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GPs at risk of conflict of interest allegations, NAO report finds

GPs could be perceived to put ‘personal interests ahead of patients’ interest’ as a result of the move to co-commissioning, a National Audit Offfice (NAO) report has concluded.

The report by the Government auditors found that ‘almost all’ CCGs fulfil key legal requirements for managing conflicts of interest, but only ‘a minority’ have actually reported that they had to manage actual or perceived conflicts of interest.

In the instances where they had done so, the NAO found that ‘the adequacy of those controls had varied’.

It also said that NHS England has collected ‘little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements’.

Monitor, the body tasked with investigating CCG conflict allegations, had investigated just one such case since CCGs were introduced in April 2013 up to June 2015, the report said.

But this comes as NHS England’s decision to allow CCGs to choose to co-commission primary care services from GPs as of April 2015 ‘is likely to increase significantly the number and scale of conflicts of interest’.

The NAO concluded: ‘To promote public confidence that conflicts are well managed, CCGs will need to ensure transparency at the local level when making commissioning decisions. In addition, NHS England will need to be satisfied that it has sufficient and timely information to assure itself that CCGs are managing conflicts promptly and effectively.’

It added: ‘Under [co-commissioning] arrangements there is potential for some GPs and their colleagues to make commissioning decisions about services they provide, or in which they have an interest. Where this is the case there is a risk that commissioners may put, or be perceived to put, personal interests ahead of patients’ interests.’

The report also revealed that some 1,300 GPs sit on CCG governing bodies, accounting for 41% of all CCG board members.

The GPC opposed the introduction of primary care co-commissioning, with members at the LMCs conference 2014 declaring the inherent conflict of interest represented the ‘ultimate poison chalice’ for general practice.

NHS England is now reviewing whether CCGs could also take on responsibility for handling patient complaints but the GPC has said CCGs taking on performance management of practies would be ‘inappropriate’.

NHS England has approved 151 out of 209 CCGs to take on greater responsibility for commissioning general practice, including 65 which took on full delegated commissioning responsibility in April.

Readers' comments (2)

  • This is just lawyer stuff for lawyers to be honest, nothing useful. The real challenges around co-commissioning are delivering good contract management with no additional resource and PCSS descending into Capita induced farce.

    However NHS England can be assured that CCGs are doing a better job than NHS England did. Was that 'one way of working' that was meant to make the staff cuts ever actually produced?

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  • Vinci Ho

    Fact, conflict of interest never goes away ever since Health and Social Care Bill was passed .
    NAO has produced reports with conclusions independent of any other authorities . Similar office appears in other western democratic countries to serve for social justice and scrutiny on how a government and its departments have been behaving , especially financially. It carries credibility.
    This report practically gave a big slap on the face of people like DC, Lansley and JH. And this is not the first time :

    Care plan savings 'over-optimistic'
    By Nick Triggle
    Health correspondent, BBC News
    11 November 2014
    From the section Health
    PatientImage copyrightAmelie-Benoist / BSIP/SCIENCE PHOTO LIBRARY
    Questions are being asked about what impact a flagship government scheme to improve the care of vulnerable patients in England will have.
    The £5.3bn Better Care Fund will be launched in April 2015 to encourage greater integration between the NHS and social care.
    But a review by the National Audit Office found the scale of potential savings was overstated to start with.
    The government said it disagreed with the criticisms.

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