Elizabeth Wade: Managing conflicts of interest in clinical commissioning groups
08 February 2012Managing conflicts of interest inclinical commissioning groupsElizabeth Wade - Head of Commissioning Policyand Membership, NHS Confederation
Managing conflicts of interest in clinicalcommissioning groups, Sept 2011
What are conflicts of interest and why do theymatter to CCGS?“A set of conditions in which professional judgementconcerning a primary interest (such as patient’s welfareor the validity of research) tends to be undulyinfluenced by a secondary interest (such as financialgain)”A situation in which “… one’s ability to exercisejudgement in one role is impaired by one’s obligationsin another”
What are conflicts of interest and why to theymatter to CCGs?Arguably, clinical commissioners have inbuilt conflictsof interest because (most) will be providers as well ascommissionersThe factors that should make them goodcommissioners (direct relationships with patients;involvement in local health economy etc.) may alsomean they have (or could be perceived to have) vestedinterestsThis is causing concern, but isn’t a new or uniquesituation for the NHS or for healthcare professionals
What are conflicts of interest and why to theymatter to CCGs?There is nothing inherently wrong with having a conflictof interest, and it is unlikely to be possible or desirableto completely eliminate themHowever, conflicts will need to be identified, declared,recorded and managed to ensure that they do notresult in impropriety or wrong-doingCurrently, there are no strict definitions or criteria todetermine what circumstances might be viewed ascreating ‘significant’ conflicts of interest
Types of conflicts of interestDirect or indirect financial interests e.g. an individual or a family member holding office or shares in a company that may do business with the CCGNon-financial or personal conflicts e.g. kudos, favours to friends and peers, bias toward CCG ‘electorate’Conflicts of loyalties e.g. to a professional body or society or special interest group
Types of conflicts of interestConflicts in professional duties and responsibilitiesThere are concerns that the central professional- patient relationship could be undermined if there is a perception that healthcare professionals might have financial or other incentives (or sanctions) affecting their referral and treatment decisions Does the requirement to deal with the competing needs of individual patients and whole populations create an unacceptable conflict, or is it just part of the role of a primary healthcare professional?
Managing conflicts of interestProfessional codes, standards and guidance set out expectations of individuals (Nolan principles; Good governance standard for public services; GMC guidance; etc.)Existing NHS policies and procedures (e.g. model standing orders) provide a governance framework: Identification, declaration and recording of interests Exclusion of individuals on account of relevant interestsWill these be sufficient for CCGs? If not, why not?
Managing conflicts of interestBasic principles might include: - Doing business properly - Being proactive not reactive - Assuming individuals will seek to act ethically and professionally, but, may not always be sensitive to all conflicts - Being balanced and proportionate Others?
Outstanding questions?Selection of members of governing bodiesDesign of commissioning incentivesExclusion of individuals with significant provider interestsAny Qualified Provider and Patient ChoiceOthers?