Since the inception of Clinical Commissioning Groups (CCGs) in 2013 one of the big areas of contention has centred on the management and monitoring of conflicts of interest. It is inevitable that there will be conflicts of interest, as many of the members of the Clinical Commissioning Group will be local GPs, who are also inevitably responsible for provision of services in the local primary care setting. Therefore, challenges exist around mitigating these conflicts that influence the way a CCG makes decisions.
NHS England describes conflicts of interest as:
'A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in another role or relationship. In some circumstances, it could be reasonably considered that a conflict exists even when there is no actual conflict. In these cases it is important to still manage these perceived conflicts in order to maintain public trust.'
In June 2016 NHS England issued the Managing Conflicts of Interest: Revised Statutory Guidance for CCGs following an extensive consultation phase. In summary, the key changes in the revised guidance, agreed following the public consultation, are as follows:
- it is strongly recommended for CCGs to have a minimum of three lay members on the governing body;
- the introduction of a conflicts of interest guardian in CCGs;
- the requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and for anonymised details of the breach to be published on the CCG’s website;
- strengthened provisions around decision-making;
- strengthened provisions around the management of gifts and hospitality;
- a requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans; and
- a requirement for all CCG employees, governing body and committee members and practice staff with involvement in CCG business, to complete mandatory online conflicts of interest training.
The revised guidance forms part of a system-wide governance project to improve conflicts of interest management across the NHS organisations and increase public confidence in the decision-making processes.
We have undertaken a Conflicts of Interest benchmarking exercise across a total of 31 CCGs based in London and the South East. For 25 CCGs we undertook a checklist approach for which an assurance rating was given. For the remaining six CCGs due to the variations in scoping and the difference in timings of the reviews (having been done in advance of the mandated requirements) we undertook a compliance-based review making comparative benchmarking difficult. The detailed findings can be found in section two.
This benchmarking exercise also identified common issues and areas of good practice alongside improvement areas across the 25 CCGs reviewed, which are detailed in sections three and four.