This site is intended for health professionals only

Commissioning dilemma – being a provider and a commissioner

Your practice is anxious about making commissioning decisions with practices they have previously been in competition with, one of which you suspect of trying to poach your patients in the past. How can you reconcile any potential conflicts of interest? Anne Crofts explores this dilemma.

The Health and Social Care Bill states that a commissioning consortium must have a constitution, and that constitution must make provision for dealing with conflicts of interests with members or employees of the consortia. In the interim, as GPs become involved in commissioning through membership of PCT sub- committees, it is in everyone's interests to address these issues by agreeing, in writing, the terms of reference of the sub-committee, which should have similar provisions for managing conflicts of interest. Such provisions require disclosures of conflicts, actual or potential, to be made at the earliest stage and clear mechanisms for managing the conflict with an appropriate audit trail recording the steps taken. The division of GP commissioner and provider roles is always going to provide a tension in the system, and should be managed through a variety of practical steps. There is clearly a difference between having to work collaboratively with other GPs in commissioning care in the best interests of patients and taxpayers, and managing the commercial conflicts of being providers in an increasingly competitive NHS market. The latter should clearly be prevented from influencing the former, but the two roles are not necessarily incompatible. It requires GPs engaged in commissioning to be very aware of which "hat they are wearing" at any one time, and a clear set of operational rules that encourage absolute transparency.

Anne Crofts is a Health Partner at Beachcroft LLP

Anne Crofts