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Private company handed GP commissioning budgets

Exclusive: The UK's largest private provider of GP care has made its most significant inroad yet into commissioning after PCT managers handed it control of budgets for outpatient appointments and prescribing, Pulse can reveal.

The Practice Plc, which runs 60 GP surgeries and further clinical assessment and treatment services (CATS) across the UK, and recently acquired the UK provider arm of US healthcare giant UnitedHealth, is now controlling commissioning budgets in Buckinghamshire, where it has formed a small consortium of its two practices in the county.

NHS Buckinghamshire said it had handed the company budgets to commission outpatient appointments and prescribing for the 11,000 patients registered at the two practices, Lynton House in High Wycombe and Prospect House in Great Missenden.

The Practice also provides ophthalmology and sexual health services in Buckinghamshire.

The PCT has also devolved prescribing budgets – but not yet outpatient budgets - to two other consortia operating within its boundaries, United Commissioning and the Bucks Primary Care Collaborative, which between them cover 54 of the 59 practices in Buckinghamshire.

A spokesperson for NHS Buckinghamshire told Pulse: ‘All three commissioning groups within Buckinghamshire are at different stages of preparation for this challenge, and The Practice Plc has been the first group to take the lead in commissioning outpatient appointments for their own registered population of around 11,000 patients.'

As well as GP surgeries, The Practice runs six walk-in-centres and provides community ENT, sexual health and ophthalmology in parts of England.

But GP leaders expressed concerns about how closely the PCT would scrutinise potential conflicts of interest, as the company would have a role in both commissioning and providing services that GPs can refer to.

Dr David Jenner, the NHS Alliance's PMS/GMS contract lead and a GP in Cullompton, Devon, said: ‘With outpatient referrals there would need to be some checks for probity to ensure that patients were offered a true choice and were not being directed to clinics run by the company. It is up to the PCT to ensure that happens. Until the health bill is passed, the PCT can devolve responsibility, but not accountability.'

Dr James Kingsland, president of the National Association of Primary Care and a senior adviser to the Department of Health on commissioning, agreed: ‘If these GPs do refer to a provider that's run by their limited company, they would have to show that there had been a choice for patients under the choice agenda. They would also have to declare their financial interest in that provider to the patient, otherwise they would be in breach of GMC regulations.'

GPC negotiator Dr Chaand Nagpaul said: ‘There needs to be a process that safeguards against what are clearly conflicts of interest. There need to be checks and balances to ensure that GP referrals are not influenced by The Practice Plc's provider function.'

Colin Thompson, QIPP & performance director for the NHS Buckinghamshire & Oxfordshire Cluster, told Pulse the PCT had 'a robust commissioning process' to guard against potential conflicts of interest.

Mr Thompson said: ‘The Practice Plc, in common with other GP consortia, is well aware of issues relating to conflict of interest and ensures that its commissioner and provider functions are kept separate.

‘As a PCT we have a robust commissioning process so that commissioners whose organisations also provide services do not gain advantage through this and they are excluded from any situations where there might be a conflict of interest. The process is overseen by a commissioning board chaired by our medical director and involving a wide range of clinicians including representatives from all of the Buckinghamshire consortia and other NHS trusts.'

A Department of Health spokesperson said: ‘In its response to the NHS Future Forum, the Government has announced a range of measures to strengthen the governance arrangements for clinical commissioning groups and ensure that they have robust arrangements in place for managing any conflicts of interest.

‘Clinical commissioning groups, once established, will be public NHS bodies. At present, PCTs can delegate decision-making to pathfinders by enabling clinicians to form a committee or sub-committee of the PCT. But, under these arrangements, the PCT remains accountable for the commissioning decisions made and for ensuring that any individual conflicts of interest are managed appropriately.'

The Practice Plc declined to comment.