Free NHS for Sale: Myths, Lies & Deception by Jacky Davis, John Lister, David Wrigley

about financial conflicts of interest are bound to increase.
    In 2013 the
BMJ
used Freedom of Information requests and CCG websites to discover that more than a third of GPs on CCGs had ‘a conflict of interest due to directorships or shares held in private companies’. The
BMJ
editor Fiona Godlee commented:
    Some of these conflicts of interest are too great to be ‘managed’. We think those GPs who have positions at executive board level in private provider companies need to choose between their competing interests and, if need be, step down from the commissioning boards. 22
    But later that year
Pulse
magazine reported that one in five GPs sitting on CCGs had a financial stake in a private company which was currently providing services
to their own CCG.
23
    When, in 2014, the West Sussex CCG awarded a £235m contract for musculoskeletal (MSK) services to BUPA it was reported that only seven out of a possible 21 people responsible for the decision were actually able to vote on it, as the others all had financial conflicts of interest. The process was halted after local protests and the discovery that the CCG had done little to determine how their decision would impact on local hospitals.
    West Sussex Hospitals NHS Trust, who had unsuccessfully bid for the contract, pointed out the obvious problems arising from the decision. The staff working in the trust MSK service were also responsible for emergency trauma care in their A&E department, so moving the MSK contract out of the trust would threaten their ability to staff the emergency services. Dr Armstrong, the chief officer of the CCG, said there was no intention to destabilise local A&E and trauma services, although she didn’t explain how these would be maintained with the profitable part of the service contracted out. At the time of writing the decision is still under review. 24
    The story illustrates the problems facing CCGs and raises important concerns. Even if those with conflicts of interest leave the room for the vote it is difficult to think that they will not influence the decision made by a small group of their colleagues who remain behind.
    In Bedfordshire they didn’t even bother to vote. The CCG awarded a five year £120m contract for MSK services to a consortium led by Circle which included a company (Horizon Health Choices) whose website announces that it is owned by 25 of the 55 GPs practices in Bedfordshire. When challengedon the propriety of GPs on the CCG board voting on this the response was that no vote was taken since the policy went through by consensus. This effectively ignored the massive potential conflict of interest in agreeing a decision that would benefit colleagues, if not the board members themselves.
    It eventually emerged that with the chutzpah characteristic of the private sector Circle intended to subcontract part of the work back to Bedford Hospital, the local NHS trust. The trust refused to become a subcontractor, preferring to compete with them, having seen a 30 per cent drop in its MSK referrals after Circle won the contract. 25
    This does not mean decisions made by CCGs are likely to be fraudulent, but that for the first time a culture has been created in which fraud and corruption are possible. Until now patients have trusted their GP’s advice to be untainted by suspicions of financial gain. Once GPs are known to have financial interests in local health providers from whom they are purchasing services then patients will inevitably be concerned that decisions will be made and advice given that may be skewed by financial considerations. In the US, for instance, the overuse of MRI scans has been linked to the fact that many scanners are owned by doctors who refer their own patients to them for unnecessary scans. 26
    As for fraud on an industrial scale, there is no lack of evidence and many of the companies moving in on the NHS have already been successfully indicted in the US. A comprehensive account of cases brought and