The NHS recently announced that it was planning to introduce, 'a comprehensive package of measures aimed at clamping down on conflicts of interest'. In times past, the issue only arose occasionally, such as when a grateful patient left a legacy or a considerable gift to a doctor.
Now, and particularly in the area of clinical commissioning, doctors work in a complex structure and must fulfil roles that risk generating conflicts of interest, or at least appear to do so.
This has been the subject of intermittent attention in the popular press. Although some articles don't always appear to fully grasp the way the Health Service and the commissioning arrangements are structured, they do serve as a timely reminder that doctors must be mindful of the need to consider this issue at all times.
It has been recognised that commissioning arrangements might inevitably create conflicts of interest, particularly when providers of services were also required to commission services for patients.
Regulation 6 of the National Health Service (Procurement, Patient Choice and Competition) (no. 2) Regulations 2013 places a statutory bar on the award of contracts for the provision of healthcare services where 'conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract'.
Be aware that a perception of a conflict can risk attracting criticism.
The GMC also provides specific guidance on commissioning in its guidance on 'Financial and Commercial Arrangements and Conflicts of Interest', and NHS England offers statutory guidance to clinical commissioning groups on managing conflicts of interest. CCGs, in turn, are required to provide clear guidance for their members and employers and one might constitute a conflict of interest.
The NHS England guidance states that a conflict of interests might occur when any other interest might impinge upon, or be perceived to impinge upon, that person's ability to make balanced decisions with regard to a commissioning decision.
Although all those involved in clinical commissioning would be well advised to consider those guidance documents in detail, there are some general principles which are helpful to follow.
- Be aware that a perception of a conflict can risk attracting criticism. It can also reduce the confidence of patients in those looking after them, even if no actual conflict is present.
- If there is a concern that a conflict might be present or may arise, it is appropriate to declare and manage it appropriately. Think about conflicts of interest broadly, and not simply in terms of financial matters.
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CCGs are also required to maintain a register of interests, and the public can access these documents. Therefore, when you are involved in commissioning, bear the following advice in mind.
- A conflict should be declared even when you consider that you won't be involved in a particular aspect of commissioning to which it is relevant or, indeed, that it will not affect your judgement.
- Financial interest can be both direct (where a practitioner might benefit from the award of a contract) or may be indirect - for example, where a person's partner may gain financially from the award of a contract.
- Conflicts of interest need not be financial in nature. Consider aspects such as a personal or professional relationship with others. This could be a professional colleague, a family member or a friend.
- Conflicts may arise when the practitioner has a long-standing relationship with or loyalty to a particular organisation, even when they may not benefit financially from the award of a contract.
- Make sure that you personally review your commitments and financial and other interests regularly. Consider whether any new undertaking or interest is declared appropriately in the other context in which you work.
- As well as the GMC and statutory guidance, be aware of local policies with regard to conflicts of interest published by your employer or Commissioning Board.
If you're concerned that conflicts of interest are affecting commissioning decisions, familiarise yourself with local policies on how to raise those concerns and be aware of the GMC guidance. MDU members are encouraged to contact us for individualised advice if they face such difficult circumstances.