Dilemma: A conflict of interest between partners
One of the GP partners at your practice sits on the CCG board, while another fronts a local GP provider organisation that is planning to bid for contracts.
You are concerned that the practice’s internal relationships might be put under strain during the bidding process and particularly if the board does not award contracts to the partner’s organisation.
How should you manage this?
The CCG board partner cannot have any say in decisions about the provider
How to deal with this will depend on the individual characters, but the provider organisation partner needs to understand the CCG board partner cannot have any say in board decisions in relation to the provider. I would have an open discussion with the provider partner and explain my concerns and expectations.
All GPs on CCGs are potentially conflicted, simply by their independent contractor status and ability to develop outside interests. It becomes more complex when board members belong to an external commercial enterprise. That person may have expert knowledge, which would be foolish to ignore, but how do you ensure impartiality?
There are only so many GPs in the UK. Those with the drive to be entrepreneurs are likely to be the same people who will make the boards a success. How do we harness that? The Committee for Standards in Public Life published the seven Nolan Principles as core working values for anyone who serves the public: selflessness, integrity, objectivity, accountability, openness, honesty and leadership. I would add another principle for conflicted CCG board members: absence. They should be excluded from conflicted items at board meetings but asked for input at seminar level where no decisions are taken.
Dr Mark Gaffney is a co-founder and joint managing director of East Sussex Out Patient Services and a GP in Eastbourne
Recognise that GPs will be involved in different areas of work
The partners should have a full discussion in the practice to ensure any adverse fallout is minimised.
The CCG board member would have to declare a conflict of interest in any procurement where their partner’s organisation is bidding. This means they are likely to be excluded from the process.
The partner who leads the provider organisation will need to accept the CCG’s decision without worrying it was influenced by their partner. They should not apply influence to the CCG board member or other CCG board members that may be interpreted as unfair.
The other partners will need to understand the CCG board member must act on behalf of all its population and practices, and cannot favour an individual practice. The lay member of the CCG, on behalf of the board, will need to have governance systems to ensure conflicts of interest do not compromise decision-making.
As the two partners have conflicts of interest it is important to have appropriate partnership agreements, particularly if there are any financial arrangements. This would include the extent to which a partner can have other provider interests and how these may financially affect the practice. Additional time partners spend on outside provider interests has to be negotiated. CCG governance and the individual’s professional duty to maintain probity should be respected, but GPs will be involved in different areas of work, and this should not discourage innovation.
Dr Ken Aswani is the medical director at Waltham Forest Federated GP Consortium and a GP in Leytonstone
The decision lies outside the practice – it is for the board to take
Management of conflicts will become an essential part of the new NHS. However in the present situation, there is nothing for the practice itself to ‘manage’.
The decision is for the CCG board to take. If there is discussion about the award of the contract to the GP provider organisation of which the fellow partner is a member, the CCG board member should remove themselves while the decision is taken.
It is important to distinguish the role a partner plays outside the practice from the partnership business. In this case, the decision has nothing to do with the partnership. If it is understood the CCG board member/partner is unable to influence the decision, that should prevent difficulties within the practice.
It is also important that partners appreciate their responsibility lies with the partnership. If an external activity presents a conflict, then they will need to decide which way to jump. It is not reasonable to expect the other partners to put up with the challenges from one GP’s external interest.
Lynne Abbess is a partner at Hempsons solicitors