CCGs face conflict of interest crackdown

CCGs face tougher conflict of interest rules after an audit of primary care co-commissioning arrangements found inconsistencies and breaches of statutory guidance.

Simon Stevens: tougher rules to prevent conflict of interest
Simon Stevens: tougher rules to prevent conflict of interest

CCGs could be ordered to appoint conflict of interest guardians under plans being discussed by NHS England.

Proposals also under consideration at an NHS England board meeting today also include tightening the national body’s own internal conflict of interest policies.

The proposals come as NHS England announced a further roll-out of delegated commissioning of primary care by GP-led CCGs.

CCG conflict of interest

GP leaders have warned since co-commissioning of primary care was first proposed that the arrangements risked creating conflicts of interest.

Measures to be consulted on in the new guidance include more extensive public registers of gifts and hospitality, wider registers of procurement decisions, training requirements on conflicts of interest management, and increasing the numbers of lay people on CCG governing bodies.

NHS England chairman Sir Malcolm Grant will draw up new rules to be adopted across the healthcare system, including proposals to ensure clinicians and procurement staff are free from unmanaged conflicts of interest, including from drugs purchasing.

The group will consider the range of consequences for ineffective managing conflicts of interest including civil legal action, and criminal sanctions.

Providers will also be required in the 2016/17 NHS Standard Contract to publish a register of gifts, hospitality and conflicts of interest.

NHS standards

NHS England's own internal policy will be toughened to include more stringent safeguards on the role of interest groups, lobbyists and commercial organisations.

An NHS England audit of CCG co-commissioning arrangements found guidance had been generally well received with examples of good practice. But it also identified a number of inconsistencies in the application of statutory guidance issued when co-commissioning was established in 2014.

The audit found one CCG of the 10 audited had failed to establish a separate primary care commissioning committee, which is required to overcome the potential conflict involved in GP-majority bodies commissioning primary care. The audit also found variation in the inclusion of GP members and their voting rights on those committees.

There were also variations in implementing the requirement to publish a register of interests. While only one CCG had made the register of procurement decisions available in its annual report. Only six of 10 CCGs had established a register of procurement decisions.

The audit found other inconsistencies in managing conflicts of interest and in training for CCG staff. Two CCGs had provided no structured conflicts of interest training for commissioning committee members or staff.

NHS England chief executive Simon Stevens said: ‘In a tax-funded health system, the public rightly demand high standards of probity from both NHS staff and health care suppliers. Recent cases in the UK and indeed worldwide have underscored the need for action. "Sunshine" rules to bring greater transparency, tougher restrictions on conflicts of interest, and clearer guidelines on industry partnerships and influence will benefit patients and protect taxpayers.’

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