The ability of clinical commissioning groups (CCGs) to make truly independent decisions has been called into question after an analysis found a significant portion of members had conflicts of interest, raising fears again of a potentially significant weak spot in the new incoming system.

CCGs are on the brink of leading one of the most radical changes to the National Health Service operating system since its birth, taking control of a huge portion of the budget - around £60 billion - in order to bring decision-making on local services to the front line.

But an analysis by the BMJ has found that 36% of the 1,179 GPs sitting on CCG governing boards have a conflict of interest, because they have a financial stake - either via directorship or share ownership - in private providers from which they could be commissioning services.

In addition, it found that 23% of 2,426 clinical, lay, and managerial members of CCG governing bodies had a financial interest in a profit-making service provider.

Particularly significant conflicts of interest uncovered by the investigation include: NHS Leicester City CCG, with seven GPs on the board having a financial interest in the LLR Leicester, Leicestershire and Rutland (LLR) GP Provider Company; NHS Oldham CCG, in which five of eight GPs on the board have links with the provider Primary Care Oldham LLP; and NHS Blackpool CCG, housing six of eight GPs with an interest Fylde Coast Medical Services, which provides out of hour care.

While a 'code of conduct' has been put together by the NHS Commissioning Board - stressing that commissioners who potentially stand to gain materially from any decisions should take themselves out of the process - some experts fear that this could lead to a 'dilution' of clinical involvement which is, after all, a key purpose of the new system.

GP James Kingsland, national clinical lead for NHS clinical commissioning, has reportedly suggested that clinicians on commissioning boards with significant stakes in local private healthcare groups should leave their roles all together, as the conflicts of interest are simply too great to overcome.

“If it is somebody who has got a major stake in some of the provider services which the CCG commissions, I don’t think excluding [himself or herself] or declaring an interest is enough—not for the public. I think they have got to step down," he said, according to the BMJ.

Prompts and checks

Clare Gerada, Chair of the Royal College of General Practitioners, said there should certainly be prompts and checks to ensure that members of CCGs are disclosing their conflicts of interest and excluding themselves from decision making where necessary. 

"Clinically-led commissioning on this scale is unchartered territory and GPs are being presented with a tremendous range of new challenges," she said, warning: "if conflicts of interest in clinical commissioning groups are not managed effectively, the consequences could badly undermine the confidence of regulators, providers and, most importantly, patients, in the system".

Laurence Buckman, Chair of the British Medical Association's GPs Committee, said "while the majority of GPs have no involvement in private companies, we have long called for stronger safeguards against possible conflicts of interest in the new commissioning process". 

He argues that "GPs who are directors of, or who have significant financial interests in, companies who might be awarded contracts to provide services should seriously consider their membership of CCG governing bodies. Alternatively, they should consider their position within provider companies". 

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