Exclusive: One in five GPs who sits on a CCG board has a financial stake in a provider which currently provides services to their own CCG, a Pulse investigation has found.
Figures obtained under the Freedom of Information Act from 76 CCGs reveal that dozens of GPs across the country are juggling commissioner and provider interests, with many being forced to leave board meetings when key decisions come up because of their conflict of interest.
There is no suggestion that the GPs concerned have done anything wrong, and CCGs reported that procedures to safeguard against conflicts of interest are being fully followed. But the findings have raised fresh questions over how CCGs should tackle conflicts of interest – and whether GPs’ influence on CCG boards is being diluted as a result of the safeguards currently in place.
A Pulse investigation last December revealed that 23% of GP board members could potentially have a conflict of interest because they held a financial stake in a private healthcare provider. But this new investigation shows for the first time since the NHS reforms came into effect how many GPs on CCGs have a financial interest in a provider actually doing work for the CCG.
Across the 45 CCGs who were able to provide full figures, 50 out of 251 GP board members (20%) held a financial stake in a provider – other than their practice – which is currently contracted by the CCG. Some 31 CCGs declined to say whether providers in which board members had interests were currently contracted to the CCG.
CCGs also provided information on the number of times board members had stepped out of board meetings due to a conflict of interest. Across the 69 CCGs to answer this question, board members in 12 areas had left the room on a total of 23 occasions.
Camden CCG told Pulse that five out of seven GPs on its board had a financial stake in a provider currently contracted to the CCG, while Eastbourne, Hailsham and Seaford CCG said that four out of five GP board members had a similar link. Enfield CCG said three of its board members with conflicts of interest had each had to withdraw from decision-making on two board meeting items.
The findings have prompted debate among senior GPs over the potential for conflicts of interest, with opponents of the NHS reforms claiming they were a matter of ‘huge concern’.
Dr Kailash Chand, deputy chair of the BMA and a retired GP in Lancashire but speaking in a personal capacity, said: ‘All people who come into this kind of board need to look at why they are there.’
‘GPs were told they need to be there as they know the local needs. But in my view, people with financial interests should not be on those boards.’
But GPC deputy chair Dr Richard Vautrey said that the figures showed that the system for safeguarding against conflicts of interest was working.
‘There will always be, and have always been, GPs involved in management roles with conflicts of interest. The important thing is that these are openly declared and appropriate action then taken. It would appear that is now happening.’
Dr Steve Kell, chair of Bassetlaw CCG and co-chair of the NHS Clinical Commissioners leadership group, said the fact that CCGs were publishing registers of interest and GPs were abstaining on decisions which presented a potential conflict was ‘reassuring’.
But he added that it was essential that financial interests in providers did not prevent GPs from being involved in commissioning as a whole.
‘The GPs who are interested in changing services are often the same ones who are interested in changing pathways through commissioning,’ he said. ‘Declaring interests properly is the key to being transparent.’
Oliver Pritchard, head of commercial health at Browne Jacobson LLP, said: ‘It is inevitable that CCGs are going to have to deal with GP conflicts of interest on a regular basis simply because of the way they are constituted from the GPs in their geographical area, so these figures are not a total surprise.’
‘However, there is a balance to be struck between glazing over potential conflicts and storing up possible legal challenges on the one hand, and, on the other hand being overly cautious and completely excluding GP’s from discussions and decisions about provider organisations where those GPs often have lots of useful experience and information to contribute to the discussion.’
The figures come as NHS England hinted at a move towards CCGs playing a greater role in commissioning primary care – a move opposed by the BMA due to the potential conflicts of interest.
NHS England deputy medical director Dr Mike Bewick told an RCGP event last month that it was a ‘waste’ for CCGs to have no role in commissioning primary care and suggested there could be ‘Chinese walls’ to prevent conflicts of interest.
‘The real key here is that you have good lay representation that would challenge and question decisions.’
How many GP board members have a financial interest in providers who hold a contract with the CCG (not including individual practices)?
Number of CCGs who answered the question – 45
Number of GP board members covered by the CCGs – 251
Number of GPs who have a financial interest – 50
How many times since 1 April has a GP board member had to remove themselves from discussions at a board meeting due to a financial interest in a provider?
Number of CCGs who answered the question – 69
Number of CCGs where GP board members have had to leave the room – 12
Total number of occasions GPs have had to leave the room – 23
Source: Freedom of Information responses from 76 CCGs