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Developing a federated model of General Practice: Conflict of interest

"Some men have thousands of reasons why they cannot do what they want to, when all they need is one reason why they can." Willis R. Whitney 

Having reflected on our attendance at the Best Practice Conference last week, the team at BW Medical Accountants all agreed the number one question we had from delegates was linked to the identification and then management of conflict of interest, which is
clearly causing barriers to progress of federations to emerge.

Following Best Practice, we participated in an excellent workshop with our colleagues Alison Oliver and Sarah Podesta from Ward Hadaway Law Firm, where they kindly provided two definitions which explain what a conflict of interest actually is, and a proper insight in to how to manage actual and perceived conflicts: 

» Set of conditions in which professional judgement concerning a primary interest (such as patients’ welfare) tends to be unduly influenced by a secondary interest (such as financial gain) D F Thompson – Understanding Financial Conflict of Interest – New England Journal of Medicine 1993

» A situation in which one’s ability to exercise judgement in one role is impaired by one’s obligation in another – Roll Back Malaria Partnership, Conflict of Interest Policy and Procedure, WHO

When might a conflict of interest arise? Put simply, when you are involved in decision makingwhere any of the following apply and you have a:

» Direct financial interest
» Indirect financial Interest
» Personal interest
» Conflict of loyalties
» Conflict of professional duties

This doesn’t though mean everything grinds to a halt.  The goal of a strong policy to manage conflict of interest should be to allow the business of the organisation to safely proceed.

For CCGs, they will all have a policy embedded within the constitution, which should ensure a register of members’ interests is available for inspection at all times.

Additionally, the Accountable Officer should ensure that every interest declared and there are arrangements to manage any conflicts, with all decisions and reasons for decision documented and available for scrutiny.

Conflicted individuals should be excluded from relevant parts of meetings; however, if this was to leave insufficient un-conflicted individuals the CCG must have a policy for this, which should provide the ability for a different committee/sub-committee or ad hoc group to take decision.  This for example could include members from another CCG or Health and Wellbeing Board.  If that isn’t enough the Governing Body can seek additional scrutiny of decisions through its own audit committee or external individuals.  Therefore there really is no situation that cannot be safely managed.

The aim of a process to manage conflict of interest is not to prevent anyone from having any private interests, but rather to protect the integrity of the CCG, its members and administrative decisions generally.  The CCG should want to promote a culture where conflict of interest is properly identified, managed and resolved in an appropriate, transparent and timely way.  Unfortunately though, what we are finding is the conflict of interest issue being used as a weapon to stifle or prevent legitimate debate. 

The key point to make is that conflict of interest applies where people are involved in making commissioning decisions that they as providers would benefit from – this simply cannot happen.  Included within that is the development of service specifications, where providers should have no input, as clearly they gain significant advantage over other providers not included in the development and that is likely to have serious repercussions. 

Both scenarios need managed, and both can safely be managed through a sensible policy and a complete understanding of how to manage conflict of interest. The fact many GPs and Practice Managers will be involved in Provider Organisations and CCG Meetings is in itself not a conflict; only where they are involved in decision making does the potential for conflict of interest arise.

A sense of proportionality is required above all else.

“Many more things would be possible if you didn’t think of them as impossible”
Darren Hardy

Next time we will explore the early sub committees you might want to consider putting in place.

In the meantime, for more information on how BW Medical Accountants can support you in forming a federation, or to arrange to speak to one of our experts please contact or call 0191 653 1022. Additionally, if you should have questions for us please email and we will do our best to answer these within our blog.

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