GPs’ Conflict of interest was an issue at the 1st October meeting of N.Kirklees Clinical Commissioning Group (NKCCG) Governing Body meeting, when the Governing Body approved its own member GPs’ Business Cases for:

• a £514,049 12 month pilot (with scope for a 3 year roll out) to deliver the first wave of ‘Care Closer to Home’, through GP-led Care Coordination
• a Beyond Over 75 Enhanced Service, aimed at keeping over 75s out of hospital through early identification of health and social care issues

The ‘Care Closer to Home’ scheme aims to replace acute and emergency hospital services that are being closed down at Dewsbury hospital, with health and social care services in the community, based on a private American healthcare system.

Both Business Cases were presented by the N.Kirklees GP Federation – Curo Health Ltd.

Curo Health was registered with Companies House in January 2014 as a private company limited by shares. Its shareholders are GPs from the 29 GP practices that are also members of the NKCCG Governing Body.

Since the membership of the NKCCG Governing Body is pretty much the same as the membership of Curo Health Ltd (apart from the Clinical Commissioning Group officers, patient reps and nurse rep), Curo Health’s request for Governing Body approval of their business cases raised obvious conflict of interest issues.

If the CCG were a Council, the GP members of Curo Health would have had to leave the meeting while the proposal was discussed and voted on.

This is also the process followed by Calderdale CCG.

NKCCG has a much weaker conflict of interest rule. This allows members with a conflict of interest to be present and to take part in the discussion. The only thing they can’t do is vote on the proposal.

A member of the public who attended the meeting said,

“No GPs left the room for the vote. No discussion was entered into without the GPs present. It is unfortunate that the Conflict of Interest presentation read out by Steve Brennan, the Chief Financial Officer, does not seem to be in the NKCCG documents.”

Curo Health Ltd’s company Directors are Dr Stuart Lawson, a Batley GP, and the Curo Health Ltd Practice Manager, Mrs Clare Louise Townend.

The Curo Health Business Cases presentation was given by Dr Stuart Lawson (clinical lead), Iain Murray (project lead) and David Copeland.

NKCCG approved Curo Health’s request for £0.51m to set up and run a pilot project starting in October 2014, initially for a year, but with a view to running for 3 years, to trial the Care Closer to Home system for over 75 year olds.

Curo Health are to set up the pilot in consultation with Kirklees Social Services and Locala, the social enterprise that runs community health services in Kirklees.

Adrian Cruden, a member of Kirklees Green Party who has been part of the Save Dewsbury Hospital campaing, said,

“The NKCCG decision to award a pilot contract to Curo Health goes to the heart of many people’s concerns about the tendering out of health services – a closed body taking decisions without any consultation of the public affected by them nor declaring any conflicts of interest. Even with the best of intentions, the process is manifestly an inappropriate way to apportion the use of public funds, ethically if not legally. Coupled with the fact that Curo Health is a private company – as opposed to a not-for-profit – its core objective legally has to be to maximise profits for its owners. How does this square with the need for public health to serve the local public, first and last?”

“As we see with the Huddersfield decision on Locala, making money from the welfare of local citizens and communities is now the major factor driving the actions of local healthcare providers. That Locala is so dependent on one contract and in turn the profits from that contract equate to such a large chunk of the CCG’s deficit shows that the system is no longer about health, but about making a buck out of sickness. The Government and its local Conservative and Lib Dem representatives have a lot of explaining to do – they should be ashamed of themselves.”

The GP-led Care Coordination for over 75 year olds proposes to employ 5 new co-ordinating nurses and a team lead with caseload. These will work ‘equitably’ between all the Federation practices, to coordinate community health care for frail elderly patients who are at risk of unplanned hospital admission. There will also be a project manager and a part time project manager.

The Beyond Over 75 Enhanced Service will be funded by the £5 per head allowance for over 75s from NHS England, to deliver ‘enhanced services’ to the GP practices.

NKCCG told Curo Health to take into account the following points:

• Since the Key Performance Indicators were the same as everyone was working to, how could Curo Health evaluate what they were doing as being an addition to everyone else?
• Commissioning on an outcomes basis may not be the way to go, because of the impossibility of attributing outcomes to one service or another.
• Elderly patients’  views needed to be heard and acted on.
• Former hospital Trust nurses would not be appropriate for the Care Coordination team because they lack breadth of experience. Community Matrons were necessary to promote self care.
• Self Care needed to be considered more, in terms of how patients set goals and evaluate achievements

GP Federations – a new type of GP company

A GP Federation is a relatively new type of organisation that is set up so that GP practices can provide services in a collaborative manner.

Critics of GP Federations say that their formation has been engineered by government cuts to GP funding, that are designed to lead to commercialised/privatised primary care.

An earlier wave of GP-led companies, set up in response to the government’s Equitable Access to Primary Medical Care scheme, opened the door to take-over by companies like Assura.

Then, when Assura found that primary care was not profitable enough, it sold its GP companies on to Virgin Care.  Three GP practices in Calderdale are now run by Virgin Care, following the buyout from Assura.