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. From the establishment of CCGs, it is inevitable that there would be Conflicts of Interest (or the perception of such), as many of the members of the Clinical Commissioning Group are 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.
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, were 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.
Based upon 31 compliance reviews completed by our Internal Audit teams in the second half of the 2016/17 financial year, we identified some common themes in areas for improvement. The key areas of concern, or where commonly further development was required were as follows:
- lack of formal training for conflicts of interest (it was recognised that the training tool originally promised by NHS England failed to materialise when promised);
- recruitment policy does not place emphasis on the completion of a declaration of interests for all employees;
- declarations of Interests were not always a standing agenda item in the contract meetings, and in some cases at the Governing Body meetings;
- several CCGs failed to publish all information regarding Conflicts of Interest on their website;
- registers of Gifts and Hospitality were not always up-to-date; and not all CCGs maintained details on historic gifts and hospitality, either accepted or rejected; and
- insufficient details within the Conflicts of Interests policy on how to manage breaches/ non-compliance and non-compliance with NHSE procedures on how to manage any instances of breaches.
If it works for CCGs, how about NHS provider organisations? Download the full report to read the full article.