Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
BMJ Open. 2017 Nov 8;7(11):e018422. doi: 10.1136/bmjopen-2017-018422.
From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services.
We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs).
SETTING/PARTICIPANTS: We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning.
Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein.
Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs.
自 2015 年 4 月起，英国国家医疗服务体系（NHS England，NHSE）开始将初级保健服务的委托职责下放给临床委托组（CCGs）。本文旨在探讨 CCG 如何管理与一组 GP 自我委托或委托其执业提供服务相关的潜在利益冲突。
我们使用 CCG 的样本进行了两次电话调查。我们还采用了定性案例研究方法，并在四个地点（CCGs）使用访谈和会议观察收集数据。
设置/参与者：我们对参与初级保健共同委托的全科医生（GP）和 CCG 工作人员进行了 57 次电话访谈和 42 次面对面访谈，并观察了负责初级保健共同委托的 CCG 委员会的 74 次会议。
利益冲突被视为 CCG 委托初级保健的必然结果。在为新激励计划获得无偏见的临床投入以及为 GP 供应商联合会提供支持方面，出现了特别的问题。在涉及初级保健共同委托的会议上，与会者在会议开始时声明利益冲突。在随后的讨论和决策中，对 GP 的参与采取了不同的方法，不一致之处在于将 GP 排除在会议之外。CCG 高级管理层有信心，新的治理结构和政策能够充分处理利益冲突，但我们发现这些安排存在局限性。虽然修订后的 NHSE 管理利益冲突的法定指导意见（2016 年）被认为优于原始指导意见（2014 年），但其中包含的各种术语和概念仍然存在一些混淆。
将初级保健共同委托的责任下放给 CCGs 造成了结构性利益冲突。NHSE 的法定指导意见应予以细化和澄清，以便 CCGs 能够妥善管理利益冲突。参与委托初级保健的委员会中非临床成员需要接受培训，以便在没有 GP 的情况下做出需要临床投入的决策。
