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Getting your head around governance

Getting your head around governance

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Life as a director on the board of a commissioning
GP consortia is set to present new challenges over the coming
months. Emerging GP consortia will need to get to grips with
the concepts of governance, accountability and liability.

Partners of practices, although jointly and severally
liable for the actions of their fellow partners from a legal
perspective, are effectively shielded from major financial
risk by virtue of the contracts and financial arrangements
they have with NHS commissioners. However, GPs who are
directors of commissioning consortia boards may find that
they are retaining risks as commissioners through the contracts those consortia have with providers. They might also acquire unexpected liability for the actions of practices (possibly their own) that contract with the consortia.

GPs need to understand their status may differ depending
on the board or committee they serve, and that being a
member of a commissioning consortia board will require a
different mindset. As a director of a statutory organisation,
their legal responsibility will be to promote the interests of the
consortium itself, and not the practice they come from, or the
cluster that may have elected them. This tricky distinction has
caught out directors in the past, and it would be all too easy
for GPs to carry across a pattern of behaviour that was right for one organisation but wholly inappropriate for another.

Interim arrangements, designed to prepare for the
transition to formal commissioning responsibilities in 2012,
also present challenges. PCTs may create subcommittees
and invite GPs to serve on them. GPs need to be alert to
the personal responsibilities they acquire by doing so, and
understand the protection (if any) they will have. PCTs will
also need to understand and manage their ongoing statutory
accountability during this stage.

In order to have a registered patient list, practices must
be members of consortia, while in order to provide a full
range of services, consortia will need to contract with GP
practices and others for services. They may have to police
practices for compliance with national frameworks and
locally agreed pathways or other protocols. In some cases,
consortia may need to apply sanctions, or even (in theory)
expel practices.

All these elements provide plenty of scope for conflicts of
interest to arise, and possibly with a frequency that may make
it impractical for individuals concerned to “step out of the
room”. Governance arrangements will have to allow interests
to be identified and declared so GPs can continue
to participate appropriately in discussions and service
provision, whilst providing an audit trail to show that no
improper considerations have influenced either contractual
or referral decisions. As such, GPs need to start thinking
now about conflict of interest so that they can identify issues
before they arrive, and be alert to the circumstances that may
give rise to them.

Finally, governance structures, mechanisms and processes
must avoid consortia being immobilised by inertia, support
safe and effective management, and allow the organisation
to adapt and react quickly to what will inevitably be very
fast-changing circumstances in the future. The management
structure must provide for a clear accountability framework
in which everything is someone’s responsibility and everyone
knows what they are responsible for, as well as the authority
they have. As for governance, any committee must be justified
by specifying how it supports its parent body to fulfil its
responsibilities, including providing assurance. Terms of
reference must be crystal clear.

Ray Tarling
Senior Advisor
Beachcroft LLP

Anne Crofts
Partner
Beachcroft LLP

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