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Liverpool GPs reject conflict-of-interest accusations over dermatology firm

Liverpool GPs were pitched into the national spotlight when Channel 4 news claimed in September that they were lining their own pockets at the expense of patients.

Liverpool GPs were pitched into the national spotlight when Channel 4 news claimed in September that they were lining their own pockets at the expense of patients.

GPs were referring NHS dermatology patients to community-based clinics run by a new private company in which the GPs themselves held shares. The chair of the PBC consortium, who had links to the new provider, was also involved in recommending the service to the PCT. The GPs and PCT insist the implied criticism about a conflict of interest was unfair.

Dr Christopher Peterson, chair of Liverpool's South Central PBC Consortium, and Katherine Sheerin, associate director of Liverpool PCT, explained the process to Practical Commissioning.

Dr Peterson says: ‘There had been concerns about the waiting times and the number of follow-ups for dermatology patients seen in outpatients at the Royal Liverpool University Hospital. The PCT had developed a clinical assessment service-type model, but our consortium thoughtwe could produce a more efficient system. We aimed to reduce the 1, 500 referrals a year to hospital down to 300 over three years and also cut the follow-up ratio, which had been 1: 7. We also wanted educational support fed back to GPs so they could manage more dermatological problems themselves. '

Rather than tender for a sole provider, the PCT invited bids for ‘willing providers'to be approved on to a menu of services to which GPs could refer. Four organisations applied: the hospital; the Liverpool arm of national firm Assura Healthcare; Our Care, the company set up by GPs within the South Central Consortium; and Aston Health Care, a company formed by GPs in Knowsley outside the PCT's area.

Assessing the bids

Ms Sheerin says: ‘The interview panel assessing the bids included two PCT managers, including myself, and Chris as a clinical adviser. Our job was to make a recommendation to the PCT's PBC committee, which would make the final decision. The PBC committee was made up of three non-executives, the PCT chief executive and our finance director. '

Dr Peterson says he resigned his shareholding in Our Care before taking part in the interviews of bidding organisations.

‘Legal advice was taken from the PCT's solicitors, which said my position was okay, and my interestwas declared at the time of the interviews, 'he adds. The PBC committee scrutinised the selection process and endorsed the recommendation to approve Assura Healthcare and Our Care as willing providers.

Ms Sheerin adds: ‘The PCT had set the price beforehand, so our recommendation was based on the quality of service. ‘We would pay £90 for a first appointment, £30 for a follow-up and £30 for a triage where the patientwas not seen. '

Assura Healthcare and Our Care subsequently merged. GPs from the South Central consortium hold just 1% of the shareholding (£5, 000 each) of this new company.

Ms Sheerin says: ‘If a GP is an Our Care shareholder they have to declare it when talking to the patient about their referral. ' Local opposition to the arrangement has been driven by the Keep Our NHS Public campaign and the hospital-based PPI forum, ‘which is frankly misinformed about large aspects of PBC', says Dr Peterson.

Situation exists everywhere

‘GPs taking an interest in practice-based commissioning and redesigning services are by their very nature going to be the ones who have the wherewithal and energy to look at provision, 'he adds.

‘It's not unique to dermatology in Liverpool, it's a situation that exists everywhere. And for a long time PCTs have been both commissioners and providers.

‘We've asked our PEC and LMC chair to draw up some kind of policy statement on how to manage this in the future. Otherwise new services could be stifled because media interest will almost always focus on an air of criticism about any new service. '

Patient satisfaction in the private service appears high, and the need for follow-ups has reduced, Ms Sheerin adds.

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