CCG decisions threatened by possible conflicts of interest

10 September 2015

Some GPs and their colleagues could be making commissioning decisions about services they provide, or in which they have an interest, according to the National Audit Office (NAO).

In an investigation into managing conflicts of interest in NHS clinical commissioning groups (CCG) in 2014-15, the NAO found 1,300 (41 per cent) of CCG governing body members were also GPs, who may, potentially, have made decisions about local health services and have been paid by their CCG for providing them.

The NAO said where this is the case, there is a risk that commissioners may put, or be perceived to put, personal interests ahead of patients' interests.

According to a report published today, Managing Conflicts of Interest in NHS CCGs, in 2013‑14 and 2014‑15, CCGs had a relatively limited role in commissioning and managing primary medical services. With most contracts for commissioning care from NHS trusts under well-established arrangements and limited new commissioning activity, the likelihood of conflicts was reduced.

But the NAO highlighted a likely increase in conflict of interest scenarios in the future due to CCGs having been able to choose to co-commission primary care services from GPs since April this year. The report said: “CCGs will need to think through carefully how they handle the likely increases in the range and frequency of potential conflicts, particularly where they use fully delegated primary care commissioning.”

The investigation acknowledged the Department of Health recognised the potential for conflicts of interest in the NHS commissioning system, and has taken a proportionate response to managing them, including by assigning formal roles to relevant bodies. The NAO also found almost all CCGs had put in place most key elements of the legislative requirements of the Health and Social Care Act 2012, which places a legal duty on CCGs to manage conflicts of interest.

While only a minority of CCGs had reported the need to manage actual or perceived conflicts of interest, the NAO said it could not always assess how the conflict had been managed, which limited local transparency. It added the adequacy of reported controls for managing conflict of interest risks had varied.

NHS England has so far collected little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements, the NAO said. It relies instead on an exception-based approach, and on Monitor as the system regulator.

Up to June 2015, health service regulator Monitor had received relatively few concerns about conflicts of interest with only one of its formal investigations including a concern about it.

The NAO said the Department of Health and NHS England recognised the risk and had responded with statutory guidance and training. The spending watchdog concluded CCGs will need to ensure transparency at the local level when making commissioning decisions to promote public confidence that conflicts are well managed.

It found NHS England had a limited understanding of how effectively CCGs were managing conflicts of interest or whether they are complying with requirements, which “will hamper its ability to respond promptly to the likely increase in conflicts”.

NHS England must be satisfied it has sufficient and timely information to assure itself CCGs are managing conflicts promptly and effectively, the NAO said.

“The Department of Health will need to be clear that it has assurance that conflicts of interest are being managed in a way that is sufficient to meet its needs as steward of the health system,” the report said. Monitor must be confident it could respond to an increased number of complaints about conflicts, and CCGs must ensure transparency at a local level.

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