1. 08 February 2012
Managing conflicts of interest in
clinical commissioning groups
Elizabeth Wade - Head of Commissioning Policy
and Membership, NHS Confederation

2. Managing conflicts of interest in clinical
commissioning groups, Sept 2011

3. What are conflicts of interest and why do they
matter to CCGS?
“A set of conditions in which professional judgement
concerning a primary interest (such as patient’s welfare
or the validity of research) tends to be unduly
influenced by a secondary interest (such as financial
gain)”
A situation in which “… one’s ability to exercise
judgement in one role is impaired by one’s obligations
in another”

4. What are conflicts of interest and why to they
matter to CCGs?
Arguably, clinical commissioners have inbuilt conflicts
of interest because (most) will be providers as well as
commissioners
The factors that should make them good
commissioners (direct relationships with patients;
involvement in local health economy etc.) may also
mean they have (or could be perceived to have) vested
interests
This is causing concern, but isn’t a new or unique
situation for the NHS or for healthcare professionals

5. What are conflicts of interest and why to they
matter to CCGs?
There is nothing inherently wrong with having a conflict
of interest, and it is unlikely to be possible or desirable
to completely eliminate them
However, conflicts will need to be identified, declared,
recorded and managed to ensure that they do not
result in impropriety or wrong-doing
Currently, there are no strict definitions or criteria to
determine what circumstances might be viewed as
creating ‘significant’ conflicts of interest

6. Types of conflicts of interest
Direct 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 CCG
Non-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

7. Types of conflicts of interest
Conflicts in professional duties and responsibilities
There 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?

8. Managing conflicts of interest
Professional 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
interests
Will these be sufficient for CCGs? If not, why not?

9. Managing conflicts of interest
Basic 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?

10. Outstanding questions?
Selection of members of governing bodies
Design of commissioning incentives
Exclusion of individuals with significant provider
interests
Any Qualified Provider and Patient Choice
Others?