NHS England will strengthen rules for managing conflicts of interest in CCGs

BMJ 2016; 353 doi: (Published 01 April 2016) Cite this as: BMJ 2016;353:i1885
  1. Gareth Iacobucci
  1. The BMJ

NHS England will introduce tougher rules for managing conflicts of interest in clinical commissioning groups (CCGs) as part of an NHS-wide overhaul of its policies.

In a strengthening of its statutory guidance to GP led bodies, NHS England will require all CCGs to nominate a conflicts of interest guardian to ensure “firmer and more consistent” decision making.

The changes, announced after a recent joint investigation by The BMJ and the Times newspaper,1 which found significant variation in the management of conflicts and the levels of transparency, will also advise CCGs to increase lay member numbers on their governing body from two to a minimum of three to provide extra scrutiny for decisions involving potentially conflicted board members.

All commissioning groups will be required to publish registers of gifts and hospitality that members have received and produce annual audits demonstrating how they have managed conflicts of interest.

The revised guidance adds that CCGs should also consider asking board members with “profound and acute” conflicts of interest to step down from one of their roles. It said that this could include conflicts such as secondary employment or involvement with an organisation that benefits financially from contracts awarded by a commissioning group.

The new measures and revised statutory guidance were outlined in NHS England’s board papers on 31 March,2 and they will be introduced later this year subject to consultation. The plans have been tabled in response to growing concerns about how conflicts of interest are identified and managed in CCGs and across the NHS.

The House of Commons Public Accounts Committee recently joined the National Audit Office in calling for greater scrutiny and assurance of conflicts of interest from NHS England in light of The BMJ’s and the Times’ investigation findings.

NHS England said that the strengthening of its policies would bring “a stronger, more consistent approach” to managing conflicts of interest, to give patients and the public “full confidence” in how NHS funds are spent. The organisation said that the proposals would move the NHS in line with “sunshine” rules that exist in other countries, such as the United States.

Alongside the new guidance for CCGs, NHS England will establish a new system-wide group led by its chair, Malcolm Grant, to develop a uniform set of rules for managing conflicts of interest across the NHS. This will include examining new proposals to ensure that hospitals, clinicians, and procurement staff are free from “unmanaged” conflicts of interest, particularly with regard to drugs and devices paid for by the NHS.

A consultation will also be launched regarding inserting a new requirement in the 2016-17 NHS standard contract that would require NHS providers to maintain and publish a register of gifts, hospitality, and conflicts of interest, to ensure greater transparency.

NHS England has pledged to strengthen its own internal conflict of interest policy to include more stringent safeguards on the role of interest groups, lobbyists, and commercial organisations in specialised commissioning.

Simon Stevens, NHS England’s chief executive, said, “In a tax funded health system, the public rightly demand high standards of probity from both NHS staff and healthcare suppliers. Recent cases in the UK, and indeed worldwide, have underscored the need for action.

“‘Sunshine’ rules to bring greater transparency, tougher restrictions on conflicts of interest, and clearer guidelines on industry partnerships and influence will benefit patients and protect taxpayers.”


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