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.