Scenario 2: There is concern GPs on the PEC will be able to influence commissioning decisions to their benefit

What’s happening

There are GPs who wear many hats, so separating their roles and responsibilities and working out what is, and what is not, a conflict of interest may be tricky.

For example, GPs involved in developing service specifications or business cases may also be present on the PEC or other decision-making board. As such they would be involved in approving them and/or deciding on the procurement method to use.

The guidelines clearly state that to ensure the board can arrive at a decision based on high-quality informed dialogue, the PCT needs the technical expertise and population knowledge of GPs.

This kind of situation should not be a barrier but GPs with an interest in a decision need to say so and exclude themselves.

Expert opinion

NAPC chair Dr Johnny Marshall says in his experience as chair of both a commissioning collaborative and a separate provider organisation, this can be a problem, but if everyone is up-front and transparent about their interests at the start, it needn’t be.

‘It’s how you manage it that is crucial and the very first point is everyone being open and honest about the different roles they have. If I’m in a commissioning meeting and there’s a potential for conflict of interest and people start to get uncomfortable, I can be excluded from that decision or that meeting.

‘It cannot be about how you remove it, but the default position of PCTs seems to be to take away the risk completely, which is not realistic,’ explains Dr Marshall.

He says the original guidance said PCTs could take four weeks to consider a business plan or eight weeks if they needed outside advice. ‘For example, if every member of the PEC was a potential provider then you need to go outside for advice. What shouldn’t happen is that the decision is made without clinical input or not made at all.’

The guidance to quote

Practice based commissioning: practical implementation, 2006

‘PCTs regularly draw upon clinical expertise to help shape and steer plans to improve the health of local communities. This means there may be a potential conflict of interest for clinicians such as GPs who are involved in the assessment of PBC business cases in which they may have a direct interest.

‘To avoid conflicts of interest in the re-provision of services through PBC, there should be clear accountability to the PCT board through a committee or subcommittee of the PCT. Clinicians must exclude themselves from decisions on any PBC business cases in which they have an interest or with which they are associated.’