Should we just accept the new reality and allow GPs to play active roles in commissioning and at providers?
It was always likely to rear its ugly head. From the moment the NHS reforms were first unfurled, there were GPs and politicians warning of the dangers of conflict of interest. Some remembered the days of fundholding, and the concerns back them that a small number of GPs were benefiting by commissioning from themselves. Many more were relatively unconcerned about the risk of GPs actually being conflicted in their commissioning decisions. What these critics were worried about was how GPs would appear to the outside world. In an age in which the Daily Mail sets the tone, would the public trust GPs to take objective commissioning decisions when so many, inevitably, have interests in provider organisations too?
A Pulse survey last autumn, for Professor Martin Roland’s guest editor issue, found as many as a quarter of GPs had an interest in a local private provider of NHS services. It prompted a debate over whether these GPs would be conflicted should they play a part in commissioning. The GPC’s view was that just owning shares in a company would not be enough to preclude a GP from commissioning, but that having a senior role – a directorship, for example – might well be. We reveal this week that there are indeed relatively large numbers of GPs playing an active role on consortium boards who also sit on the boards of private companies. The lurking fear that the NHS reforms could subject GPs to criticism and suspicion could be about to be realised.
It’s perhaps not surprising that pioneering GP commissioners are at least as likely, and probably a bit more likely, to have interests in external providers than GPs in general. Commissioning attracts just the same kind of entrepreneurial sorts who might decide to involve themselves in business propositions outside their practice. But our findings do raise at least a couple of very serious concerns.
The first is not about the 17 PCTs who released details of the outside interests of those involved in their local consortia – it is about the 56 PCTs who replied but did not provide information, claiming they were not in a position to do so. Transparency is the great purifier, yet many trusts do not appear to have rigorous systems for collecting and publishing information about potential conflicts of interest on consortium boards. A Pulse survey of 460 GPs reinforces the point, finding only 23% were aware local consortium leaders had made full declarations of conflict of interest.
Secondly, our findings underline just how well advanced is the game of commissioning, and yet how poorly worked out are its rules. Consortia are making it up as they go along. Many have already held selection processes for board members. Will they have to go through the process all over again if rules are released on conflict of interest that prevent directors of private companies from sitting on consortium boards? Or what if, as seems more likely, the rules when released accept the new reality, and permit GPs to play active roles in both commissioning and at providers? Where will that leave the integrity of the profession? And will justice not only be done, but be seen to be done?