Friday, 5 April 2013

Concerns grow about GP conflicts of interest on new clinical commissioning groups

The concern about conflicts of interest for GPs serving on the new clinical commissioning groups (CCGs) continues. Last month an investigation for the prestigious British Medical Journal (BMJ) found GP conflicts of interest “rife” on the new NHS commissioning boards.More than a third of general practitioners on the boards of new clinical commissioning groups (CCGs) have a conflict of interest due to directorships or shares held in private companies providing services for the NHS.

Now the Medical Protection Society has published the result of a survey showing that 59% of GPs had concerns about conflicts of interest. Now the BMA, the body representing doctors, has suggested that GPs with conflicts of interest should seriously consider whether it is appropriate for them to serve on a CCG,. 

Responding to the findings of the Medical Protection Society’s survey of GPs and practice managers about the introduction of Clinical Commissioning Groups (CCGs), Dr Mark Porter, Chair of BMA Council, said:

“While the vast majority of GPs have no involvement or connections with private sector companies, the BMA has repeatedly called for strong measures that guard against possible conflicts of interest during the newly formed commissioning process.

"It is not surprising that a number of GPs and practice managers are concerned about this issue given the scale of the government's intended changes. It is important that everyone involved in the commissioning process understands clearly how to act if they are faced with any situation that could result in a conflict of interest.

"The BMA believes that any GP who has financial interests in a private sector company that might be awarded contracts in their area should consider seriously whether they should be a member of a (CCG) governing body.

“Given the tough economic climate facing the NHS, there is a widespread concern amongst GPs that the introduction of CCGs will coincide with reductions in budgets for general practice. CCGs will also inherit a situation where GPs are facing an unnecessary increase in administrative box ticking and a decline in funding following enforced and ill-advised changes to the GP contract.

“Ministers must ensure that CCGs have an appropriate level of resources so that they can meet the needs of their patients."

This conflict of interest is a scandal waiting to happen. It is unclear how the public can be reassured that it would not affect the proper running of the CCGs. It is also unclear how breaches of conflict of interest will be dealt with. What, for example, would be the penalties for failing to declare an interest? What would be the boundaries of declarable interest in relation to families or friends? A code of conduct, should it exist, should be published along with any procedures to monitor it. It should not be left to individual CCGs to sort this out.

The template Code of Conduct issued by the Department of Health suggests the following:

"Where certain members of a decision-making body (be it the governing body, its committees or sub-committees, or a committee or sub-committee of the CCG) have a material interest, they should either be excluded from relevant parts of meetings, or join in the discussion but not participate in the decision-making itself (i.e. not have a vote). In many cases, e.g. where a limited number of GPs have an interest, it should be straightforward for relevant individuals to be excluded from decision-making."

Where all or most of the GPs have a 'material interest' it suggests: 

1) refer the decision to the governing body and exclude all GPs or other practice representatives with an interest from the decision-making process, i.e. so that the decision is made only by the non-GP members of the governing body including the lay members and the registered nurse and secondary care doctor;
2) consider co-opting individuals from a Health and Wellbeing Board or from another CCG onto the governing body – or inviting the Health and Wellbeing Board or another CCG to review the proposal – to provide additional scrutiny, although such individuals would only have authority to participate in decision-making if provided for in the CCG’s constitution; and
3) ensure that rules on quoracy (set out in the CCG’s constitution) enable decisions to be made.

It is in short a total shambles. 

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