NHS reform could ‘destroy patient-doctor trust’

A Channel 4 News investigation on Wednesday revealed that the NHS reforms could see GPs making decisions based on profit rather than the clinical needs of the patient.

While the Department of Health stressed that the potential conflict of interests would be managed, patient groups told Channel 4 News their concerns that this may not be the case.

Katherine Murphy, Chief Executive of the Patients Association, told Channel 4 News: “When the Government first announced its reform plan my first comment was on my concerns that there would be a conflict of interest. Now it is clear that those concerns were justified.

“The conflict of interest will utterly destroy any relationship of trust between doctor and patient. Katherine Murphy, Patients Association

“How can such a glaring loophole have been allowed to exist in the Health Bill, allowing doctors to commission in their own interest? There needs to be specific provisions preventing those with financial interests from commissioning services that will enrich them. Without this, how will patients have the confidence that they are receiving the best care possible rather than the care that is in the best interests of their doctor’s bank balance?

“Those with financial interests must give up those interests if they want a direct hand in commissioning services, otherwise the conflict of interest will utterly destroy any relationship of trust between doctor and patient.”

Concerns

Concerns centre around one of the key elements of the Coalition’s NHS reform plans. In the Health and Social Care Bill, which is currently going through Parliament, the Health Secretary Andrew Lansley outlined plans to transfer 80 per cent of the NHS budget into the hands of GPs.

The idea is that this will improve care for patients, but the worry is that it also opens up potential conflict of interest situations.

GPs will use the budget to commission, or buy, services for patients – anything from a hip operation to cancer treatment. There are at least two major concerns over potential conflict – one is that GPs may have financial interests in the companies providing treatments, which would present a clear problem if they referred to that company without informing the patient or allowing them to choose.

The other – Channel 4 News discovered on Wednesday – is that private companies which have set up to help GPs manage the commissioning process could have too much of a focus on profit, raising serious questions over whether GPs could put profit ahead of care.

The surgeon's view 
But what if your family doctor had a financial interest in your decision? Perhaps owns the company he is recommending? There is nothing in this bill that precludes a financial conflict of interests.

It is a matter of public record that the Health Secretary, Andrew Lansley, himself has received funds from the very health companies which stand to benefit from his legislation. Publicly funded healthcare will now be delivered by any company or organisation, not just the NHS. Any willing provider is the buzz-word.

As a surgeon who has been in intensive medical training for fourteen years (and counting), any willing and able provider might have sounded more reassuring. But maybe that's just my self-interest talking.

Read more from the NHS surgeon: the reality of 'choice' 

GP and Chairman of the National Association of Primary Care, Dr Johnny Marshall, told Channel 4 News that there was not much detail yet on how the conflict of interest concern could be managed – but it would be dealt with.

“In two years’ time when we have GP consortia, then we absolutely need to make sure we have robust arrangements in place to make it clear what the accountability is – and transparency so everyone knows what is going on,” he said.

“We absolutely need to make sure we protect patients, and doctors, around this. It’s really important to get this nailed – fortunately we’ve got two years to do it.”

A spokesperson for the Department of Health said: “The NHS Commissioning Board and Monitor will develop clear binding guidance for consortia to ensure decisions are fair, transparent and avoid any perceived or potential conflicts of interest. Each consortium must also set out arrangements for managing potential conflicts of interest and publish a constitution that details this. The Bill also contains clear duties on the NHS Commissioning Board, and if necessary Monitor, to intervene where there are concerns about the fairness of commissioning decisions.”

Lack of support

The NHS reform plans have hit a number of hurdles since they were introduced in a White Paper last year. While many health service providers broadly support some of the concepts of the reforms, such as giving more power to GPs and patients, some are worried about the speed of the reforms, particularly at a time of serious NHS spending cuts and job losses.

A survey from the British Medical Association found that doctors had major issues about elements of the reforms.

Read more: Channel 4 News Special Report on the NHS reforms

BMA council chairman Hamish Meldrum said: “This survey shows that the Government can no longer claim widespread support among doctors as justification for these flawed policies.”

The Government can no longer claim widespread support among doctors as justification for these flawed policies. BMA Chairman Hamish Meldrum

He told Channel 4 News: “The top level buzzwords were better engagement and choice for patients, more clinicians running services, and a focus on quality. No one would argue with that but when you dig deeper there is a real concern in the profession – which I think would be shared by the public if they knew the detail – there’s a big doubt if the reforms will deliver.”

Most doctors are not convinced that the potential benefits of the Government’s plans outweigh the risk, the BMA said.

Only a fifth of the 1,645 surveyed are supportive of the plans – and even in that group, two-thirds think increased competition will lead to fragmentation of services. Doctors believe the changes that are most likely to be achieved in the shake-up are those which are least welcome – 88 per cent believe the reforms will lead to increased competition, but only 21 per cent believe this will improve the quality of NHS care.

Over 60 per cent believe the reforms will result in them spending less time with patients, a change which only 1 per cent would welcome.

On the issue of conflict, Dr Meldrum said: “We are concerned to see colleagues in situations where conflict can arise. We are very keen that the doctor/patient relationship is maintained.

“We have two concerns over private companies – we are back to the issue of fragmentation, and the other issue is, nobody’s saying that we can’t learn something from private companies, but any profits there are, if that is what you want to call them, we would want to see those profits going back into patient care.”