Commissioning health services – scope for fraud and corruption to increase?

When the new structure for health commissioning was introduced a couple of years ago, we had concerns about a number of elements within the overall process. One was the potential for conflicts of interest, with doctors sitting on the new Clinical Commissioning Groups being responsible for awarding contracts, some of which might go to organisations in which they themselves had a financial interest.

There have been a few cases which supported our fears, but it is fair to say nothing too serious has really hit the headlines. Yet.  However, the new head of NHS England, Simon Stevens, seems to be moving in a direction that will increase the likelihood of these conflicts.

The Pulse website reported that “NHS England will invite CCGs to express interest if they want to commission primary care in their area, it has announced. Under the plans, CCGs are being asked to come forward with their suggestions for how they would use these commissioning powers to improve care in their area and help to keep it sustainable. Speaking at the NHS Clinical Commissioners conference in London this afternoon, NHS England chief executive Simon Stevens said this would help to ‘properly resource’ primary care.”

But of course primary care is delivered in the main by the traditional family doctors ('GPs') and surgeries, many of which are independent businesses owned and run by those GPs – the same people who sit on the CCGs. So this seems to suggest that GPs will be able to influence major decisions about billions of pounds potentially being spent with ... GPs. Even the BMA, the doctor’s professional body, worries that this “would result in conflicts of interest and mean GPs in CCGs would have to performance-manage their own contracts”.

Indeed. We wouldn’t dream of allowing procurement managers to own their own businesses on the side and then bid for contracts for which they are also running the procurement process, so why should this be different? I don’t pretend to understand all the machinations of the health service and what exactly is going on, but this just seems like a fundamental breach of ‘separation of duties’ – the very basic financial and procurement principle that every sensible organisation has in place.

At the very least, there need to be clear rules about conflicts, insisting that those conflicted play no part in contracting decisions. Even then, the scope for favouritism and nepotism is clear.

First Voice

  1. Ian Taylor:

    Primary care used to be commissioned by the now abolished Primary Care Trusts and there has been a vacuum since. The performance of different GP’s and their practices was very varied including their referral rates to hospitals. Some GPS’s were involved as part of the PCT role in development and improvement work but they were effectively supervised by the PCT and the also now defunct Strategic Health Authorities. The potential conflicts of interest in this proposal are obvious but the lack of any alternative leaves the performance management of primary care in real muddle. Still we can only be another year at most away from another big NHS reorganisation……shame this one wasn’t thought through.

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