• Review found gaps in conflict of interest management for procurements
  • No evidence that conflicted members left procurement meetings
  • CCG says it has taken multiple steps to improve processes and change directors

A clinical commissioning group has been criticised for how it handled potential conflicts of interest when it handed out contracts to organisations owned by its own GPs.

Channel Health Alliance was awarded a home visiting contract by South Kent Coast CCG in April 2017 despite issues recorded in the minutes of the primary care commissioning committee at the time, about the company’s readiness to take on the work and its registration with Companies House and the Care Quality Commission.

A governance review into South Kent Coast and three other East Kent CCGs said that awarding a contract to an organisation in this position “represents significant risks in terms of quality and safety”.

Channel Health Alliance said it was registered with Companies House the day before the contract was awarded and, while it was not registered with the CQC until March 2018, during this time the work was sub-contracted to another organisation which was registered as a provider. Channel Health Alliance has subsequently been inspected by the CQC and rated as “good”.

The governance review – carried out by PwC in April and May 2018 and released to HSJ 11 months after our initial freedom of information request – raises “significant concerns” over conflicts of interest at the CCG.

Reviews were also carried out at the same time into three other east Kent CCGs: Ashford, Thanet and Canterbury and Coastal.

For South Kent Coast, the review identified gaps in COI management, unmitigated risks and concerns with procurements involving Channel Health Alliance and Invicta Health Community Interest Company, a GP Federation, according to the report.

According to the review, concerns over COI  “range from individuals being present when business cases involving their own interests are presented to business cases inappropriately being written to include assumptions about financial and commissioning information prior to clinical decisions being made”.

There were no records which suggest that conflicted members left the meeting when the home visiting contract was awarded, it continues, although the review team was told they took part in the discussion but did not vote – something PwC said was “not sufficient to mitigate the COI risk”.

Channel Health Alliance has said that its directors were not involved in the debate, although all GPs in the area were members of the Alliance.

The review recommended the four CCGs in east Kent should: review current and imminent procurements; review COI risks and mitigate any which were immediate; and ensure only committee members made decisions; and that conflicted members can’t take part in discussions or decisions about procurement.

It recommended the South Kent Coast governing body should scrutinise the future procurement for contracts held by Channel Health Alliance and Invicta, “in which the vast majority of local GPs have a material interest”, and that decisions related to Invicta should be reviewed.

The reviews on the other three east Kent CCGs indicated some areas where COI policy could be improved, but do not make serious criticisms akin to those about South Kent Coast.

The reviews were also critical about how the CCGs handled an emerging £28.5m deficit in 2017-18. 

In a statement about the reviews, the four east Kent CCGs said they had taken steps including putting in place more robust processes about conflicts of interest in advance of the governance review last spring. 

They said: “The contracts held by Channel Health Alliance have not yet been re-procured. Both contracts have been extended whilst new service models are developed. The extensions were agreed under the scrutiny of the contracting, finance and performance committee chaired by the audit chair. The purpose of the extensions are to ensure service continuity for patients pending the development of the new service models.”

They said the “locality lead role” – which was particularly conflicted, according to the review – “no longer exists and the three individuals in South Kent Coast CCG who were fulfilling this role as well as provider directorships are no longer employed by any of the east Kent CCGs nor have positions on any east Kent CCG committees”.

They added: “The SKC [governing body] has been through several rounds of scrutiny and has no provider directors or [primary care network] clinical directors sitting [on its governing body]. Several GPs have willingly stepped down to facilitate this process. New appointees to any of the EK CCG [governing bodies] and decision making committees are subject to an enhanced screening with emphasis on awareness of and compliance with Nolan principles.”

The decision on the Invicta Health procurement had been reviewed, and due diligence was undertaken and conflicts of interest were managed appropriately, they added, 

A spokesman for Channel Health Alliance said it had worked with the CCG to comply with its conflict procedures.