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GPs warned over potential conflicts of interest in CCG decisions

NAO says co-commissioning primary care will increase conflict risk

Adrian O'Dowd

Monday, 14 September 2015

GPs will have to be even more careful about potential conflicts of interest as clinical commissioning groups (CCGs) take on co-commissioning of primary care, according to the National Audit Office (NAO).

The NAO has published a new report* of its findings from an investigation into managing conflicts of interest in CCGs and says the public could easily perceive there to be serious potential problems here.

The report says, given that all GP practices are members of their local CCG and within each CCG, some GPs are members of their CCG’s board, there is potential for some GPs and their colleagues to make commissioning decisions about services they provide, or in which they have an interest.

The report says: “Where this is the case there is a risk that commissioners may put, or be perceived to put, personal interests ahead of patients’ interests. Because they are also providers of local clinical services, GP commissioners are particularly likely to have potential conflicts of interest.”

From the investigation, the NAO found that around 1,300 (41%) of CCG governing body members in position at the time of its analysis in 2014-15 were also GPs, who could, potentially, have made decisions about local health services and have been paid by their CCG for providing them.

Up to June of this year, Monitor had received relatively few concerns about conflicts of interest, said the NAO, and only one of its formal investigations included a concern about conflicts of interest in a CCG.

However, since April of this year, CCGs have been able to choose to co-commission primary care services from GPs, which was likely to increase significantly the number and scale of conflicts of interest, said the report’s authors.

The Department of Health and NHS England had recognised the risk and responded by issuing statutory guidance and providing training and support to CCGs.

To promote public confidence that conflicts were well managed, CCGs would need to ensure transparency locally when making commissioning decisions, said the NAO.

In addition, NHS England would need to be satisfied that it had sufficient and timely information to assure itself that CCGs were managing conflicts promptly and effectively.

From the start, the Department had recognised the potential for conflicts of interest in the NHS commissioning system and had taken a “proportionate response” to managing such conflicts, including by assigning formal roles to relevant bodies.

The Health and Social Care Act 2012 places a legal duty on CCGs to manage conflicts of interest, says the report.

The NAO found almost all CCGs had put in place most key elements of the legislative requirements, which help them to prevent and manage conflicts.

During 2014-15, a minority of CCGs had reported they had to manage actual or perceived conflicts of interest.

However, the NAO could not always assess from publicly available information how CCGs had managed such conflicts of interest, which limited local transparency.

NHS England has so far collected little data on how effectively CCGs were managing conflicts of interest or whether they were complying with requirements, said the authors.


* Managing conflicts of interest in NHS clinical commissioning groups. National Audit Office. HC 419 session 2015-16 11 September 2015.

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