Archive for February, 2012

Competition panel ruling leaves GPs open to conflict of interest challenge

Posted on February 8, 2012. Filed under: Closure |

Exclusive: GPs are being warned they are likely to face a series of challenges to commissioning decisions they make under the Government’s NHS reforms after a competition watchdog ruled being a GP partner at a practice was a significant conflict of interest.

The Co-operation and Competition Panel (CCP) found a PCT had breached conflict of interest rules by involving GP commissioners in a consultation on the closure of a Darzi centre – on the grounds their practices and other provider interests stood to benefit from the decision.

The case was brought after 3Well Medical, the GP-led limited company that runs the Darzi centre, alleged Dr Mike Caskey, chair of NHS Peterborough’s GP commissioning committee, was one of two clinicians involved in the consultation with ‘vested financial interests’ in the centre’s closure as his own practice could benefit.

But lawyers have warned the ruling has opened the door to legal challenges to GPs’ attempts to restructure care on the grounds clinical commissioning group board members’ practices could gain.

Ross Clark, a partner at solicitor Hempsons, said his firm’s procurement team already spent half of its time ‘challenging procurement processes’.

He added: ‘This is an indication of the break-up of the NHS family into separate components. Those freestanding bits will do whatever they can to stay alive and will therefore challenge decisions like this.’

Michael Rourke, associate solicitor at Lockharts Solicitors, said: ‘More cases could go to the competition panel or the High Court. I think there will be judicial reviews looking to get decisions quashed, and people going to the panel where they feel decisions have been reached infringing the principles set out in co-operation and competition guidance.’

The CCP ruling stated: ‘The commissioner’s actions were not consistent with the principles and rules [of competition] because of the involvement of two lead clinicians who had associations with primary and/or urgent care providers that might gain from the consultation process.’

But the CCP said NHS Peterborough ‘did not appear to discriminate’ against Alma Road.

Dr Rupert Bankhart, 3Well medical director and a GP in

Peterborough, said: ‘We welcome the CCP’s conclusion that there was a conflict of interest.’

He added 3Well Medical looked forward to working with local GPs on ‘correcting the impact’ of the decision.

Dr Sushil Jathanna, chief executive of NHS Peterborough, said the PCT ‘supported’ the panel’s recommendation that the consultation was reviewed by independent clinicians.

He added: ‘It is important to state we do not believe there has been any actual conflict of interest.’

Dr Amit Bhargava, a GP in Crawley, Sussex, and chair of the Crawley Commissioning Consortium, said: ‘Because [commissioning] is localised and we are talking about localism, then almost every local person has a conflict of interest in almost every local decision.

‘Whether it’s a GP, a nurse, a lay person or a manager who lives in the region, they will all be impacted by a decision, whether gaining or losing.’

But he added: ‘If we are clear about the vote structure and the transparency in which decisions are made and people

declare conflicts of interests at the beginning of discussions, then the pooling of decision making and intelligence will make sure the right decision is made.’

 

Potential conflicts

 

Darzi centres

GPs on CCGs could face challenges if their own practices are seen to benefit from the closure of Darzi centres or walk-in centres.

 

Out-of-hours provision

GP commissioners will be responsible for commissioning urgent care, but many practices will be involved in out-of-hours co-ops.

 

LESs

CCGs will commission LESs, meaning their own practices could benefit or lose out from the decisions.

 

Diagnostic services

CCG members’ practices may be part of LLPs or provider services offering diagnostics.

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Private firm closes flagship GP practice in north London

Posted on February 7, 2012. Filed under: Closure | Tags: |

Exclusive: GP practices in north London have been told they must absorb 4,700 patients in the next two months after the leading private health provider The Practice Plc announced it will close a high-profile GP practice less than a year after taking over the service.

The Camden Road Surgery – a long-standing GP practice which has been at the centre of the NHS privatisation debate ever since it was taken over by US health giant UnitedHealth in 2008 – will close its doors in April, with plans in place for a ‘mutual termination’ of its APMS contract with NHS North Central London.

NHS managers said the decision to close the surgery, which was broken to GPs on Friday, was forced by a decision by the surgery’s landlord to refuse an extension for the premises lease beyond April.

The Practice’s contract to run the surgery had been due to expire in March 2013, but NHS North Central London said that the early ‘mutual termination’ of the contract would not involve any compensation payouts to the private provider.

In recent years the Camden Road Surgery has been at the centre of controversy over the private sector’s role in general practice. The Practice Plc took on ownership of the practice last April after taking over the contract from UnitedHealth. The decision to award the original APMS contract to UnitedHealth in 2008 attracted vehement opposition from anti-privatisation campaigners, after NHS managers snubbed rival bids by local GPs to run the surgery despite them being judged to offer superior core services.

LMC leaders and leading GPs warned that the move to close Camden Road surgery at such short notice would be ‘hugely disruptive’ to patients and GPs.

Dr Paddy Glackin, medical director at Londonwide LMCs and a GP in Islington, North London, said: ‘The patients, who have had long-term relationships and have come to depend on a practice despite all the changes in management, are now going to have their practice taken away from them without having even been asked. We would like to have seen a meaningful consultation with patients and looking at actual alternatives to closing the practice down and dispersing the patients.’

‘They should look at some potential solution generated by the GPs and the patients, rather than this which has been imposed on them from without.’

RCGP chair Dr Clare Gerada said: ‘This is hugely disruptive for patients. They had the new provider not long ago, and before that UnitedHealth. The patients themselves need to feel that they have a GP who is there to look after them and that they trust. For the last year we’ve focused so much on GPs as a commissioner but we have to remember that GPs as providers is our most important role.’

NHS North Central London said it will be contacting local GPs to see how many patients they can take on and will be consulting with patients who will be given the option of choosing a new surgery or being allocated to a new practice.

A spokesperson said: ‘We are absolutely confident that there is capacity in the system for other Camden GPs to take on these patients.  We are in the process of contacting them to discuss how many they can take at which practice and this will depend to some extent on the outcome of the allocation/dispersal consultation we are undertaking.’

A spokesperson for The Practice said: ‘It is with regret that The Practice can confirm that it is currently in the process of closing its surgery on Camden Road.’

‘The lease on the property expires in April and although the PCT and The Practice have both worked tirelessly to negotiate an extension to this lease, unfortunately the landlord has decided not to grant an extension . Working with the PCT we are currently in consultation with our patients in order to ensure they will continue to be looked after within the area once the surgery has closed. We remain at all times committed to our patients and their best interests and will do our very best to ensure a smooth transition.’

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Darzi centre gets stay of execution after PCT found in breach of competition rules

Posted on February 1, 2012. Filed under: Closure, GP-led health centres |

An under threat Darzi centre has been given a stay of execution, after the NHS competition watchdog ruled that PCT bosses breached conflict of interest rules by enlisting GPs with ‘vested interests’ –  including the local CCG chair – to lead a consultation on the centre’s possible closure.

The Cooperation and Competition Panel ruled that NHS Peterborough’s consultation recommending the closure of the Alma Road surgery fell foul of conflict of interest rules.

The CCP ruled that the PCT had acted inappropriately by involving two GPs with links to surgeries and urgent care services that could benefit from the centre’s closure to act as ‘lead clinicians’ for the consultation.

The case was brought after 3 Well Medical, the GP-led limited company that runs the Darzi centre, alleged that Dr Mike Caskey, chair of NHS Peterborough’s GP commissioning committee and Dr Harshad Mistry, NHS Peterborough’s urgent care commissioning lead, had ‘vested financial interests in the closure of Alma Road’, as their own local practices could benefit from the change.

The CCP report stated: ‘The commissioner’s actions were not consistent with the Principles and Rules [of competition] because of the involvement of two lead clinicians in the commissioner’s consultation process that had associations with primary and/or urgent care providers that would be directly affected by and might gain from the consultation process.’

But the CCP said NHS Peterborough ‘did not appear to discriminate’ against Alma Road, and found it’s consultation did not restrict patient choice.

The watchdog is set to recommend to health secretary Andrew Lansley that an independent body of clinicians review the consultation responses. Mr Lansley will decide how to act on the CCP’s advice in mid-February at the earliest.

Dr Sushil Jathanna, chief executive at NHS Peterborough and NHS Cambridgeshire said the PCT ‘supported’ the CCP’s recommendation that the consultation was reviewed by independent clinicians.

He said: ‘We have reflected on the processes and feel that we managed potential conflicts of interest appropriately, but accept that the CCP has recommended we work further to engage independent clinicians outside the Peterborough area to provide further assurance.’

‘It is important to state that we do not believe that there has been any actual conflict of interest and that the clinicians we involved in answering questions from the public have not profited in any way from this process and no evidence was found to the contrary. The PCT drew on their expertise as local clinicians in helping explain how systems work. They were not involved in developing the proposals, nor would they have been involved in making final decisions about the consultation.’

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