Are GPs exploiting NHS markets?

Watch the report at
www.channel4.com/news/society/health

By: James Blake, Channel 4 News

Doctors may be boosting their income by outsourcing treatments to 
companies they have a stake in.

Their salaries are already at an all-time high. But now there's 
concern that some GPs could be further boosting their income by 
taking advantage of the health service's internal market.

Under the NHS's new "practice-based commissioning" scheme, 
treatments can be outsourced to private companies which doctors are 
allowed to recommend to patients.

But as Channel 4 News has discovered, in Liverpool more than 70 GPs 
have a financial stake in one of those companies. It has led to 
accusations of a conflict of interest and calls for the rules 
regulating the award of contracts to be tightened.

The unit had to apply to provide healthcare to the city for the 
first time - and lost. Now most patients will be referred to two 
private companies - and that'll have a big impact on the funding for 
the hospital.

Yet many GPs will personally make money from the contracts. Channel 
4 News has learnt that 73 local doctors are shareholders of one 
private company that won.

Nicholas Jones, a dermatology patient with severe psoriasis, will 
now be treated at the private clinic. Yet he questions whether he 
can trust any GP with a financial stake in his care.

He says: "I would get the impression that clinical decisions are 
being driven by financial incentives. So if these companies want to 
make more money, its in their interests to refer less patients to 
the consultants.

"And that way they save more money which is more profits for 
shareholders. And for GPs who have their own interests. So I'm very 
frightened and very horrified."

     'I would get the impression that clinical decisions are being 
driven by financial incentives.'
     Nicholas Jones, dermatology patient

The hosptial can't compete with the two companies on cost. They 
charge the Primary Care Trust (PCT) £90 for each new patient - £25 
pound less than the specialist unit here.

"The sum of money they'll receive under payment by results applies 
to the NHS as well as the private sector. Yes they are paid for each 
individual patient that is seen as is the NHS. The price they'll be 
receiving from the PCT is less than NHS hospitals."

In Liverpool the private companies and the hospital had to apply to 
an official consortium of 19 local GPs - that works under the 
direction of the PCT.

But was the process fair? And did the hospital have a chance? The 
woman who monitors the process on behalf of patients was surprised 
by the revelations.

She said: "There certainly is a conflict of interest. If you walked 
down town and asked people is that a conflict of interest they would 
say yes.

"It's a conflict of interest for the GP because they should tell the 
patient about the financial interest. It's a conflict of interest 
for the patient because how are they to decide what is the best 
service for them."

     'The procurement method for the service is a matter for the 
Primary Care Trust and we are satisfied that the highest standards 
of probity have been followed.'
     Our Care's statement

The private company, Our Care, is based above a GP practice in 
Liverpool. One of the GP directors accepted he is in the 
Commissioning Consortium - but denied having a personal involvement 
in awarding the contracts. The company refused to do any interviews 
but issued this statement.

"The procurement method for the service is a matter for the Primary 
Care Trust and we are satisfied that the highest standards of 
probity have been followed. As a matter of course we do not comment 
on individual contracts."

There is an independent scrutiny committee at the City Council, 
which examines the new services and will make an assessment after 6 
months. The chairman says he trusts the PCT - that there is no 
conflict of interest here. But he was not personally told the GPs 
linked to Our Care were in the consortium.

The government has rules to protect patients - the process must be 
transparent and GPs offering a service must exclude themselves from 
the group making a decision about a service.

But health think tank the Kings Fund says that's not enough and 
argues conflict of interest is inherent in the policy.