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How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis
OBJECTIVES: From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning the...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695513/ https://www.ncbi.nlm.nih.gov/pubmed/29122801 http://dx.doi.org/10.1136/bmjopen-2017-018422 |
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author | Moran, Valerie Allen, Pauline McDermott, Imelda Checkland, Kath Warwick-Giles, Lynsey Gore, Oz Bramwell, Donna Coleman, Anna |
author_facet | Moran, Valerie Allen, Pauline McDermott, Imelda Checkland, Kath Warwick-Giles, Lynsey Gore, Oz Bramwell, Donna Coleman, Anna |
author_sort | Moran, Valerie |
collection | PubMed |
description | OBJECTIVES: From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. DESIGN: We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs). SETTING/PARTICIPANTS: We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning. RESULTS: Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein. CONCLUSIONS: Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs. |
format | Online Article Text |
id | pubmed-5695513 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-56955132017-11-27 How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis Moran, Valerie Allen, Pauline McDermott, Imelda Checkland, Kath Warwick-Giles, Lynsey Gore, Oz Bramwell, Donna Coleman, Anna BMJ Open Health Policy OBJECTIVES: From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. DESIGN: We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs). SETTING/PARTICIPANTS: We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning. RESULTS: Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein. CONCLUSIONS: Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs. BMJ Publishing Group 2017-11-08 /pmc/articles/PMC5695513/ /pubmed/29122801 http://dx.doi.org/10.1136/bmjopen-2017-018422 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Policy Moran, Valerie Allen, Pauline McDermott, Imelda Checkland, Kath Warwick-Giles, Lynsey Gore, Oz Bramwell, Donna Coleman, Anna How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title | How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title_full | How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title_fullStr | How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title_full_unstemmed | How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title_short | How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis |
title_sort | how are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in england? a qualitative analysis |
topic | Health Policy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695513/ https://www.ncbi.nlm.nih.gov/pubmed/29122801 http://dx.doi.org/10.1136/bmjopen-2017-018422 |
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