Conflict of interest
Conflict of interest risk faced by England’s clinical commissioning groups (CCGs) can be reduced by tackling six key areas, including more challenge by audit committee members and more transparency, was the finding of a seminar led by Verita.
The seminar Managing conflicts of interest: a topical risk for CCGs took place in London on Wednesday 13 July and was attended by senior national and local NHS commissioners and chaired by Lucy Scott-Moncrieff, Verita senior associate and the newly appointed House of Lords commissioner of standards.
In a wide-ranging debate, the seminar identified that the conflict of interest risk often arose from the passion of GPs to ‘do the right thing’ and there is no ‘clear line’ demarcating the point at which the commissioner/provider split is crossed.
The discussions identified six key areas which CCGs should consider to help reduce the risk of conflicts of interest, which can often result in whistleblowing claims or legal challenges:
- immature structures and reliance on interims means a lack of corporate memory and proper documentation to support and demonstrate a transparent decision-making process;
- a strong culture of challenge is as important as robust structures and policies in supporting GPs to effectively manage their accountability for dispensing large sums of public money. There also needs to be a clear understanding of the need for formal accountability for the management of millions of pounds of public money.
- the current commissioning structure has built-in an inherent tension between commissioning and provision, and this may be exacerbated as further powers are delegated to local organisations;
- transparency is the best policy – GPs and other senior decision-makers should declare any relevant interests, no matter how far removed, and expert opinion and scrutiny should be sought from colleagues outside the organisation as a further check and balance;
- be aware of the perception of, and actual opportunity for, conflicts of interest to arise through unclear division between core and enhanced contracts and;
- all relevant appointments should complete conflict of interest declarations on day one – whether permanent or interim.
One contributor from a CCG in south London said: “It is essential to have regular checks on information governance and also have someone, especially with responsibility for audit, who is ‘happy to call it out’. We also regularly call on external help from neighbouring CCGs on contracts as a ‘clean pair of eyes’, and are happy to do likewise.”
Concluding, Ed Marsden, managing director at Verita said: “Given that the structure and responsibilities of CCGs are still bedding down, and the reliance on interim staff affecting corporate memory, it is clear that properly managing conflicts of interests for GPs remains a significant challenge”.