News

New approach on primary care co-commissioning conflicts of interest

A ‘strengthened’ approach to dealing with conflicts of interest will be put in place when CCGs take on an increased role in the commissioning of primary care services. 

In a paper presented to NHS England’s board today, Ian Dodge, national director of the commissioning strategy, wrote: “without a strengthened approach, co-commissioning of primary care could significantly increase the frequency and range of potential conflicts of interest – especially for delegated services.” 

A significantly ‘enhanced’ approach has been developed, working closely with NHS Clinical Commissioners, which will be “put on a statutory footing for the first time”.

It includes a strengthened approach to the make-up of the decision-making committee, which must have a lay and executive majority and have a lay chair, with national training for CCG lay members available to support and strengthen their role. 

On top of this, there will be external involvement of local stakeholders: the local Health Watch and a local authority member of the local Health and Well-being Board having the right to serve as observers on the decision-making committee. 

The public register of conflicts of interest will include information on the nature of the conflict and details of the conflicted parties. The register will also form an obligatory part of the annual accounts and be signed off by external auditors. CCGs will also be required to maintain and publish, on a regular basis, a register of all key procurement decisions. 

He added, however, that CCGs are already handling conflicts of interests as part of their day to day work, and there is formal guidance and a code of conduct in place for CCGs and General Practitioners in commissioning roles. 

But the current system has come under fire, with the Public Accounts Committee earlier this year describing the current system between some CCGs and providers as ‘too close’. NHS England’s CEO Simon Stevens was in agreement. 

Ruth Robertson, Fellow in Health Policy at the King’s Fund think tank, has noted that “public outrage at claims of GPs lining their own pockets” was one of the factors that scuppered GP fund-holding in the 1990s. She wrote in a blogpost when co-commissioning was first announced: “These new responsibilities shine a light once again on an issue that has plagued CCGs since their inception – the conflict of interest faced by GPs who are buying services from themselves and potentially managing their own contracts. 

“Ensuring conflicts of interest are managed robustly will be key to the legitimacy and on-going sustainability of the CCG model.” 

Since May, however, when NHS England asked CCGs to come forward with expressions of interest to take on an increased role in commissioning for primary care, there has been a strong response.

According to NHS England, the overall aim of primary care co-commissioning is to harness the energy of CCGs to create a joined up, clinically-led commissioning system which delivers seamless, integrated out-of-hospital services based around the needs of diverse local populations. 

To this end, co-commissioning of primary care is also a critical enabler of the NHS Five Year Forward View: both to implement the new deal for primary care, and to support the development of new models of care, such as Multispecialty Community Providers and Primary and Acute Care Systems. 

Dodge stated that an early policy intention was to take a permissive approach to local variants of models of delegations of functions. However, the early expressions of interest submitted by CCGs contained in excess of 150 different models, the implementation of which would add “great complexity to the financial, governance, and assurance arrangements required”. 

“To simplify matters for both CCGs and NHS England, a standardised approach is instead being proposed where CCGs can opt for either (1) greater involvement in primary care decision-making; (2) joint commissioning arrangements; or (3) delegated commissioning arrangements. It will include a standard governance framework each for joint and delegated commissioning arrangements,” he added.  This approach has been supported by NHS Clinical Commissioners. 

Pending board approval, the next steps towards primary care co-commissioning will be published on 10 November 2014. Between mid-November and early December, NHS England’s Commissioning Strategy and Commissioning Operations directorates will also be holding regional roadshows offering support and help to CCGs in developing their co-commissioning proposals for implementation. 

Tell us what you think – have your say below or email [email protected]