GPs, CCGs, major contracts: a recipe for rotten boroughs

The most damning evidence of the folly of the ‘purchaser-provider split’ has been revealed by The Times*, which reports on contract-awarding bodies throughout the NHS giving contracts to the same organisations their GP members are on. ‘An ethical conflict’ is putting it mildly.

Using freedom of information laws and public board papers, The Times and the BMJ obtained details from 151 CCGs, of which 50 had given at least one contract to enterprises in which members of their governing body had declared interests.

Groups of GPs who control local NHS budgets have handed at least £2.4 billion of taxpayers’ money to organisations that their members own or work for. A total of 437 contracts, worth at least £2.4 billion, involved doctors or lay board members with direct conflicts of interest. The most common arrangement, accounting for 233 contracts, saw GP surgeries owned or run by doctors on CCG boards being paid by them for extra services, which could boost their take-home pay.

GPs are only obliged to declare any conflict of interest and not vote on any decision relating to it. They are sometimes expected to leave the room when a vote is cast.

If ever there was an example of the folly of marketising the NHS and the intolerable professional and personal conflicts such madness places on doctors, this is surely it. This is not so much a ‘purchaser-provider split’, the dream-child of neoliberal hegemony, as a purchaser-provider mutual gain at the taxpayers’ expense. How can anyone hold this parody up as anything remotely virtuous?

We are not suggesting that our GP colleagues are corrupt: far from it. Most of them are on their knees with their ever-mounting workloads, and very few even have the time to be part of their CCG. But the very system they are expected to be a part of, as the pathfinders for Lansley’s ‘giving control back to the doctors’ under the Health and Social Care Act (which was only ever a travesty in itself, in our view), is corrupting: that is the point.

It is one this government should heed. This is damaging the NHS by being the antithesis of its founding principles, namely openness, fairness, and public accountability. Were MPs to take part in such an arrangement, the public outcry would be deafening – the return of the Rotten Borough. This is a rotten system which is rotting the NHS from within. It needs to end.

*The Times has a paywall so we haven’t put in a link. Sorry!
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