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RCGP sets out strict ethical standards for commissioners to avoid ‘MPs expenses-style’ scandals

The RCGP and NHS Confederation have urged GPs to declare all potential conflicts of interest before they join commissioning groups, in new joint guidance to reduce the risk of ‘reputational damage’.

The RCGP and the NHS Confederation said GPs face a substantial risk from their dual roles as providers and commissioners, and that a failure to manage conflicts effectively could have serious consequences and badly undermine the confidence of ‘regulators, providers, and patients’ in the NHS. 

A recent investigation by Pulse and the Bureau of Investigative Journalism revealed at least half the board members of some CCGs have links with private healthcare company Assura, while many others have interests in other private providers.

But the new document, ‘Managing Conflicts of Interest in Clinical Commissioning Groups’, which follows previous guidance from the BMA on managing conflicts of interests, says early intervention, good planning and governance can be effective tools in mitigating risks.

The guidance categorises the four key types of conflict of interest facing CCGs, as direct financial interest, indirect financial interest, non-financial or personal interests and conflicts of loyalty.

It outlines a series of principles to help CCGs avoid and manage conflicts, including having transparent needs assessments, consultation mechanisms, commissioning strategies and procurement procedures in place from the outset, to enable them to identify, avoid and address issues more easily.

It recommends proactively identifying actual or possible potential conflicts of interest before individuals are selected to join CCGs, and excluding individuals if these conflicts are too great. It says this could be achieved my asking prospective board members to include a statement within their application/manifesto prior to election declaring all possible conflicts of interest.

It advises groups to ‘establish and maintain registers of interests, and agree in advance how different situations would be handled, rather than waiting until they arise’.  

The guidance suggests CCG members should be expected to volunteer information about conflicts of interest and exclude themselves from decision making where they exist, but adds that there should be ‘prompts and checks’ to reinforce this in cases where they display ‘ a lack of awareness’.

But it also advises that rules to manage conflicts should be ‘balanced and proportionate’, protecting and empowering people by ensuring that decision making is efficient, transparent and fair, but also without constraining people by being ‘overly complex or slow’.

RCGP Chair, 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.

‘For all GPs, maintaining the highest ethical standards in all their activities is fundamental.’

Dr Dennis Cox, RCGP council member and clinical commissioning champion, said: ‘There is a chance of a lot of reputational damage if we get this wrong. We don’t want to go down the MPs expenses route.’

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.

‘While some conflicts of interest are inevitable, in most cases it is possible to address them by ensuring that they are identified and managed in the right way. No one wants confidence in their healthcare professionals undermined. That’s why tackling the issue head on now, and providing clarity for clinical commissioners about what are unacceptable conflicts of interest, will help minimise the impact.’

Click here to download the RCGP document from