Unacceptable conflicts of interest in Calderdale GP Commissioners’ bid for role in commissioning primary care services

Calderdale Clinical Commissioning Group is among the 87% of Clinical Commissioning Groups (CCGs) that have bid for a role in commissioning primary care.

This is despite the fact that in May this year, GPs at the Local Medical Committees’ Conference in York voted against co-commissioning of primary care by CCGs, on the grounds that this would create “unacceptable” conflicts of interest.

CCGs are made up of local GPs, and primary care covers GP practices as well as dental practices, community pharmacies and high street optometrists.

Until now, Calderdale CCG has only had responsibility for commissioning these health and care services for the area:

  • Planned hospital care
  • Urgent and emergency care
  • Rehabilitation care
  • Community health services
  • Mental health and learning disability services

Ken Cheslett, Chair of Calderdale 38 Degrees NHS Campaign group, said,

“In the light of the fact that the Local Medical Committees have voted against it, and pointed out the conflict of interest, I think an explanation from Calderdale CCG, as to why they should be pursuing this, is required.”

Dr Alan Brook, Chair of Calderdale Clinical Commissioning Group, commented

“Simon Stevens [Head of NHS England] announced the co-commissioning of primary care initiative in May and NHS England have encouraged CCGs to become involved since.  As CCGs seek to develop all NHS services, not just those in hospitals, they inevitably want to see Primary  Care services adequately supported so they can make their appropriate contribution to care. For their part NHSE probably reflected on how they had struggled to commission GP services throughout their first year.

All the other West Yorkshire CCGs, including Greater Huddersfield, have expressed an interest. I would argue that Calderdale has been the most cautious of the local 10 CCGs, for the reasons below, but is currently anxious that failure to participate in this exploratory phase might disadvantage our member practices.

There are a number of concerns, notably

  • The GP board members of CCGs will have to manage a conflict of interest very carefully
  • The CCG GPs were elected by member practices with a mandate to commission other services only and not primary care
  • At the inception of CCGs it was anticipated that NHSE would be much more active in supporting and developing primary care than has been the case
  • As things stand, CCGs would be expected to co-commission from within the existing management allowance, with no additional resources offered

We have therefore declared an interest in order to remain involved, but will strive to help NHSE to address these issues.”

NHS England, previously called the NHS Commissioning Board, was set up under the 2012 Health and Social Care Act. It is currently responsible for commissioning primary care, including GP services.

But it recently invited Clinical Commissioning Groups to bid for roles in this area of commissioning.

Josh Fenton-Glynn, Labour Parliamentary Candidate for Calder Valley, said,

“This is one of the many reasons why the government’s topdown reorganisation of the NHS is so deeply flawed. It puts power of commission into the hands of GPs – most of whom didn’t actually want such power – even though GPs are also providers, meaning there is an obvious conflict of interest. If these plans go ahead there is a danger that GPs could be free to line their own pockets by commissioning their own services rather than always putting the needs to the patient first.

“Labour has rightly pledged to repeal the Health and Social Care Act if it wins the next election, but in the short term the CCG needs to make clear what robust governance structures they will put in place to ensure there is transparency around their commissioning decisions so that vested interests are not put before patient care.”

Dr Steve Ollerton, Clinical Lead at Greater Huddersfield CCG, said at a public meeting in Kirklees in March, that it would be wrong for CCGs to commission GP services, since this would mean they were in effect commissioning themselves and this would involve a conflict of interest between their roles as commissioners and their roles as GPs.

Karen Kinder, Media Officer at NHS England’s North, Midlands & East Communications Services, told Plain Speaker that a Calderdale CCG spokesperson said,

“Calderdale CCG can confirm we have submitted our expression of interest to NHS England to co-commission primary care in 2015 subject to some further clarification on how this would operate. We are now waiting to hear if we have been selected to proceed to the next stage.”

There are 3 categories of bids for CCG roles in co-commissioning primary care.

  • Category A: greater CCG involvement in influencing commissioning decisions made by NHS England area teams.
  • Category B: joint commissioning arrangements.
  • Category C: delegated commissioning arrangements.

Plain Speaker doesn’t yet know which type of bid Calderdale CCG has made.

Plain Speaker has invited these organisations and individuals to comment but they have not yet replied:

  • The Chair and Secretary of Calderdale Local Medical Committee (The LMC is made up of GPs and serves the needs of GPs working in Calderdale)
  • Craig Whittaker, Calder Valley MP
  • Alisdair Calder McGregor, Calder Valley LibDem Parliamentary Candidate

Updated 31 July with comment from Dr Brook, Chair of Calderdale CCG.

Posted from Hebden Bridge, England, United Kingdom.

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