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  • GP trainee round 1 recruitment increases 10%

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conflict-of-interestSeptember 16 2015

Around 1,300 or 41% of clinical commissioning group body members were GPs in 2014-15, the National Audit Office has said.

These GPs may potentially have made decisions about local health services which may have resulted in them being paid by the CCG for providing them, it has warned. In 2014-15, CCGs were controlling £64.3 billion or around two thirds of the NHS commissioning budget.

In addition, changes to the co-commissioning of primary care services from GPs introduced in April 2015 have increased “the risk of significant conflicts of interest in CCGs.”

The concerns are raised in a report ‘Managing conflicts of interest in NHS clinical commissioning groups’ published by the NAO in conjunction with the Department of Health, NHS England and Monitor.

In 2013-14 and 2014-15, NHS England had been responsible for commissioning most of the primary medical services. However, the changes brought in this year mean CCGs have been given the option to have a much greater involvement in GP commissioning, said the NAO.

Taking on that role means CCGs “will be able to commission care for their patients and populations in more coherent and joined-up ways - but they also expose themselves to a greater risk of conflicts of interest, both real and perceived.

“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.”

It points out that NHS England issued statutory guidance for CCGs in December 2104 to help CCGs be aware of the potential for all GPs on a decision-making body to have a material interest in a decision. There is also a legal duty on CCGs to manage conflicts of interest and must maintain and publish specified registers of interest, it says.

However, the NAO report warns: “NHS England has a limited understanding of how effectively CCGs are 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.” As at June 2015, Monitor had only undertaken one formal investigation that included concerns about a conflict of interest in a CCG.

“To promote public confidence that conflicts are well managed, CCGs will need to ensure transparency at the local level when making commissioning decisions. In addition, NHS England will need to be satisfied that it has sufficient and timely information to assure itself that CCGs are managing conflicts promptly and effectively,” said the NAO

Responding to the report, Dr Amanda Doyle, co-chair of NHS Clinical Commissioners and Chief Clinical Officer of NHS Blackpool CCG, said: “The NAO report highlights the risk of conflicts of interest for CCGs but also shows they have been managing them, and getting the support from NHS England and the Department of Health to do so.”

“Our members recognise that potential conflicts of interest will occur when CCGs commission primary care, but they are manageable. As long as CCGs are working to their strategic commissioning plans and have the recommended checks and balances in place when they procure services, then the rationale for what and how they are commissioning from member practices will withstand scrutiny.”

Dr Steve Kell, NHSCC Co-chair and Chair of NHS Bassetlaw CCG, said: “Managing conflicts of interest in the NHS is not new. CCGs must have strong governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.”

He added that NHSCC has worked with the RCGP and BMA to develop a set of shared principles on managing conflicts of interest.

Links:

NAO announcement     

Summary ‘Managing conflicts of interest in NHS clinical commissioning groups’  

NHSCC response             

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