Exclusive: More than one in five CCG board members have financial interests in private healthcare providers exposing them to multiple possible conflicts of interest when commissioning services from next April, a Pulse investigation has uncovered.
The analysis of nearly 900 CCG board members’ registered interests shows that 23% are directors, owners, partners or shareholders in private healthcare providers, or have a family member with an interest in a private healthcare provider.
The figures ignited a row over how CCG board members should tackle potential conflicts of interest, with the Government’s commissioning tsar to suggesting current guidelines were inadequate and board members with problematic financial interests should consider stepping down from their positions.
The call goes much further than NHS Commissioning Board’s rules – backed by the BMA – that specifiy that CCG boards must have a publicly available register of interests and that CCG board members to exclude themselves from any decisions where they may have a ‘material interest’.
Pulse looked at the register of interests for 64 CCGs in England. Some 194 of the 864 CCG governing board members from those CCGs had financial interests in private healthcare providers.
The majority of the interests were for small private businesses run by clinicians, providing services such as diagnostics, minor surgery and locums. A number of CCGs boards had a majority of GPs who had financial interests in local collectives, such as out-of-hours providers, or had a significant number of members running practices in conjunction with large private sector businesses.
An investigation by Pulse earlier this year showed that Virgin Care had links with more than half of governing board members on some CCGs. But this has been reduced after Virgin Care said that it was to end joint partnerships with 300 practices to avoid any potential perceptions of conflict of interest in October.
Of 101 CCGs investigated, 38 did not have a publicly available register of interests on their website – contrary to the NHS Commissioning Board’s code of conduct for managing potential conflicts of interest.
The BMA said that CCG board members were doing the right thing by declaring any financial interests that might be potential conflicts of interest.
Dr Richard Vautrey, a GPC negotiator and a GP in Leeds, said: ‘I think the most important thing is if they declare it.
‘It is then important that people recognise it and do something about it when decisions are being made that have impact on the organisation they are involved with, like step out of discussions.’
But Dr James Kingsland, who is a special adviser to the Department of Health on commissioning, said this advice was ‘not good enough’ and that commissioners should consider stepping down from the board if they had interests that could be a potential conflict.
He said: ‘In some areas, there is the sense that just declaring an interest, and excluding yourself from the relevant discussions, is enough.
‘If there is a conflict of interest in the declarations by board members, there has to be serious discussions about whether that person should be on the board. The declaration itself does not negate the conflict. I have heard people say “I have declared my interest, and when discussions come around where we discuss the service, I’ll just exclude myself” – that is not good enough.’
Dr Kingsland said that when perceived conflict of interests arose, there must be wider discussions than simply within the governing board.
He added: ‘I do hear from practices that they are not comfortable with this sort of person on the Board, my question is has it been aired and what do members of the CCG think, what does the Health and Wellbeing Board and what do patients think of it? If they are all comfortable, that will be fine.
‘If there are still issues, then it is time to say the board member should step down.’
Dr Dennis Cox, an RCGP council member who co-authored the RCGP and NHS Confederation guidance on the subject, said there would be times when it is not appropriate for these members to leave discussions.
He said: ‘GPs are naturally small businessmen. To take them from that role and say “you are custodians of public finances”, in other words civil servants, is really difficult.
‘You might be the expert and the board can’t have a discussion without you. If it is a minor surgery unit and you are the only one who has done any minor surgery, you might be an intregal part of the discussions.’
CCG board members who do have potential conflicts of interest should use the ‘Paxman test’, he added. ‘If you think you will be slightly embarrassed explaining it to Jeremy Paxman’ then you must look to change your arrangements, he said.
Revealed: Extent of potential conflicts of interest
23% – number of CCG board members had a potential conflict of interest with a healthcare provider*
38% – proportion of CCGs without a publically available list of registered interests for board members on their website
*A director, owner, partner or shareholder in a healthcare related private company, have a close family member – spouse, children – with an interest in a healthcare-related private company or had a practice run in conjunction with a private healthcare company (not partner-run practices)