Public confidence in management of conflicts in NHS commissioning “vital”: NAO

September 14, 2015

Public confidence that conflicts of interest are well managed in the new system for NHS commissioning will be vital, the National Audit Office has said following an investigation.

Under the regime, all GP practices are members of their local clinical commissioning group (CCG). Within each CCG, some GPs are members of their CCG’s board – its governing body.

“Under these 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 NAO said.

The key findings of the investigation were as follows:

Some 1,300 (41%) of CCG governing body members in position at the time of the NAO’s analysis in 2014-15 were also GPs, “who may, potentially, have made decisions about local health services and have been paid by their CCG for providing them”;
The Department of Health recognised the potential for conflicts of interest in the NHS commissioning system “and took a proportionate response to managing such conflicts, including by assigning formal roles to relevant bodies”;
The Health and Social Care Act 2012 placed a legal duty on CCGs to manage conflicts of interest. The NAO found almost all CCGs had put in place most key elements of the legislative requirements which helped them to prevent and manage conflicts;
During 2014-15, a minority of CCGs had reported they had to manage actual or perceived conflicts of interest. “However, the NAO could not always assess from publicly available information how CCGs had managed such conflicts of interest, which limits local transparency”;
Where CCGs reported information about their controls for managing risks of conflicts of interest, it showed the adequacy of those controls had varied;
NHS England had so far collected little data on how effectively CCGs were managing conflicts of interest or whether they are complying with requirements. “It relies instead on an exception-based approach, and on Monitor as the system regulator”;
Up to June 2015, Monitor had received relatively few concerns about conflicts of interest; only one of its formal investigations included a concern about conflicts of interest in a CCG;
From April 2015, CCGs can choose to co-commission primary care services from GPs “which is likely to increase significantly the number and scale of conflicts of interest”. The Department and NHS England had recognised the risk and had responded, including issuing statutory guidance and providing training and support to CCGs.

“To promote public confidence that conflicts are well managed, CCGs will need to ensure transparency at the local level when making commissioning decisions,” the watchdog said.

“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.”

A copy of the NAO report can be viewed here.