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How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis
  1. Valerie Moran1,
  2. Pauline Allen1,
  3. Imelda McDermott2,
  4. Kath Checkland2,
  5. Lynsey Warwick-Giles2,
  6. Oz Gore3,
  7. Donna Bramwell3,
  8. Anna Coleman2
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
  3. 3Division of Population Health, Health Services Research and Primary Care and Alliance Manchester Business School, University of Manchester, Manchester, UK
  1. Correspondence to Dr Valerie Moran; valerie.moran{at}


Objectives 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.

Design 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.

Results 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.

Conclusions 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.

  • conflicts of interest
  • clinical commissioning groups
  • primary care

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  • Contributors All of the authors met the criteria for authorship and contributed to the drafting, revision and finalisation of this paper. KC, IM and AC devised the study. VM, IM, LW-G, OG and DB collected and analysed the data for this study. VM and PA drafted the initial version of the manuscript. VM, PA, IM and KC were involved in the interpretation of results.

  • Funding This study was funded by the Department of Health via its Policy Research Programme (grant no 101/0001). The study formed part of the programme of the Policy Research Unit in Commissioning and the Healthcare System.

  • Disclaimer The views expressed here represent those of the researchers, and not the Department of Health.

  • Competing interests None declared.

  • Ethics approval The study received ethical approval from the University of Manchester’s Research Ethics Committee (ref 11104).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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