19.12.14
CCGs told to tackle ‘perceived’ and ‘actual’ conflicts of interest
Unless the potential for ‘perceived’ and ‘actual’ conflicts of interest when Clinical Commissioning Groups (CCG) procure services from their GP member practices are tackled early, there are fears it could affect the ability of commissioners to develop new models of care.
This is according to NHS Clinical Commissioners (NHSCC), the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA), who have come together to support CCGs to manage conflicts of interest when they take up proposals to commission primary care in 2015.
As part of NHS England’s updated guidance on managing conflicts of interest, the three organisations have developed a set of ‘shared principles’. These says that if CCGs are doing business properly then the rationale for what and how they are commissioning is clearer and easier to withstand scrutiny. In particular, decisions regarding resource allocation should be evidence‐based, and there should be robust mechanisms to ensure open and transparent decision making.
They also believe CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.
CCGs should assume that those making commissioning decisions will behave ethically, but individuals may not realise that they are conflicted, or lack awareness of rules and procedures. To mitigate against this, CCGs should ensure that formal prompts, training and checks are implemented to make sure people are complying with the rules. As a rule of thumb, ‘if in doubt, disclose’.
Dr Amanda Doyle, co-chair of NHSCC and chief clinical officer for NHS Blackpool CCG, said: “Developing these shared principles with the RCGP and BMA sends out an important message that the primary care and general practice sector are committed to making the co-commissioning agenda work and that we are working together for our patients and local populations”
The latest document adds that conflicts of interest in the NHS are not new and they are not always avoidable. They added that there needs to be an effort made in tackling perceived wrongdoing early as it can be as detrimental as actual wrongdoing, and risks “losing confidence in the probity of CCGs and the integrity of wider clinicians such as GPs in networks/federations, individual practices and partners”.
Dr Maureen Baker, chair of the RCGP, said “The RCGP sees "co-commissioning" as an important vehicle to target resources where they are needed. There is of course significant potential for conflicts of interest to arise.
“This document which we have jointly written with the NHS Clinical Commissioners and the BMA shows that these potential conflicts are manageable and shouldn't be seen as a barrier to commissioning high quality care in a local context.”
Within NHS England’s latest guidance document it sets out the additional factors that CCGs should address when commissioning primary medical care services, either under joint commissioning or delegated commissioning arrangements.
This includes the factors CCGs should consider when drawing up plans for services that might be provided by GP practices; and it also includes the necessary aspects of the makeup of the decision-making committee which must have a lay and executive member majority.
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