NHS England takes next step on tackling conflicts of interest

NHS England is launching a major consultation on proposals to strengthen the management of conflicts of interest, clamp down on inappropriate behaviour and ensure that the NHS is one of the leading healthcare organisations in the world in tackling these issues.

The six-week consultation is an opportunity for all interested parties to make their voices heard about these proposals which cover gifts, hospitality, employment, sponsorship and other interests.

In March this year, NHS England set up a group to look into developing a stronger approach to managing conflicts of interest, both real and perceived. Drawing on expertise from a wide range of organisations, the group is led by Sir Malcolm Grant, Chair of NHS England and includes representatives from the British Medical Journal, NICE, the Care Quality Commission, the Local Government Association and the Association of the British Pharmaceutical Industry.

The group has investigated best practice in health, other sectors and internationally and is now proposing measures to strengthen conflict of interest identification and management. These proposals include:

  • setting out what is and is not acceptable in relation to individual types of interest such as the need to seek prior approval from the employing NHS organisation for any outside employment
  • the processes by which interests should be identified and conflicts of interest managed appropriately, for example ensuring all senior staff complete an annual declaration of interest
  • information which NHS organisations must publish in relation to the interests of their staff
  • ensuring that staff and others understand what constitutes both interests and conflicts of interest as well as the circumstances in which they can occur
  • the processes which organisations should have in place to ensure they appropriately manage any breaches of conflicts of interest policy.

Following the consultation, NHS bodies will work together to finalise the guidance and ensure effective implementation of the plans.

Sir Malcolm Grant said: “The public expect the highest standards of behaviour in the NHS, but we know there are times when the NHS has failed to meet this expectation.

“We have a responsibility to use the £110bn healthcare budget provided by the taxpayer to the best effect possible for patients, with integrity, and free from undue influence. Spending decisions in healthcare should never be influenced by thoughts of private gain.

“We want to hear from as wide a range of people and organisations as possible so they can help us bring greater transparency, and clearer guidelines for staff in a way that will benefit taxpayers, patients and the health service.”

Miss Clare Marx, President of the Royal College of Surgeons, said: “Clear guidance for NHS staff on managing any potential conflicts of interest is long overdue. The NHS is a complex organisation in which conflicts of interest may arise, and they must be handled with openness, transparency and consistency to ensure all staff work in the best interests of patients.

“For surgeons, our own guidance – Good Surgical Practice – is explicit that surgeons must demonstrate probity in all aspects of their professional practice, which includes declaring any commercial involvement, or work outside of the NHS. Patients rightly have a huge amount of trust in the medical profession and this guidance will help doctors to think about any potential conflicts of interest and help them to act appropriately at all times.”


  1. NHS England says:

    Many thanks for all of the comments given regarding this work, the consultation on which closed on 31 October 2016.

    We are analysing the responses and will publish further information about next steps shortly. You can keep up to date with developments on our Conflict of Interest Task and Finish Group page.

    Kind Regards
    NHS England

  2. Alistair Blair says:

    A key potential conflict of interest is waiting list initiative payments in secondary care. These can be substantial and are more pertinent than outside or private earnings done in a consultants own time. Clearly many initiatives are needed to maintain 18 weeks, but this is work above and beyond contracted hours and the public could say that waiting lists are to a degree, controlled by the clinicians.

  3. Dr Francis Matthey says:

    I have no problem with the need to resolve conflicts of interest. I can see why stating the private earnings made on an NHS site would be logical in the context of working their agreed job plan but I cannot see why consultants should declare their earnings outside of this. If I choose to work in my free time seeing private patients I do not see how the requirement to declare my earnings in this activity addresses conflict of interest issues. If a private hospital was required to release this information without my agreement then it is probably a breach of data protection. What earnings from non medical activities have to be declared as well? This proposal aims to de-professionalise medicine and it may lead to some consultants ceasing all NHS activity altogether, which would affect both the clinical service and junior doctor training also. Will all NHS staff, including non-medical, be required to publicly declare their earnings or is this only to be targeted at senior clinicians?

  4. Dr Umesh Prabhu says:

    In NHS we got to tackle conflict of interest. So far all regulation is focused on clinical staff (Trust disciplinary action, GMC, NMC and so on) and Organisational (CQC, Monitor, College visits and so on) but no accountability for NHS Trust Board leaders and managers. Until today, as far as I am aware no Trust Board leaders have been held to account. They move from one Trust to another.

    With 110 Billion public money available it is important to make sure there is proper accountability for everyone. The culture of bullying, racism, discrimination, victimisation are all common in our NHS and it puts patients and staff at risk and lots of cover up goes on in our NHS

    Hope this document holds everyone to account. Sad reality in our NHS is BME staff are more severely disciplined and disproportionately disciplined due to subconscious bias and in some cases blatant racism. No leader has been held to account for bullying. Hope this document goes long way to make NHS safer and better for all

  5. Andrew Forsyth says:

    Yet another unnecessary set of statistics to be collected and aggregated by NHS England, should the proposal to track private income from work undertaken by consultants outside their NHS contracts be implemented. As has been said, it will add nothing to transparency to see how much consultants earn this way – and they already have to state that they undertake private practice as part of their ‘whole scope’ declaration at every annual appraisal. We already need an ever-growing battalion of managers to track NHS England ‘initiatives’, which seem to grow ‘like Topsy’ – don’t let’s add to it with unnecessary ‘headline grabbers’ which do nothing for effectiveness and undermine efficiency.

  6. Andrew Flynn says:

    NHS England makes these claims, spends huge sums of tax payers money that should go into healthcare doing these various ‘consultations’, getting ‘Guidance’ written up that is ignored, and has no powers to force anything on any of the NHS Trusts etc, NO powers to prosecute failing trusts, and as has been shown most recently with Southern Health, sits back and is unable or unwilling to put themselves forward to tackle the dreadful situations happening. Then now claims to be spending another £100 million or so ‘transforming mental healthcare’, without as stated earlier, any powers to enforce any of the changes they claim they are pushing for, when the evidence shows that their ‘Guidance’ in the form of Govt Legislation is just ignored, just as later legislation will be ignored. The only difference is that the country will spend this £100 million or so with the only net result of a few people making a whole lot of money out of the consultation process. Doesn’t sound very transforming to me

  7. Jem Dean says:

    As a consultant with a small private practice in addition to a full time NHS job I would make it clear that the time spent on ‘private’ work (which includes a lot of work on NHS patients treated by private providers) is clearly documented in my job plan kept by my employing NHS trust. There is no conflict of interest as a result of the transparency entailed. I have no difficulty in my job plan being available for public inspection. It is immaterial to the transparency in this process to require me to make reference to the financial sums involved.

  8. Dr Peter J Gordon says:

    Sir Malcolm Grant,
    It is most welcome to have an “independent Chair”. The public could not wish for more.

    Where can we find who you are, and the way your career has progressed till now? This is necessary to understand your independence.

    My personal view is that the proposals of the group that you Chair seem weaker than weak.

    Dr Peter J Gordon
    NHS Scotland

  9. Dr Peter J Gordon says:

    I am not sure if this response, of two days ago, was received:

    Response by Dr Peter J Gordon, 20 Sept 2016:

    May I comment from NHS Scotland where a public consultation has recently taken place and the majority of those consulted were of the view that it should be MANDATORY for financial conflicts of interest to be declared.

    In NHS Scotland, GUIDANCE produced by the Scottish Government, has been widely ignored by all NHS Boards.

    I have to say I find the proposals of the Group chaired by Sir Malcolm Grant as extremely disappointing.

    If you wish to look at the evidence why this matters, and the potential for patient harm, please look here:

  10. Paul Conyers says:

    Given that that NHS is a high profile public entity, first and foremost is the public’s perception of its operations. For conflict of interest to work effectively there needs to three separate but distinct elements:
    1. Legal implications for compliance with all the relevant statutes, policies and other related laws.
    2. Standard Code of Ethics of which the profession must abide by.
    3. Agreed and accepted good practice on how to handle conflicts of interest when then arise that are linked to points 1 and 2.

  11. Kassander says:

    ” …NHS England set up a group to look into… managing conflicts of interest,… expertise from a wide range of organisations…led by Sir Malcolm Grant,… includes representatives from:
    * the British Medical Journal,
    * NICE,
    * the Care Quality Commission,
    * the Local Government Association and
    * the Association of the British Pharmaceutical Industry.”
    Patients and the Public.
    Not your choice of those you consider to be Patient Leaders (Self declared).
    OUR choice, selected and elected by, and answerable to, US.
    After all, it is OUR nhs, not yours.
    Whatever happened to:
    ” we’re all in this together”, and
    “no decision about me without me”?

    • Trevor Fossey says:

      Absolutely – patients should be given the opportunity to be involved within this initiative from the outset
      The initiative should be expected to, and provide evidence that it is, complying with co-production model which was recently published?

    • NHS England says:

      Dear Kassander,
      The task and finish group was formed by inviting representatives from organisations with knowledge in the areas under consideration. This includes the health department, provider confederations, regulators and industry representatives.
      We also engaged with a number of stakeholders outside of the task and finish group, including patient bodies and representatives.
      The consultation period is of great importance as it gives patients, service users, carers, colleagues and the general public a chance to give their thoughts, feedback and to make suggestions.
      You can take part and to give your views, please visit the consultation hub.
      Kind regards,
      NHS England

  12. Tim Cotter says:

    Sir Malcolm needs to allow doctors to declare zero or less than zero earnings from private practice to give the public transparency. The lowest earnings bracket of “less than £50,000 quoted in the media” will be a travesty.

  13. Anonymous says:

    Clare Marx appears to contradict herself. On the one hand she claims that guidance on handling conflict of interest is long overdue but then states that in fact her College already has explicit guidance in place for its Fellows, who, by the way, are the major group of consultants undertaking private practice. So which is it?

  14. Anonymous says:

    Appears to be an assault on Doctors from all angles. Perhaps there are more pressing issues that need to be addressed in regards to the state of the NHS. As a tax payer I feel this is a waste of resources at this critical time in the NHS and does this not provide further discouragement for anyone considering a career in the medical profession. I know from first hand experience that waste and inefficiency within the NHS is endemic and focusing on this particular group appears to be missing the point and very short sighted!

  15. Anonymous says:

    CCGs commissioning services to Companies in which CCG Board Members have an interest in is a serious conflict of interest- how will you address this!

    • Anonymous says:


    • NHS England says:

      Dear Sir/Madam,
      In June 2016, NHS England published revised statutory guidance on managing conflicts of interest for clinical commissioning groups (CCGs). The guidance was developed in partnership with CCGs and national partners.
      The guidance includes a number of strengthened safeguards to mitigate the risk of real and perceived conflicts of interest arising in CCGs. If you would like to know more visit the CCG conflicts of interest management page.
      To take part in this system wide consultation, have your say, please visit the consultation page.
      Kind Regards,
      NHS England