Clinical commissioning groups
Last week Peter Killwick wrote in this blog about a number of risks associated with governance in clinical commissioning groups (CCGs). Since then the issue has hit the headlines with the front page of The Times taken up with an investigation into how CCGs deal with conflicts (see http://www.thetimes.co.uk/tto/health/news/article4610741.ece – behind a paywall) following a joint investigation with the BMJ.
Conflicts of interest are an inevitable part of the current commissioning environment. The NHS having spent years carefully separating commissioners from providers, they were comprehensively mixed up again by the 2012 Act.
There are obvious advantages to having local GPs at the heart of commissioning and in many areas they have made a massive contribution. But the governance challenges are enormous. In recent months, Verita has been working with a number of CCGs who have found those challenges difficult. At times they have fallen short. Often the first time the CCG realised that something was wrong was when they have to respond to a complaint from a whistle-blower. With the integration agendas (vanguards, new models of care) blurring neat distinctions, this problem is only going to get worse.
The first, and biggest, mistake is to be in denial. Having a conflict of interest sounds like a bad thing, so people want not to have them. But it is impossible for a CCG to be doing its job properly and not have conflicts. A CCG which isn’t involved in improving primary care, reducing demands on A&E and integrating different parts of the system simply isn’t doing its job.
Having worked with a number of CCGs, Verita has now developed an audit tool that can help CCGs tackle these problems. By coming into a CCG and carrying out interviews with key members of staff we are able to collect data to populate it. This enables a clear picture to be drawn of where the CCG is on its ability to manage conflicts of interest. An action plan for resolving any problems can then be developed. Conflict of interest issues aren’t difficult to deal with if you have a good understanding of them, but getting a clear perspective on them from the inside can be difficult.
If you are interested in hearing more about how we can help you with this, let us know… after all, it is better to hear these things from a critical friend than from a whistle-blower!