Protest groups working to stop the ongoing NHS privatisation gained a small victory this month when Health Minister, Norman Lamb, announced that part of the Health and Social Care Act would be re-written. Lamb claimed that the controversial Regulation 257 would be re-worded in order to make it absolutely clear that ‘no Clinical Commissioning Group (CCG) would be forced into competitive tendering’ and stated that the new wording would ‘leave no doubt’. For many activists his words rang hollow; too many previous promises have been broken.
The government have repeatedly sought to reassure voters that they don’t wish to privatise the NHS. Yet when ministers state ‘no privatisation’ what they seem to mean is that the NHS will remain free at the point of delivery and continue to be wholly financed through taxation - both of which are untrue. As explained here, the range of services required to be provided free has already been cut and clear provision has been made in law for the introduction of charges. That aside, there remain still further ways in which creeping privatisation can occur. The World Health Organisation (WHO) sees privatisation as a process in which "non-governmental actors become increasingly involved in financing and/or provision of healthcare services" and go on to note that increased reliance on the private sector may lead to diminished equity amongst users.
Back in 2011, consultant oncologist Clive Peedell wrote in the British Medical Journal of his concerns that government reforms would constitute further privatisation. He used the WHO definition, along with other academic research, to show how the Health and Social Care Act will inevitably lead to privatisation. One of the ways this could occur would be the contracting out of services to private organisations. News this week showed that more than a third of GPs on CCG’s have a conflict of interest due to their private sector work.
A British Medical Journal investigation into commissioning groups discovered more than 36% of GPs “in executive positions have a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.” The BMJ even found some cases where most of the GPs on the CCG board held interests in the same private healthcare organisation.
This could create an uneven playing field for patients, dependent upon where they live and the members of their local CCG board. CCGs where there are no conflicts of interest among board members will clearly focus on clinical outcomes. The danger is if those CCGs with a high number of members with private interests become driven by additional factors - a danger pointed out repeatedly by the Act's opponents but one the government failed to address adequately.
In response to these concerns some commissioning groups have argued that they have checks and balances in place to ensure that decisions remained neutral. Yet doubts remain. Amanda Doyle, a GP and chief clinical officer at NHS Blackpool CCG admitted that most of the GPs on the local board would have to step back if, for example, the local out of hour’s service came up for re-tender. In this instance boards have stated they would either bring in doctors from neighbouring boards to make decisions or give the vote to lay members of the board.
However this may not be enough to convince patients and a public already very wary of the current health reforms. James Kingsland, the government’s national clinical lead for NHS clinical commissioning, stated that some doctors may have to choose between their role on the CCG and their private sector involvement if serious and regular conflicts of interest arose.
Further problems for the governments reforms may come in the form of GPs themselves not buying into the commissioning process. A report for GP Online shows that doctors on the ground are still suspicious of the reforms. Pollster Edna Robinson, an adviser to the Department of Health, warns that grassroots GPs remain to be convinced and goes on to say: “Commissioning GPs are in a ‘good place’ about their roles, but frontline GPs want to know that the 'commissioning agenda' is not just about money and targets but about driving up the quality of services.” This latest news about CCGs could lead to conflict between GPs on the ground and their own commissioning groups - hardly the harmonious, patient-led experience the public were promised.
If GPs themselves still don’t trust the reforms, how can patients be expected to? Yet trust is a vital component of the doctor and patient relationship, one that could be eroded as concerns regarding conflicts of interest arise. GPs in some areas could be viewed as working towards their own financial gain and not in the best interests of the patient. For campaign groups too, this news could have significant impact as they continue fighting encroaching privatisation. It will mean taking the fight to local areas and watching individual CCGs closely to guard against any conflicts of interest.
Once again the government's health reforms are shown to be worryingly lax when it comes to upholding their promise to safeguard our NHS. The government insisted strict measures would be put in place to avoid conflicts of interest with commissioners - as is now clear, that is simply untrue.