CCGs: Conflicts of Interest
Concerns over potential conflicts of interests with CCG boards have begun to emerge. The Health and Social Care Act (2012) makes it a requirement that CCGs must have arrangements for managing conflicts of interest and potential conflicts of interest. The need for this is made clear by research by the BMJ indicating that more than a third of GPs on the boards of CCGs have a conflict of interest resulting from directorships or shares held in private companies. That research showed that 36% of the 1179 GPs in executive positions had a financial interest in a for-profit private provider beyond their own general practice from which their CCG could potentially commission services. These interests ranged from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors.
Another investigation by Pulse found that more than one in five CCG board members had financial interests in private healthcare providers which could expose them to multiple possible conflicts of interest when commissioning services. The analysis of nearly 900 CCG members found that 23% were directors, owners, partners or shareholders in private healthcare providers, or had a family member with an interest in a private healthcare provider. More recently, another Pulse investigation showed that one in five GPs who sits on a CCG board has a financial stake in a provider which currently provides services to their own CCG. Using figures obtained under the Freedom of Information Act from 76 CCGs, the Pulse investigation revealed that many GPs are juggling commissioner and provider interests, with many having to leave board meetings when key decisions come up because of their conflict of interest. This raises questions about whether GPs’ influence on CCG boards is being diluted as a result of the current safeguards.
A further recent survey by OnMedica of 761 GPs revealed that 54% of GPs acknowledged that conflicts of interest are a central issue which may threaten the long-term viability of CCGs. The GPs questioned had little confidence that the government will be able to resolve concerns about conflict of interest in CCGs, with only 6% believing that it will create sufficient safeguards. The majority of respondents (74%) considered that asking GPs with a potential conflict of interest not to take part in specific CCG board’s decisions would not necessarily ensure that CCGs run transparently and effectively. There were also concerns that there will be no assurance that GPs will declare all interests beforehand.
Managing conflicts of interest
Much has been written in the press about the duty of CCGs to manage conflicts of interest. In his article, David Reissner explains how the Department of Health has introduced regulations to control for the potential for problems. These regulations, to be regulated by Monitor, state that NHS England and CCGs must:
- act with a view to securing the needs of people who use the NHS, improving the quality of services and improving efficiency in the provision of services;
- act in a transparent and proportionate way and treat providers equally and in a non-discriminatory way, including by not treating a provider more favourably than any other providers, in particular on the basis of ownership;
- not award a contract for healthcare services where conflicts or potential conflicts of interest arise.
It is clear that CCG board members should declare all relevant financial interests and exempt themselves from discussion of contracts from which they might benefit personally. However, David Reissner points out that it remains to be seen whether Monitor will regulate the procurement regulations effectively, particularly given that its enforcement guidance suggests that it will manage its limited resources by taking action only in cases it considers serious, or in cases where a widespread type of abuse requires deterrence. He also argues out that GPs involved in CCGs generally have such extensive interests in private health provision that conflicts of interest cannot be avoided, and the best the public can hope for is that conflicts will be managed.
Whilst it may not be possible for CCGs to completely avoid conflicts of interests, their challenge is to identify where and how they arise and to deal with them appropriately to ensure proper governance and defensible decision making. CCGs will need to ensure that they demonstrate transparency and fair procurement practice.