Transparency essential in commissioning decisions

New clinical commissioning groups (CCGs) in England will need clear and robust mechanisms for managing real and perceived conflicts of interest to avoid having the integrity of clinicians being seriously undermined, according to a new guidance document from the RCGP Centre for Commissioning and the NHS Confederation.

Managing Conflicts of Interest in Clinical Commissioning Groups summarises key points that have emerged from conversations with commissioners, providers, regulators and professional bodies and sets out some draft principles that CCGs should adopt when developing local policies for managing conflicts of interest.

Among the recommendations, CCGs are encouraged to do "business properly" by having transparent needs assessments, consultation mechanisms and commissioning strategies in place from the outset. CCGs should also be proactive, not reactive. "Potential conflicts of interest should be identified before individuals are selected to join Clinical Commissioning Groups, and groups should agree in advance how different situations would be handled if a conflict of interest arises."

The document recommends that staff should volunteer any information about possible conflicts of interest and exclude themselves from decision making where they exist, with prompts and checks to reinforce this. The guidance also states that rules to manage conflict of interest should ensure that decision making is efficient but without constraining people by being overly complex or slow.

Mike Farrar, chief executive of the NHS Confederation, said: "There have been considerable concerns raised by MPs and professional bodies alike about this issue since the Health Bill was introduced and commissioning pathfinders were established. It’s a fundamental issue for Clinical Commissioning Groups to get to grips with, but there are some simple ways to manage it. It is important that people have the information and guidance they need to deal with these tricky issues.

"While some conflicts of interest are inevitable, our publication makes it clear that in most cases it is possible to address them by ensuring that they are identified and managed in the right way. No one wants confidence in their healthcare professionals undermined. That's why tacking the issue head on now, and providing clarity for clinical commissioners about what are unacceptable conflicts of interest, will help minimise the impact on the commissioning model."