Conflicts of interest threaten patient trust, say RCGP and NHS Confederation

Conflicts of interested threaten to destabilise public confidence in clinical commissioning, the RCGP and NHS Confederation has warned.

Dr Clare Gerada: 'I hope this publication will prove invaluable in helping them recognise and address potential conflicts of interest.'
Dr Clare Gerada: 'I hope this publication will prove invaluable in helping them recognise and address potential conflicts of interest.'

The RCGP and NHS Confederation have issued joint guidance to clinical commissioning groups (CCGs) on 'real and perceived' conflicts of interest.

The guidance, Managing conflicts of interest in clinical commissioning groups, warned that conflicts of interest could undermine regulators’ confidence in the fairness of commissioners’ decisions, weaken patient confidence and, ultimately, ‘destabilise public confidence in the system as a whole’.

RCGP chairwoman Dr Clare Gerada said: 'GPs are facing a tremendous range of new challenges with clinically-led commissioning and I hope this publication will prove invaluable in helping them recognise and address potential conflicts of interest.'

The document includes a number of recommendations to help CCGs avoid and manage conflicts of interest.

These include; identifying potential conflicts of interest before individuals were selected to join CCGs, and agreeing in advance how different situations would be handled if a conflict of interest arose.

The guidance also advises putting additional prompts and checks in place to ensure no conflicts existed on the CCG board.

Although CCGs will be able to adopt methods currently used by PCTs to manage conflicts of interest, under the new commissioning arrangements, handling conflicts of interest could become ‘more complex’, the guidance said.

It warned that failure to acknowledge and address potential conflicts of interest could result in 'poor decision making, legal challenge and reputational damage'.

Problems may arise as there are currently no strict definitions or criteria to determine what situations or circumstances might be viewed as creating significant conflicts of interest for GPs and other clinical commissioners, the guidance says.

In some instances it could be very clear that a conflict of interest might arise, for example if the member of CCG board is also a major shareholder in a provider company.

However some conflicts of interest may be less easy to identify, the guidance says.

The guidance therefore recommended the ‘Paxman test’ to identify conflicts of interest.

‘One simple check for identifying possible conflicts of interest could be described as 'the Paxman test' – if you might be embarrassed if asked to explain a situation to an investigative journalist or reporter, a conflict of interest probably exists.’

Because many of the conflict scenarios that professionals and managers in CCGs will face are similar in nature to those that arise for other NHS bodies they will often be able to follow existing NHS guidance and policies, the guidance says.

It is still not completely clear, however how CCGs will be monitored and assessed, the guidance says.

Despite there being potential for conflicts of interest to arise within CCGs, they will rarely be so great that the individual can no longer function as a commissioner, the guidance says.

‘Concerns about this issue are understandable, however, and the risks of getting it wrong are great for individual healthcare professionals and CCGs, and for the new commissioning model as a whole,’ the guidance says.

Mike Farrar, chief executive of the NHS Confederation, said: 'There have been considerable concerns raised by MPs and professional bodies alike about this issue since the Health Bill was introduced and commissioning pathfinders were established.

'It’s a fundamental issue for CCGs to get to grips with, but there are some simple ways to manage it. It is important that people have the information and guidance they need to deal with these tricky issues.'

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