Best Practice Update on Conflicts of Interest Management

Best Practice Update on Conflicts of Interest Management: Call to Action for CCGs
NHS England 21 February 2019

• A practical toolkit, including templates and case studies to support CCGs with conflicts of interest management.

Conflicts of interest indicator: submission process for CCGs

Conflicts of interest indicator: submission process for CCGs
NHS England 13 February 2018

• This document provides further information on the conflicts of interest indicator in the CCG Improvement and Assessment Framework, and the process for completing and returning the self-certification submissions, including updated templates.

Managing conflicts of interest: revised statutory guidance for CCGs

Managing conflicts of interest: revised statutory guidance for CCGs
NHS England 16 June 2017

• A practical toolkit, which includes templates and case studies to support CCGs with conflicts of interest management.
• A number of minor amendments have been made to ensure it is fully aligned with “Managing Conflicts of Interest in the NHS“, which was published in February 2017.
• See Conflicts of interest management for the latest documents

Managing conflicts of interest: CCG case studies

Managing conflicts of interest: CCG case studies
NHS England 16 June 2017

• Conflict of interest case studies intended to raise awareness of the different types of conflicts of interest that could arise in CCGs and to support CCGs to robustly and effectively identify and manage them.
• See Conflicts of interest management for the latest documents

NHS England Board meeting, 9 February 2017

NHS England Board meeting, 9 February 2017

Highlights for Arden & GEM CSU by Anne Gray, Knowledge Officer, Arden & GEM CSU

Video available here.

Agenda

Item 2 – the minutes of the meeting held on 15 December
Item 3 – Chairman’s Report (no supporting papers)
Item 4 – Chief Executive’s Report (no supporting papers)
Item 5 – Conflicts of interest in the NHS
Item 6 – NHS Rightcare and the shift to value-based healthcare
Item 7 – NHS England Corporate and NHS Performance Report
Item 8 – Consolidated Month 9 2016/17 Financial Report
Item 9i – Report from the Commissioning Committee
Item 9ii – Report from the Investment Committee
Item 9iii – Report from the ARAC

Highlights :


4: Chief Executive's report

• Simon Stephens reinforced the following points:
• It not permissible for a GP practice to charge NHS patients for appointments.
• CCGs cannot change the national contrac relating to QOF.
• The Five year Forward View delivery plan for 2018/19 - 2019/20 will be published at the end of March. It is not a bidding paper but an examination of realistic deliverables to 2020.
• "STPs are here to stay" The delivery plan will include 
• the formal appointment process for STP leads
• STPs will take resources from across the system to beef up its process
• decision rights to facilitate reconfiguration changes to statutory organisations to support its work

Managing Conflict of Interest updated guidance

Managing Conflicts of Interest in the NHS: Guidance for staff and organisations

NHS England, 7 February 2017

• This updated guidance is applicable to CCGs, NHS Trusts, NHS FTs and NHS England and is recommended to those under contract to the NHS.
• A suite of tools and supporting materials are under development. (see https://www.england.nhs.uk/ourwork/coi/ )
• This guidance comes into force 1 June 2017
• The principles of this guidance will be included in a revised version of the statutory guidance for CCGs. Until this guidance comes into force existing guidance issued under these powers continues to apply, and is accessible at: https://www.england.nhs.uk/commissioning/pc-co-comms/coi/
• The Guidance was first published in a paper to NHS England Board meeting on 9 February 2017, which also includes a report of the consultation leading to the revised guidance.

Consultation on Managing Conflicts of Interest in the NHS

Managing Conflicts of Interest in the NHS: A Consultation
NHS England 19 September 2016

• Proposals for change to the way in which conflicts of interest in health are managed to support the increasing collaboration and partnership working between public, private and third sector bodies.
• The consultation period is open from Monday 19 September 2016 to Monday 31 October 2016.

Conflicts of interest management - Revised statutory guidance

Conflicts of interest management: Revised statutory guidance for CCGs
NHS England 28 June 2016

• NHS England has published revised statutory guidance on managing conflicts of interest for CCGs following a public consultation. 
• A series of conflicts of interest case studies, templates and short, role-specific summary guides are also available.
• Mandatory online conflicts of interest training is under development and should be ready in autumn 2016.
• Mills and Reeve have highlighted seven key changes to the latest guidance 
• CCGs are to have a minimum of three lay members on the governing body. 
• New role for conflicts of interest guardian in CCGs. 
• CCGs need to adopt a robust process for managing breaches within their conflict of interest policy and there is a requirement for CCGs to publish anonymised details of the breach on the CCG’s website for learning purposes. 
• Tighter provisions around decision-making when a member of the governing body, or committee or sub-committee is conflicted. 
• Strengthened provisions around the management of gifts and hospitality including a publicly accessible register of gifts and hospitality. 
• CCGs need to include an annual audit of conflicts of interest management and to include the findings within their annual end of year governance statement. 
• All CCG staff including practice staff, committee members, governing body need to complete NHS England’s mandatory online conflicts of interest training which will be supplemented by training sessions for CCG leads in key decision-making roles. 

NHS England Board meeting 26 May 2016

NHS England Board meeting, 26 May 2016
Highlights by Anne Gray, Knowledge Officer, Arden & GEM CSU

Papers available here.  Video available here. Minutes available here.

Agenda
Item 1: Board meeting agenda
Item 2: Minutes of meeting held on 31 March 2016
Item 3: Chief Executive’s Report
Item 4: Sustainability and Transformation Plans – progress report
Item 5: Strategic Framework
Item 6: NHS England Corporate and NHS Performance report
Item 7: NHS England Finance Report
Item 8: NHS England Governance Manual Approval
Item 9: NHS England Complaints Policy Update
Item 10:Conflicts of Interest summary report
Item 11: Update on NHS Diabetes Prevention programme
Item 12 Healthy Workforce
Item 13a Audit and Risk assurance Committee - verbal
Item 13b Commissioning Committee Update
Item 13c Specialised Services Commissioning Committee Update
Item 13d Investment Committee Update

Health Select Committee report on Primary Care

Primary Care 

House of Commons Health Select Committee 21 April 2016

• This report analyses the challenges facing primary care and examines the long-term solutions which can improve access to services and patient care. 
• Conclusions and recommendations
• Utilising information technology
• Variable quality
• Improving the patient experience
• Multi-disciplinary teams
• The role of federations
• Guarding against conflicts of interest
• Workforce planning
• Selection of undergraduates
• Tackling local shortages
• Nursing
• Training and education
• Workforce and federations
• Regulation
• GP leadership
• Changing incentives in the system
• Investing in primary care
• Future funding

Recommendations directly affecting CCGs:

Revised Conflict of Interest Standards for CCGs

Managing Conflicts of Interest
NHS England Board meeting paper 31 March 2016

• Revised guidance for CCGs on managing conflicts of interest based on the statutory guidance developed to support the delegation of primary care commissioning to CCGs.
• An audit of conflicts of interest management in ten co-commissioning arrangements was undertaken in 2015/16 (see Annex for a summary of the audit findings)
• From April 2016 NHS England will be consulting on revised statutory guidance to CCGs 
• Core proposals (subject to consultation) are:
• All CCGs have a minimum of three lay members on the Governing Body,
• A conflicts of interest guardian in all CCGs to be undertaken by CCG audit chairs 
• All CCGs will include an annual audit of conflicts of interest management within their internal audit plans and to publish the audit findings within their annual endof-year governance statement
• Strengthen the provisions around the management of gifts and hospitality. 
• Strengthen the provisions around decision-making when a member of the group is conflicted.
• CCGs will be required to have a robust process for managing breaches within their conflict of interest policy and to publish any breaches on the CCG’s website
• All CCG staff and the staff of their member practices are to complete mandatory online conflicts of interest training, which will be provided by NHS England. 
• Final guidance will be taken to NHS England Board meeting in May 2016 with a view to publishing it in early June 2016. CCGs will be required to review their processes in line with the guidance and strengthen them, where required, by the end of November 2016 
• Rationalising medicines optimisation arrangements (para 28)
• To support the work around Managing Conflicts of interest around medicines across NHS England four regional medicines optimisation committees will be created and medicines evaluation will be shared across the NHS.
• “local medicines formulary committees will be far less involved in processes that the pharmaceutical industry may seek to influence. It also reduces the wasteful multiple requests for the same information being made by the NHS by the pharma sector”. 
• It is expected these principles will be in place by April and the committees operational later in the year.

NHS England Board meeting, 31 March 2016 - Highlights

NHS England Board meeting, 31 March 2016

Highlights by Anne Gray, Knowledge Officer Arden & GEM CSU

Video will be available here: https://www.youtube.com/playlist?list=PL6IQwMACXkj0U7BzZm4AxeykK5OgnS2sl

Agenda

• Item 1: Board meeting agenda
• Item 2: Minutes of meeting held on 25 February 2016
• Item 3: Chief Executive’s Report
• Item 4: NHS England business plan 2016-17
• Item 5: Transforming Maternity Services – implementing the national maternity review
• Item 6: NHS England Corporate and NHS Performance report 
• Item 7: NHS England Finance Report
• Item 8: [Greater Manchester Health and Social Care Devolution] The Journey So far (paper from Sir Howard Bernstein)
• Item 8b: Greater Manchester Health and Social Care Devolution [Internal Delegation arrangements]
• Item 9: Managing Conflicts of Interest 
• Item 10: Delegation of Primary Medical Services Functions
• Item 11: Emergency Preparedness Resilience and Response
• Item 12a: Commissioning Committee Report to the Board
• Item 12b: Investment Committee Report to Board
• Item 12c: ARAC Report to the Board

Highlights

Managing conflicts of interest

Managing conflicts of interest in NHS CCGs

National Audit Office 11 September 2015

• Findings from an investigation into managing conflicts of interest in NHS CCGs.
• The key findings:
• Some 1,300 (41%) of CCG governing body members in position at the time of our analysis in 2014-15 were also GPs, who may, potentially, have made decisions about local health services and have been paid by their CCG for providing them
• The Department recognised the potential for conflicts of interest in the NHS commissioning system and took a proportionate response to managing such conflicts, including by assigning formal roles to relevant bodies
• Almost all CCGs had put in place most key elements of the legislative requirements which help them to prevent and manage conflicts
• During 2014-15, a minority of CCGs had reported they had to manage actual or perceived conflicts of interest. 
• Where CCGs reported information about their controls for managing risks of conflicts of interest, it showed the adequacy of those controls had varied
• NHS England has so far collected little data on how effectively CCGs are managing conflicts of interest or whether they are complying with requirements. It relies instead on an exception-based approach, and on Monitor as the system regulator
• Up to June 2015, Monitor had received relatively few concerns about conflicts of interest; only one of its formal investigations included a concern about conflicts of interest in a CCG
• From April 2015, CCGs can choose to co-commission primary care services from GPs which is likely to increase significantly the number and scale of conflicts of interest. The Department and NHS England recognise the risk and have responded, including issuing statutory guidance and providing training and support to CCGs.

Risks to CCGs in the transition to co-commissioning

Risk or reward? The changing role of CCGs in general practice
Kings Fund, Nuffield Trust, 25 January 2015

• A report which considers how CCGs are functioning as membership organisations and how they are supporting the development of primary care in their local area has concluded that CCGs risk becoming unsustainable without changes to the way they attract leaders and adequate funding to help them expand their remit.
• The research included a survey, interviews, observations and reviews of CCG board papers.
• The report authors found that:
• CCG leaders questioned whether they had sufficient capacity to expand into primary care commissioning. 
• While the majority of CCG leaders felt that conflicts of interest were being managed adequately, researchers highlighted examples of decisions where there was the potential for conflict. 
• Few GPs felt that managing GP performance – something that contract management responsibilities under co-commissioning may lead to – was an appropriate role for CCGs. 
• The study outlines a number of key recommendations to CCG leaders and NHS England to assist CCGs in making the transition to co-commissioning and ensure the sustainability of CCGs.

Managing conflicts of interest - guidance for CCGs

Managing conflicts of interest: statutory guidance for CCGs
NHS England 18 December 2014

• This statutory guidance sets out how CCGs should manage conflicts of interest. 
• It contains specific provisions in relation to co-commissioning primary care services but the guidance is relevant to CCG responsibilites generally.
• Update of March 2013 guidance

Managing conflicts of interests

How conflicts of interest in CCGs will be regulated
HSJ, 10 April 2013

• David Reissner  (partner and head of healthcare at Charles Russell LL) considers how the commercial interests of GPs can be reconciled with the role of clinical commissioning groups so the integrity of their decision making is not compromised.