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GPs ‘should publish profits’ to ease conflict of interest fears

By Gareth Iacobucci

GPs involved in commissioning should be compelled to adhere to the same set of standards as other public officials, publish their profits and declare any conflicts of interest, say NHS managers.

In a critical briefing responding to the Health and Social Care Bill, the NHS Confederation calls for the Government to include better safeguards in the legislation to ensure GP consortia are transparent and have good governance procedures.

It urges the Government to provide a ‘detailed explanation of how conflicts of interests for GPs will be managed’, suggesting: ‘Measures such as open-book accounting, which gives the public greater access to financial information, might be a simple way of ensuring effective scrutiny of GPs’ profits.’

The organisation – which represents NHS managers – also criticises the Government’s communication of its policies, which it said had so far ‘failed to support the reform programme’, and called on ministers to be more honest about the scale of GP opposition to its controversial reforms.

The warnings are contained in Where next for NHS reform?, a briefing paper advising the Government on how to address the growing surge of opposition to its reforms.

It also follows a Pulse investigation that revealed last week that one GP in 10 on the boards of new commissioning consortia also holds an executive-level position with a private provider, exposing the serious potential for conflict of interest in the reforms.

The NHS Confederation says a requirement should be written into the bill to compell GPs in consortia to adhere to the Nolan principles that require qualities such as openness, selflessness and objectivity in public life.

‘While the Government’s aim of allowing local flexibility is in many ways laudable, it has allowed an impression to be formed that there could be a lack of proper and effective governance in place.

‘A simple response to this would be for the Government to include in the legislation a requirement for commissioning consortia to comply with the Nolan principles of public life.’

The NHS Confederation also claimed the debate about the reforms had become ‘entrenched and polarised’ and claimed that the Government should be ‘making the argument more confidently for the appropriate use of competition in healthcare to drive innovation’ but also ‘providing a clear explanation of how integrated services could be put in place’.

The Confederation also urged the Government to clarify the role of Monitor by ‘making it clear that that competition is seen as a means rather than an end, and clarifying that Monitor will operate with this in mind’, and called for a ‘more sophisticated, phased approach to the expansion of the Any Willing Provider policy’.

Nigel Edwards, acting Chief Executive of the NHS Confederation, said: ‘The Government has got to ask itself some hard questions about how it manages the reforms from here on in. We are not saying we have all the answers but we do want to start a conversation about the solutions.

‘There is a recurring theme running through our analysis. We have often found a reality gap between ideas that are good in principle and the details of practical delivery, which have often looked opaque or too optimistic.’

The NHS Confederation’s recommendations

• make argument more confidently for appropriate use of competition in healthcare to drive innovation
• provide clear explanation of how integrated services could be put in place, covering people with multiple long-term conditions, not just individual care pathways, and allowing test projects if appropriate
• accelerate work on defining and measuring quality of health services, and back this with investment
• introduce more sophisticated, phased approach to expansion of Any Willing Provider
• make it clear that competition is seen as means rather than an end, and clarify that Monitor will operate with this in mind.

GP commissioning
• acknowledge more needs to be done to encourage more GPs to enthusiastically take on new commissioning responsibilities
• clarify that consortia will be free to decide how much commissioning support they want from external organisations
• make clear that consortia remain publicly accountable for their commissioning performance regardless of any external support arrangements
• provide support to consortia to help them get value for money from external support for commissioning
• give detailed explanation of how conflicts of interests for GPs will be managed, and consider steps such as open-book accounting
• allay fears about financial incentives for GPs by giving a detailed explanation of how the commissioning outcomes framework will avoid conflicts of interest.

• accelerate work – following establishment of NHS Commissioning Board – to set out in detail how accountability arrangements will work in practice
• require consortia to comply with the Nolan principles of public life, through the legislation
• strengthen powers of scrutiny at local level so that consortia are required to account for their decisions to local overview and scrutiny committees and health and well-being boards.

• considering whether the Government should be less directive in terms of its timetable for implementation, allowing local flexibilities in how and when the reforms were put in place
• resolving the futures of NHS trusts with significant structural problems, taking decisions on reconfiguration and providing greater certainty for trusts unlikely to achieve foundation trust status
• improving the Government’s communications by developing a compelling narrative in favour of the reforms, and not devaluing the NHS staff responsible for making the changes.

Nigel Edwards Where next for NHS reform?