Intended for healthcare professionals


Doctors and politicians call for tighter rules on commissioners’ conflicts of interest, after BMJ investigation

BMJ 2013; 346 doi: (Published 19 March 2013) Cite this as: BMJ 2013;346:f1810
  1. Gareth Iacobucci
  1. 1BMJ

The UK Labour party has called for new rules to bar GPs from taking part in any commissioning decision in which they could be perceived to have a financial interest, in response to the BMJ investigation last week,1 which found widespread conflicts in new clinical commissioning groups.

The BMJ analysis, which found that more than a third of GPs on the governing bodies of new groups had financial interests in private providers through shares or directorships, sparked a political debate about the effects of the government’s reorganisation of the health service.

Labour’s shadow health secretary, Andy Burnham, said that the findings showed there was a “real risk” that the doctor-patient relationship would be “corroded,” and he urged the government to tighten the rules.

The BMA and the Royal College of General Practitioners also called for tougher measures to manage and scrutinise conflicts in light of the investigation.

Burnham said, “Patients and the public want those entrusted with making decisions about the NHS to have its best interests at heart. They will be shocked to learn that so many have a potential conflict of interest.

“Labour has consistently warned David Cameron that his NHS Act enshrines a huge conflict of interest at the heart of the NHS. He refused to listen and now there is a real risk that the doctor-patient relationship will be corroded and public trust in the NHS lost.

“At the very least, to uphold public trust, ministers must bring in new rules to ensure that no GP takes part in any decision in which they could be perceived to have a financial interest.”

The matter was raised in parliament by the Labour MP Andy Slaughter, who made reference to the BMJ investigation.2

Commenting on the investigation, Laurence Buckman, chairman of the BMA’s General Practitioners Committee, said, “In our view, GPs who are directors of, or who have significant financial interests in, companies who might be awarded contracts to provide services should seriously consider their membership of CCG [clinical commissioning group] governing bodies. Alternatively, they should consider their position within provider companies.

“We support the principle of greater clinician involvement in commissioning, but it must not come at the expense of the trust of patients. Measures to prevent conflicts of interest will improve confidence that decisions are being made to benefit patients.”

Clare Gerada, chairwoman of the Royal College of General Practitioners, said that GPs were “fully aware of [their] responsibilities in declaring any conflicts of interest” and said that the profession would have to establish quickly “how we operate fairly, ethically, and effectively” in the new system.

She added: “Members of clinical commissioning groups should be expected to disclose information about conflicts of interest and to exclude themselves from decision making where a conflict of interest exists. But there should be prompts and checks to reinforce this and rules to ensure that decision making is efficient, transparent, and fair, without being overly complex or slow.

“Clinically led commissioning on this scale is uncharted territory, and GPs are being presented with a tremendous range of new challenges. If conflicts of interest in clinical commissioning groups are not managed effectively, the consequences could badly undermine the confidence of regulators, providers, and, most importantly, patients, in the system.”

A spokesman for the NHS Commissioning Board said, “Clinical commissioning groups (CCGs) are under clear duties to ensure that they manage any potential conflicts of interest in ways that preserve the integrity of their decision making processes. This is why it is so vital that everyone working for a CCG or serving on its governing body declares any interests they have.

“This allows the CCG to put arrangements in place to ensure that those individuals are not involved in any decisions that would give rise to a conflict. The NHS Commissioning Board will shortly be publishing its statutory guidance on managing conflicts of interest, building on the ‘code of conduct’ published last year.”


Cite this as: BMJ 2013;346:f1810


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