Providers are likely to have to complain to the NHS Commissioning Board before approaching Monitor with concerns about clinical commissioning groups’ conflicts of interest, HSJ has been told.
Further details of the new commissioning system and economic regulation regime, including how complaints will be made and handled, are due to be set out in regulations in the summer.
The Department of Health last month asked the Co-operation and Competition Panel to review the issue of commissioners’ conflicts of interest and advise it on them. Health minister Earl Howe made the request following the DH’s ruling on a complaint about the involvement of two local GPs in an urgent care consultation by NHS Peterborough.
Co-operation and Competition Panel director Catherine Davies, speaking ahead of its review, said it would explore different best-practice approaches taken to involving clinicians and avoiding conflicts. It would report on possible solutions, it said.
She said it was likely the Principles and Rules for Co-operation and Competition – which the CCP currently uses to guide its judgements – would form the basis for new DH regulations on commissioning, and for Monitor’s licensing regime.
Ms Davies said under the new system those with a complaint about CCG decisions on primary or community services – where GPs may be conflicted – were likely to have to first contact the NHS Commissioning Board. If they were still not satisfied they could then complain to Monitor.
That would mirror current rules which require complainants to try to resolve their problem with commissioners before approaching the CCP. Monitor is due to take on the CCP’s decision-making panel and staff as it develops its economic regulation functions, Ms Davies said. However, Monitor has not yet announced details of its structure and governance under the new system.
Meanwhile, NHS Cambridgeshire and Peterborough chief executive Sushil Jathanna supported the need for clearer guidance on local clinicians’ involvement in commissioning decisions. He said at present there were potential “grey areas”.
Dr Jathanna also warned that decisions like that made by the CCP could dissuade clinical involvement. He told HSJ: “We need to get the right balance between having local clinicians championing the case for change, as opposed to preventing clinicians coming forward.”
The complaint about NHS Peterborough was made by 3Well Medical after a decision to close the Alma Road primary care health centre, which it runs. Earl Howe said in his decision letter last month that he agreed with a CCP ruling that the PCT “should have better managed potential conflicts of interest”. But he rejected a suggestion the PCT should have its plans reviewed by a group of clinicians from outside the area.
He added: “I will be asking the panel for further advice on best practice in handling conflicts of interest in commissioning decisions… to inform the regulations under [Health Act].”