• GP social enterprise had “unwieldy” and “inappropriate” governance processes, report finds
  • Governance structure for GP out of hours provider “too complex” for small organisation

PRIMARY CARE: Governance arrangements at an east London out of hours provider were “inappropriate” and “unwieldy” for its size, a review commissioned by NHS England found.

City and Hackney Urgent Healthcare Social Enterprise, a GP led out of hours provider in the City and Hackney, was told its initial governance arrangements were “inappropriate”, in a report by consultancy firm Verita.

The report, commissioned in 2014 following whistleblower allegations against City and Hackney Clinical Commissioning Group and CHUHSE, said that the governance structure of CHUHSE was “too complicated for an organisation of its size”.

The organisation, run by local GPs, was awarded the contract to run GP out of hours services by the CCG.

Verita was critical of the provider’s governance processes at the time of the allegations, but said the provider now has a governance structure “more suitable to its size” and its processes are “generally adequate”.

However, the report added: “We do not believe that the current board has sufficient independent oversight. This could be rectified by the appointment of at least one non-executive who is not a GP.”

Nigel Wylie, chief executive for CHUHSE, has confirmed that the organisation is now looking for a non executive director who is not a GP.

One of the key incidents raised in the report was the overruling of non-executive directors after they challenged a contract for smoking cessation services, which CHUHSE wanted to sign on behalf of a local GP federation. The chair, medical director and chief executive took the decision to sign the contract despite concerns raised by non-executives that not enough time was given to consider the deal. Concerns were also raised that the chair had a conflict of interest, which the report authors found to be true but that the benefit to the chair was marginal.

The report said: “The non-executives were doing their job in questioning whether signing the contract was in CHUHSE’s interest and were correct not to agree until they were satisfied that everything was in order.

“It was a mistake for CHUHSE to enter in to the contract without their assent, irrespective of the technicalities of their exact position.”

The report found the governance arrangements had no effect on the quality of care given by CHUHSE.

A CCG spokesman said: “CHUHSE plays a vital role as part of City and Hackney’s local health service. It performs well on the NHS’s national quality requirement, scoring highly on patient satisfaction and experience.

“The issues raised by Verita relate to CHUHSE’s start-up year in 2014. It makes clear that there is no evidence of anything improper and that CHUHSE’s new management team now has appropriate measures in place which the CCG is continuing to closely monitor and review.

“We are happy with the progress made since 2014 and will continue to work with CHUHSE to ensure that it keeps delivering a responsive and high quality service to City and Hackney residents.

“The CCG has an agreed action plan with CHUHSE that requires the appointment of a new non executive director by the end of Autumn 2016. They will be a non-GP and non-City or Hackney resident. The CCG holds a regular Clinical Quality and Service Review meeting with CHUHSE and is satisfied that it will meet this deadline.”