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NAO questions CCG transparency in managing conflicts of interest

It is not always possible to uncover how CCGs have managed their conflicts of interest, which “limits” local transparency, according to the National Audit Office (NAO). 

The organisation’s ‘Managing conflicts of interest in NHS clinical commissioning groups’ report published today (11 September) revealed that during 2014-15  in 75 instances of potential or actual conflicts the NAO found the “level of detail given about the conflict and how it had been managed varied”. 

In 14 cases the information provided was insufficient for the NAO to assess how the CCG managed the conflict. However, it was stated that NHS England expects its updated guidance for CCGs, issued in December 2014, to lead to more consistent disclosures across the sector. 

But the NAO added that NHS England has collected little data on 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”. It relies instead on an exception-based approach, and on Monitor as the system regulator. 

The latest report revealed that 41% of CCG governing body members in position at the time of the NAO’s analysis in 2014-15 were also GPs, who may, potentially, have made decisions about local health services and have been paid by their CCG for providing them. 

It also follows an NHE investigation earlier this year which revealed that a fifth of CCGs have required more than half of their board members to withdraw from a meeting because of conflicts of interest

At the time NHE reported that primary care co-commissioning raises obvious and unavoidable potential for conflicts of interest. But in the information provided to NHE, we found that while many CCGs noted a conflict of interest when discussing primary care co-commissioning, very few people withdrew from meetings about it. 

From April 2015, CCGs could choose to take an enhanced role in GP service commissioning. This included an option to take on fully delegated responsibility from NHS England for commissioning primary medical services. 

Under the new arrangements, the NAO stated it is “increasingly likely” that sometimes all GPs on a decision-making body could have a material interest in a decision. 

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners (NHSCC) and chief clinical officer of NHS Blackpool CCG, said the ability for CCGs to become involved in the commissioning of General Practice has the potential to bring many benefits to patient care. 

However, she did say it does also bring with it the potential for perceived, and actual conflicts of interest, when CCGs are procuring services from their member practices. 

“If these are not tackled early on they could limit a commissioner’s abilities to develop and deliver new models of care for the benefits of patients and their local populations,” said Dr Doyle. “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.” 

NAO said to promote “public confidence” that conflicts are well managed, CCGs will need to ensure transparency at the local level when making commissioning decisions.


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