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Managing conflicts of interest in NHS clinical commissioning groups

The National Audit Office has published the findings from its investigation into managing conflicts of interest in NHS clinical commissioning groups. All GP practices are members of their local CCG. Within each CCG, some GPs are members of their CCG’s board – its governing body. Under these arrangements there is potential for some GPs and their colleagues to make commissioning decisions about services they provide, or in which they have an interest. Where this is the case there is a risk that commissioners may put, or be perceived to put, personal interests ahead of patients’ interests.

The key findings of the investigation are as follows.

  • Some 1,300 (41%) of CCG governing body members in position at the time of our analysis in 2014-15 were also GPs, who may, potentially, have made decisions about local health services and have been paid by their CCG for providing them
  • The Department recognised the potential for conflicts of interest in the NHS commissioning system and took a proportionate response to managing such conflicts, including by assigning formal roles to relevant bodies
  • The Health and Social Care Act 2012 places a legal duty on CCGs to manage conflicts of interest. The NAO found almost all CCGs had put in place most key elements of the legislative requirements which help them to prevent and manage conflicts
  • During 2014-15, a minority of CCGs had reported they had to manage actual or perceived conflicts of interest. However, the NAO could not always assess from publicly available information how CCGs had managed such conflicts of interest, which limits local transparency
  • Where CCGs reported information about their controls for managing risks of conflicts of interest, it showed the adequacy of those controls had varied
  • NHS England has so far collected little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements. It relies instead on an exception-based approach, and on Monitor as the system regulator
  • Up to June 2015, Monitor had received relatively few concerns about conflicts of interest; only one of its formal investigations included a concern about conflicts of interest in a CCG
  • From April 2015, CCGs can choose to co-commission primary care services from GPs which is likely to increase significantly the number and scale of conflicts of interest. The Department and NHS England recognise the risk and have responded, including issuing statutory guidance and providing training and support to CCGs.

To promote public confidence that conflicts are well managed, CCGs will need to ensure transparency at the local level when making commissioning decisions. In addition, NHS England will need to be satisfied that it has sufficient and timely information to assure itself that CCGs are managing conflicts promptly and effectively.

September 2015



Notes for Editors

1. This report is a National Audit Office Investigation. The NAO conducts investigations to establish the underlying facts in circumstances where concerns have been raised with us, or in response to intelligence that we have gathered through our wider work.

2. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.

3. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 810 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.15 billion in 2014.

PN: 51/15