Around 1,300 GPs already serve on CCGs with responsibility for commissioning primary care services according to a recent investigation by the National Audit Office (NAO).
CCGs have a legal duty to manage conflicts of interest and NHS England has produced statutory guidance for commissioning groups. If you are a GP serving on your local CCG, you need to meet the GMC’s ethical standards about conflicts of interest.
Sometimes conflicts are unavoidable but with careful planning and management, GPs should be able to avoid criticism when they are conflicted. Consider the following proactive steps:
1. Be transparent
Your CCG is obliged to publish a register of interests and a register of procurement decisions. Ensure you report relevant interests on appointment and whenever they arise to the person with responsibility for updating the register. You could also consider declaring your membership of a CCG on your own practice’s website and literature.
The GMC expects doctors to ‘formally declare any financial interest that you, or someone close to you, or your employer has in a provider company, in accordance with the governance arrangements in the jurisdiction where you work.’
2. Check your CCG code of conduct
The GMC expects doctors to show leadership if they have additional responsibilities for managing resources, or commissioning or delivering health services.
In Leadership and management for all doctors, it says: ‘You must make sure that there are appropriate systems in place to make sure that actual or perceived conflicts of interests are managed in an open way, and in line with [GMC] guidance…’
NHS England’s statutory guidance requires CCGs to set out a code of conduct which reflects the standards established by the Professional Standards Authority. This requires individuals to ensure their 'organisation’s contractual and commercial relationships are honest, legal, regularly monitored, and compliant with best practice in the management of public money'.
3. Declare new conflicts of interest promptly
Your CCG should provide clear guidance on what might constitute a conflict of interest and provide examples but you are expected to use your professional judgment and speak out as soon as you become aware of a potential conflict. As well as direct financial conflicts, be aware that perceived conflicts might arise from your personal relationships, or professional loyalties.
The GMC expects you to ‘declare any conflict to anyone affected, formally and as early as possible, in line with the policies of your employer or the organisation contracting your services.’ If in doubt, you could seek advice from your medical defence organisation. The GMC generally recommends that you act as though there is a conflict.
In its statutory guidance for CCGs, NHS England says that ‘individuals who have a conflict should declare this as soon as they become aware of it, and in any event not later than 28 days after becoming aware’.
4. Exclude yourself from decision-making
In the event of a conflict, you should abide by your CCG’s established arrangements. For example, the chair may ask you to leave for the relevant part of a meeting or permit you to join in the discussion but not have a vote.
CCG’s are obliged to record how any conflict of interest issue has been managed in the minutes of the meeting and in its registers.
The GMC also suggests that doctors take steps to manage any conflict between their duties as a doctor and commissioning responsibilities, such as ‘excluding yourself from the decision making process and any subsequent monitoring arrangements’.
5. Declare conflicts to patients if appropriate
If a conflict of interest arises when your CCG is procuring primary care services, be aware that it might also apply to your clinical decisions in practice. For example, if you have a financial interest in an organisation which has been commissioned to provide a particular local service, such as a clinic, pharmacy or nursing home to which you are referring a patient.
The GMC says: ‘you must not allow that interest to affect the way you prescribe for, advise, treat, refer or commission services for patients’ and not try to ‘influence patients’ choice of healthcare services to benefit you, someone close to you, or your employer’. If your interest in a provider could be perceived to affect your decisions you must be open and honest with your patients.