GPs are accused of putting own interests ahead of patients

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GPs who also make decisions about local health services could be putting their own interests ahead of their patients, the National Audit Office (NAO) has warned.

The public spending scrutiny body fears some 1,300 family doctors across England have the potential to personally profit from new health services they vote in favour of as members of their local clinical commissioning group’s (CCG) governing body.

The findings were published by the NAO as part of its investigation into managing conflicts of interest in CCGs, which plan local health services in England and are made up of local GP practices.

The NAO said: “Within each CCG, some GPs are members of their CCG’s board - its governing body.

“Under these arrangements there is potential for some GPs and their colleagues to make commissioning decisions about services they provide, or in which they have an interest.

“Where this is the case, there is a risk that commissioners may put, or be perceived to put, personal interests ahead of patients’ interests.”

The NAO found between 2014-2015 some 1,300 (41 per cent) CCG governing body members who were also GPs may have made decisions about local health services and have been paid by their CCG for providing them.

While the NAO found during the same period that a “minority” of CCGs had reported an actual or perceived conflict of interest, it said it was not always able to assess how issues had been dealt with.

NHS England has so far collected little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements, the NAO said.

Since April, CCGs can choose to co-commission primary care services from GPs which is likely to increase significantly the number and scale of conflicts of interest.

The NAO added: “To promote public confidence that conflicts are well-managed, CCGs will need to ensure transparency at the local level when making commissioning decisions.

“In addition, NHS England will need to be satisfied that it has sufficient and timely information to assure itself that CCGs are managing conflicts promptly and effectively.”

CCGs were set up as clinically led groups to include all of the GP groups in their locale with the objective of giving doctors the power to influence commissioning decisions.

Each CCG has a constitution and is run by its governing body. Each has to have an accountable officer responsible for the CCG’s duties, functions, finance and governance. Most CCGs initially appointed former PCT managers to these posts.[4] Earlier this year nine clinical commissioning groups in Yorkshire were approved to take responsibility for budgets covering the majority of GP services.

A total of 64 of the GP-led groups in England have been given delegated responsibility for commissioning GP services as part of efforts to give local communities more scope for deciding how services develop.

A key aim is to better integrate care in and out of hospital. The responsibility has lain with NHS England for the last two years after the Government’s controversial NHS reforms. Officials say a “transparent and robust framework” has been put in place to manage conflicts of interest.

Clinical commissioning groups (CCGs) selected in Yorkshire include Barnsley, Rotherham, Vale of York, Harrogate and District, Scarborough and Ryedale, Bradford City, Bradford Districts, Calderdale and Wakefield.