical, the GP-led limited company that runs the Darzi centre, alleged Dr Mike Caskey, chair of NHS Peterborough's GP commissioning committee, was one of two clinicians involved in the consultation with ‘vested financial interests' in the centre's closure as his own practice could benefit.

But lawyers have warned the ruling has opened the door to legal challenges to GPs' attempts to restructure care on the grounds clinical commissioning group board members' practices could gain.

Ross Clark, a partner at solicitor Hempsons, said his firm's procurement team already spent half of its time ‘challenging procurement processes'.

He added: ‘This is an indication of the break-up of the NHS family into separate components. Those freestanding bits will do whatever they can to stay alive and will therefore challenge decisions like this.'

Michael Rourke, associate solicitor at Lockharts Solicitors, said: ‘More cases could go to the competition panel or the High Court. I think there will be judicial reviews looking to get decisions quashed, and people going to the panel where they feel decisions have been reached infringing the principles set out in co-operation and competition guidance.'

The CCP ruling stated: ‘The commissioner's actions were not consistent with the principles and rules [of competition] because of the involvement of two lead clinicians who had associations with primary and/or urgent care providers that might gain from the consultation process.'

But the CCP said NHS Peterborough ‘did not appear to discriminate' against Alma Road.

Dr Rupert Bankhart, 3Well medical director and a GP in

Peterborough, said: ‘We welcome the CCP's conclusion that there was a conflict of interest.'

He added 3Well Medical looked forward to working with local GPs on ‘correcting the impact' of the decision.

Dr Sushil Jathanna, chief executive of NHS Peterborough, said the PCT ‘supported' the panel's recommendation that the consultation was reviewed by independent clinicians.

He added: ‘It is important to state we do not believe there has been any actual conflict of interest.'

Dr Amit Bhargava, a GP in Crawley, Sussex, and chair of the Crawley Commissioning Consortium, said: ‘Because [commissioning] is localised and we are talking about localism, then almost every local person has a conflict of interest in almost every local decision.

‘Whether it's a GP, a nurse, a lay person or a manager who lives in the region, they will all be impacted by a decision, whether gaining or losing.'

But he added: ‘If we are clear about the vote structure and the transparency in which decisions are made and people

declare conflicts of interests at the beginning of discussions, then the pooling of decision making and intelligence will make sure the right decision is made.'

 

Potential conflicts

 

Darzi centres

GPs on CCGs could face challenges if their own practices are seen to benefit from the closure of Darzi centres or walk-in centres.

 

Out-of-hours provision

GP commissioners will be responsible for commissioning urgent care, but many practices will be involved in out-of-hours co-ops.

 

LESs

CCGs will commission LESs, meaning their own practices could benefit or lose out from the decisions.

 

Diagnostic services

CCG members' practices may be part of LLPs or provider services offering diagnostics.

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