Commissioning – we must keep the fox out of the chicken coup

It is only natural that the most commercially minded General Practitioners will become actively involved in Clinical Commissioning Groups (CCGs). It’s also logical that these commercially minded GPs will already have some involvement with private companies delivering care to both private and NHS patients. There is, I believe, nothing wrong with that, especially as we must not forget that GPs are, after all, privately contracted to the NHS in the first place. This only becomes a problem when GPs are given the power to choose providers for their patients and may have a financial interest in one or more of the providers being selected.

According to a recent report, more than a third of GPs on the boards of new NHS commissioning groups in England may face potential conflict of interest in the commissioning process. The investigation, undertaken by the British Medical Journal, estimated that 426 out of 1,179 (36%) GPs surveyed who are in executive positions on NHS Commissioning Boards have a financial interest in a for-profit health provider outside their practice.

This entirely predictable predicament now has to be subject to guidance to be issued by the NHS Commissioning Board.

However honourable and decent these GPs are, (and I have no doubt that most, if not all, are) – to be faced with a choice of the best provider for a particular treatment pathway, knowing that you have an intimate personal or/or financial relationship with that provider can be at best challenging, at worst, impossible. If you exclude a provider on the grounds of conflict of interest, you are at risk of reducing appropriate choice. If you exclude a commissioning GP on the grounds of conflict of interest, you may be denying a population of patients of an expert opinion. Catch 22.

I am pleased to see a growing number of recruitment adverts from CCGs and Commissioning Support Groups for pathway mapping, service redesign and cost reduction experts to enhance the whole process and deliver an effective and independent commissioning service. Considering the high proportion of GPs with declared private interests, each CCG may need to appoint additional independent advisers to redress the balance and maintain an impartial majority.

Ideally – there should be an independent organisation to commission clinical services in a region.

Ah yes – there used to be. They were called Primary Care Trusts, and they are due to be abolished next month.