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At the heart of general practice since 1960

Standing up to scrutiny

Commissioning services from non-traditional GP provider organisations can lead to perceived conflicts of interest. Christine Campbell explains the measures her consortium has put in place to defend itself.

http://www.pulsetoday.co.uk/practical-commissioninglFive years ago, some 25 GP practices set up Peninsula Health LLP, a GP provider company, in partnership with Assura Medical, now Virgin Care.

The LLP provides services for the whole of the Wirral, covering 330,000 patients, and offers audiology, orthopaedics, rheumatology, dermatology, ENT and ophthalmology. These have been commissioned through traditional contracts and AQP.

Wirral GP Commissioning Consortium, one of three organisations that make up Wirral CCG, has since commissioned further services from Peninsula Health, including podiatry and physiotherapy, to improve access and reduce waiting times.

As a first-wave pathfinder we have made every effort to put appropriate governance arrangements in place to ensure openness, accountability and transparency at all times. This applies when Peninsula Health LLP is involved as a service provider, as many practices within the consortium are also members of Peninsula Health.

We want to make sure that all decisions we take will stand up to public scrutiny and we feel this is especially important when working with providers outside the traditional NHS family.

There are a lot of misconceptions about Peninsula Health LLP – about its relationship to Wirral practices – but our approach to that has been to be very open and transparent.

 

Patients control profits

From the start of the partnership with Assura Medical/Virgin Care, each of the practices involved has made a clear commitment they will have no financial or commercial interest from their partnership and that any profit or dividend received by the practice will be reinvested in patient care. 

Earlier this year, this commitment was cemented through the formation of a patient trust. It is made up of seven trustees, five of whom are patients who oversee the reinvestment of any profits directly back into patient care.

This might include the purchase of clinical equipment, or in the commissioning of clinical services for Wirral patients.

Not only does this ensure the investment of surplus to the benefit of patients, it is also a way of demonstrating there are no conflicts of interest, as only patients gain from the partnership.

As a result of media coverage of private companies working within the NHS, people can be wary and believe these companies are out to make huge profits from the taxpayer, rather than focusing on patient care. The patient trustees say the model goes a long way to address fears people have about the private sector. Patient feedback about the services has been very positive. They like being seen quickly at GP practices.

 

Patient engagement

The trust is just one way that we ask patients for input on what we do and the decisions we make. We have our own patient council with more than 50 representatives from member practices and it meets bi-monthly. Within this group there is also an executive that meets on alternate months to decide agendas and set the direction of travel.

We make sure any decisions we take at the board level have the opportunity to go through the council first and any key commissioning decisions, such as to commission services through AQP, must be supported by the council before implementation.

We also have a discussion forum on our website and are trying to encourage canvassing of a range of different views to inform our decisions at the board.

In terms of which patients engage with us on these issues, we sometimes find we get a similar demographic. It can be hard to reach some groups but we are trying to overcome that difficulty by using our website, collecting patient email addresses and doing things by text.

The most important thing is informing patients about the changes that are going on so they have a rounded understanding of what we are asking them to offer an opinion on. It is no good just asking them for their view on issues such as use of different provider companies, and what services they want and where, when they do not really know about or understand the commissioning cycle or things like QIPP.

At our last meeting we did a presentation on the NHS changes and how they relate to healthcare in our area and what it means for patients. We sent it to all the practices so they could show it to their patient groups.

 

Conflicts of interest

All our board meetings are held in public and agendas and minutes are published on the website. We want the commissioning process to be very open and transparent.

All of our board members are required to declare any interests that they or their family members have, which is held by the consortium, CCG and the PCT cluster and updated annually. Any board members with an interest that may impair their judgment on a particular matter will not be able to take part in the decision-making process.

If there are any matters to be discussed in a board meeting, anyone with a conflict of interest would have to declare that at the start of the meeting. And we have procedures in our consititution for someone to take over the role of chair if needed.

A recent example of a decision where there was a potential conflict of interest was about an admissions prevention service provided by one of our GP practices, which has a GP who is the chair of the consortium. When it was proposed to extend the contract for this service, the chair declared the conflict of interest and the non-executive adviser stepped into the role of chair for that meeting.

Last year we put out a tender for a primary care mental health service, which was awarded to three providers including Peninsula Health LLP. During that process we made sure there were no GPs whose practices were members of Peninsula on the panel making that decision. In addition, no consortium board members have any executive position with Peninsula Health LLP, or are members of the Peninsula Health LLP Clinical Management Board. 

This process of declarations of interest is not new to us and has been in place – initially to NHS Wirral or the PCTs – since before the formation of Peninsula Health LLP in 2007. So there is no way that anyone with a relationship or interest in Peninsula can profit from influencing that decision-making process.

 

Communication

The feedback from patients and our patient council has been very positive. It is clear their priority is to be offered choice and high-quality, safe services.

‘We have found that patients are getting more involved and taking an interest – which is good because really it is their views that need to inform everything we do.

‘There have been several media enquiries relating to conflicts of interest, which the consortium has dealt with by highlighting the actions that they have taken. In the future, we will signpost any enquiries to a governance section on our website – we want to be as proactive as we possibly can.

‘Our patient council has discussed the issue of trying to reach those that are difficult to engage with, and exploring strategies other than inviting people to meetings, and expecting people to pick up information in the practices. They asked for us to do a newsletter that would explain what the consortium is and how they can get involved, and encourage people to use our website and provide feedback. This newsletter, which went out in April to all households registered with our practices, was also made available through surgeries.

‘We are aiming to do virtual newsletters in future, and really are open to any ideas for how we can better engage with our patients and stakeholders.'

 

What the patients say

Harry Parsonage, member of the Patient Council Executive Board, and patient trustee: ‘I was delighted to have the opportunity to be involved in the trust, as I feel it goes a long way to address the fear that people have around the private sector and healthcare, and gives patients a real say in how resources are spent.'

Arthur Waller, MBE, member of the Patient Council Executive Board: ‘I am keen to improve dementia care locally, and am working closely with the core team to develop a work plan. You've got to involve patients at all stages – the council meetings are very lively, but it's great as it shows that patients are interested and want to get involved. ‘My background is not in the NHS – I like to think I can add a different dimension to discussions and help the NHS team think outside the box.'

Eddy Shallcross, chair of the Patient Council Executive Board and board member: ‘As long as we know that GPs making a referral are giving us a choice and basing a recommendation on quality and safety and our needs, then we are happy.

As long as GPs and commissioners are very open there's no problem. Right from the first board meeting I've been extremely impressed with the emphasis on operating openly, transparently, and involving patients at all times. I think we have done tremendously well at engaging patients locally – there is the consortium patient council, most practices have their own patient groups and there is the patient trust at Peninsula.'

 

Christine Campbell is acting chief officer of Wirral GP Commissioning Consortium

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