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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.