Potential conflicts of interest between the commissioner and provider roles of GPs have been clear from the start of the government’s plans to axe PCTs and replace them with clinical commissioning groups (CCGs).

There’s no shortage of guidance for CCGs but hard and fast rules from the coalition government have been thin on the ground, perhaps unsurprisingly given natural Conservative opposition to unnecessary red tape.

The Co-operation and Competition Panel last month ruled that: ‘The involvement of NHS Peterborough of two clinicians in lead, influential roles, in a service reconfiguration consultation process was not appropriate in circumstances where those clinicians were associated with providers that would be directly affected by and might gain from the process.’

But as was discussed at a Nuffield Trust event operating under Chatham House rules I attended this morning, isn’t the whole point of the Health Bill that because of their inside knowledge GPs are best placed to be involved with such decisions?

The Nuffield Trust debate did contain some tips for GPs and CCGs about how they might operate most effectively in such an uncertain world.

* You may have involved yourself with the CCG to help its development but withdraw from it if you want to be free to criticise it and from conflicts of interest accusations.

* If you remain, aim not to minimise conflict of interest risks but for excellent commissioning. Be open and honest. Involve patients and the local press in the decision-making process.

* Refer decisions to an independent CCG sub-committee. CCGs would still be responsible for the decisions they take but basing them on the recommendations of a sub-committee would ease conflict of interest fears.

* Think big. CCGs which represent larger populations are far less likely to find themselves accused of conflicts of interests purely because the pool of GPs able to be involved in decision-making is so much larger.

It was a fascinating debate which included the fear that CCGs might tender services as a knee-jerk reaction to avoid conflict of interest accusations. This might be a consequence of reform but surely not something the government would intend, given the cost and time involved?

Another tricky question posed was when is it acceptable not to tender? What should CCGs do if they would prefer to try to improve their existing primary care population without the disruption that competitive tendering causes?

GP’s Commissioning section has covered the  conflict of interest guidance available but look out in the next few weeks for an article looking at the possible pitfalls, exactly what happened in Peterborough and its ramifications.