GP conflicts of interest

The article reports the results of an investigation conducted by The Times and the British Medical Journal.

The leading article, “Cynical Commissioning”, reports that: “Nearly three quarters of England’s CCGs responded to freedom of information requests about conflicts of interest. A third of these reported at least one contract awarded to an entity in which a board member had declared an interest.”

This will come as no surprise to GP providers who have been acutely aware of the potential for conflicts of interest to arise ever since CCGs were created in April 2013.

It is a requirement of every GP contract that the practice is represented on a CCG and yet it is inevitable that every CCG will find itself in a position of awarding contracts for services that its member practices will be interested in providing, either directly or indirectly through federated provider organisations. Indeed, in many cases, it will be the practices or the federated organisations that will be best placed to deliver those services.

Where do CCGs stand?

CCGs are not allowed to award contracts where actual or potential conflicts of interest affect – or appear to affect – the integrity of the award. They are required to have in place processes for managing conflicts of interest and recording information about how conflicts are managed.

However, The Times’ view is that these rules are not sufficiently robust. The leading article says that: “The most perplexing aspect of local healthcare commissioning is that none of the contracts on which we report today breaks any rules. There is only one explanation. The rules are not tough enough.”

With stories like this hitting the headlines, it is more important than ever that individual GPs are mindful of CCG rules, GMC guidance and general good practice in relation to conflicts of interest.

What should GP practices do?

In summary, GPs (and other practice staff who have roles outside the practice) should:

as providers of clinical services:

• act in patients’ best interests when making referrals, providing or arranging treatment
• not allow commercial or financial interests to influence clinical decisions
• tell patients about interests in organisations to which you are referring

as federated/provider organisation board members:

• not hold a position on the CCG board of the area where you are providing services (this does not mean that federation board members should not hold any CCG posts, but good practice is that they should not be on the governing body of the CCG)
• declare interests when you apply, when you are appointed, at meetings (in relation to specific agenda items) and whenever your circumstances change

as CCG board members:

• declare interests when you apply, when you are appointed, at meetings (in relation to specific agenda items) and whenever your circumstances change
• declare conflicts of interest as soon as you become aware of them

What constitutes a conflict of interest?

You should remember that there are a number of different types of conflict of interest, not all of which might be immediately obvious, but all of which need to be identified and managed. The main types are:

• Direct financial interest (e.g. when a CCG board member is a partner or shareholder in a GP practice or other provider interested in providing a service being commissioned by the CCG)
• Indirect financial interest (e.g. when a relative of a CCG board member owns a provider company)
• Personal interest (e.g. kudos gained by awarding a contact or referring patients to a personal contact)
• Conflict of loyalties (e.g. a special interest in a particular medical condition)
• Conflict of professional duties (e.g. between the duty to manage resources vs the duty to be an advocate for patients)

The King’s Fund recently published an article by Ruth Robertson (“Should we be worried about CCG conflicts of interest?” 29 September 2015) which stressed that concern about conflicts of interest extends beyond the award of contracts. For example, decisions about broader allocations of funding between acute and community settings will also attract scrutiny.

It is important to be as open and transparent about your interests as possible and be prepared to objectively explain any action or decision you make.

If you feel that you would have difficulty explaining or justifying a decision or course of action, this is a good indicator that it might not be the right course of action.

How can Ward Hadaway help?

For more information on issues arising from this article and how Ward Hadaway’s expert Independent Healthcare Team can help, please don’t hesitate to get in touch.