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togofwarNovember 18 2015

GPs need to be aware of perceived conflicts of interest in their relationship with clinical commissioning groups, a medical indemnity provider has warned.

The advice follows an investigation by the BMJ and The Times which found that CCGs “have awarded hundreds of contracts worth at least £2.4bn to organisations in which their board members have a financial interest.” The data relates to a sample of 151 out of 209 CCGs and the contracts they awarded between April 2013 and July 2015.

Dr Richenda Tisdale, Medicolegal Adviser at Medical Protection (MPS), said that GPs will be acutely aware of professional and ethical duties, and will use their professional judgment to identify when conflicts of interest arise. However, transparency is important, she said.

“Trust between GPs and their patients is essential to maintaining effective professional relationships, and GPs understand that this trust may be damaged if conflicts of interests, whether actual or perceived, affect their professional decision making.”

CCGs can put doctors in a challenging position as the GP is “not just the patient advocate but also the budget holder and this leaves them vulnerable to accusations of conflicting interests.

“In most cases it is an entirely appropriate and possibly unavoidable scenario, such as in rural areas where GPs will often sit on several boards, providing essential services for the local area. In other cases, all of the GPs in a decision-making body could have an interest in a decision, particularly where the CCG is proposing to commission services on a single tender basis from all GP practices in the area.

“However, it is important that perceived and actual conflicts are dealt with openly and stand up to public scrutiny and GPs must continue to be mindful of the need for transparency in decision making. The CCGs also have an obligation to make details on commissioning public for just this reason, and include clear and robust governance structures and processes for the scenarios when all local practices could be conflicted.”

Writing for the BMJ, Gareth Iacobucci said that the investigation had identified 50 CCGs which had awarded contracts where a conflict was present, “with a total of 437 out of 5,671 contracts awarded to healthcare providers in which one or more CCG board members had declared an interest. Most of the money went to NHS trusts or other similar organisations providing a range of acute, community, and mental health services (£2.2bn gained from a total of 116 contracts awarded with a conflict present).”

Conflicts of interest involving with GP practices were noted in232 contracts worth £7.4 million, covering services such as provision of screening, anticoagulant clinics and minor surgery.

Mr Iacobucci’s report includes examples of CCGs where there are potential conflicts of interest, board members with declared interests and how potential conflicts are managed by the CCG.

Links:

MPS advisory

G Iacobucci. ‘General practice commissioning: in whose interests?’. BMJ 2015; 351. Published online November 11 2015)

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