Clinical commissioning groups are considering swapping GPs with their neighbouring groups to safeguard against potential conflicts of interest in commissioning primary care.
CCGs have been invited to submit proposals to co-commission primary care, which is currently the responsibility of NHS England’s area teams. LGC’s sister title Health Service Journal revealed this week that 77 groups are bidding for delegated responsibility, meaning they would be responsible for the performance management and budgets of their member GP practices.
British Medical Association GP committee chair Chaand Nagpaul told HSJ his “biggest concern” was that “no practice should feel that decisions about their contract, performance management and investment decisions about their practice are being influenced by local colleagues who sit on the CCG board”.
NHS England issued national guidance at the end of last year, stipulating that CCGs must create “decision making committees” with a lay chair, and in which lay and executive members form a majority, rather than GPs.
Mark Hayes, chief clinical officer of Vale of York CCG, which has applied for full delegated commissioning, said any decisions about primary care would be made by its quality and finance committee, which has a lay chair. The group also has one representative each from two local councils, and has appointed additional lay members.
Vale of York is considering a swap arrangement with neighbouring CCGs, in which GPs from one CCG area could sit on the committee commissioning primary care in another.
Dr Nagpaul said such an option would be a “valid way of achieving both GP presence in [primary care] decisions but from non-conflicted, external general practitioners”.
“It’s absolutely right that decisions that involve general practice should have GP contribution,” he added.
Dr Hayes also stressed the importance of GP involvement. “You can’t have an organisation that’s supposed to be clinically led, but remove all the clinicians from thinking about anything,” he said.
He added that CCGs commissioning primary care was “such a clear and stark conflict of interest [that] it’s probably easier to deal with it than some of the more subtle conflicts of interest that sometimes you don’t even realise are conflicts until someone points it out”.
Dudley CCG has also set up a separate committee to take on delegated commissioning. Chief officer Paul Maubach said it is “helpful and necessary [to have] people who have an understanding [of primary care] to be involved in the process”, but CCGs should “ensure that the governance keeps that separate”.
Across London CCGs have formed a single joint committee between NHS and a number of neighbouring groups.
Howard Freeman, chair of Merton CCG which forms part of the South West London Collaborative Commissioning collective of six CCGs, said having a single committee across several CCGs “means that there will be a wider pool of GPs to make decisions” who have no direct interest.