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Relationships between some CCGs and providers are too close – Stevens

NHS England chief executive Simon Stevens has agreed with MPs that some GPs on CCGs have overly “close” relationships with the provider organisations they commission services from – a clear conflict of interest.

Margaret Hodge MP, who chairs the Commons Public Accounts Committee, said such relationships were “incestuous” at Monday’s hearing, where Stevens was giving evidence. He appeared to agree.

Stevens was being questioned about GP out-of-hours services by the public spending watchdog. Hodge, Labour MP for Barking and Dagenham, used the example of Barndoc Healtchare, an out-of-hours provider in North London, which she said had eight shareholder GPs, including the company chairman, on Barnet, Enfield and Haringey CCGs.

“So we have a theoretical separation between the commissioner and the provider, and actually an incredibly incestuous relationship between them,” said Hodge.

She added: “Where you have got a commissioner in this instance who is actually chair of the provider organisation it's just too close. You wouldn't do it.”

To which Stevens replied: “I agree.”

He said later: ‘There is a dilemma here, that if we don't want a bunch of out-of-area locums staffing up out-of-hours services, then by definition, it is going to be GPs in the local area who are going to be involved in actually providing those out-of-hours services. Nevertheless we have got to put clear daylight between the decision processes as to who's doing it, and the people who are then subsequently providing it and earning off the back of it.”

The hearing follows a report from the National Audit Office (NAO) that found while some areas of the NHS in England are achieving value for money for out-of-hours GP services, this was not the case across the board.

Amyas Morse, head of the National Audit Office, said: “NHS England has much to do to help secure improvements throughout the system and to increase its oversight of the out-of-hours GP services it commissions directly. It should also work to raise public awareness of how and when patients should contact out-of-hours GP services, and needs to be prepared to take the lead in integrating these services effectively with other parts of the urgent care system.”

According to the NAO the risks of conflicts of interest are understood by CCGs but the system relies on self-reporting. Hodge referred to this as, “not good enough,” and said, “it feels wrong.”

Dame Barbara Hakin, NHS England’s deputy chief executive, told the committee that from September, the area teams would be asked to ensure CCGs can demonstrate how they manage conflicts of interest.

(Library image of Simon Stevens giving evidence earlier this year: PA)

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