Commissioners often ask us how they can benefit from clinical involvement in the commissioning process while avoiding the conflicts that can arise, especially when GPs are involved in designing new models of community care.
One clinical commissioning group's approach
We recently looked at the issue of conflicts of interest after we received an anonymous complaint that GP members of a clinical commissioning group (CCG) were involved in bidding for a new contract being commissioned by the CCG.
The contract for an existing service was expiring soon and the CCG had decided to hold a competitive tender to select the provider of the new contract. The CCG told us how they were putting their conflicts of interest policy into practice in this procurement exercise.
Identify potential conflicts
The first step was presenting a business case to the CCG governing body for approval. Before the business case was presented, CCG staff checked the declarations of interest register and identified that some clinical members of the CCG governing body had potential conflicts of interest.
Remove potentially conflicted members from the approval process
The clinical members who were potentially conflicted did not take part in the approval of the business case for the procurement. The approval was given by the executive, non-executive and lay members of the governing body.
Source alternative clinical expertise
To ensure the CCG had the necessary clinical input in making decisions about the procurement, the CCG told us it brought in clinical expertise from a neighbouring CCG area. The CCG also checked that the clinical experts being brought in did not themselves have any conflicts.
The procurement is not yet complete but the CCG told us they intend to follow their conflicts of interest policy during the rest of the process, and that any recommendation for contract award would not be shared with the conflicted clinical members. Based on this, we found no grounds to take the complaint any further.
In our guidance, we say that commissioners should ask themselves: are there any conflicts between the interests in commissioning the services and providing them? This CCG’s approach is a streamlined, transparent and non-bureaucratic example of how you can help to make sure that patients always have access to the best possible providers of services. No doubt many CCGs are already adopting a similar approach.
Your approach
Have you encountered any of the potential conflicts that may arise from having doctors involved in commissioning and delivering services? How have you managed these?
For more on managing conflicts, you can also read guidance for CCGs from NHS England (PDF) and the BMA.
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