{"id":1246,"date":"2018-03-26T23:32:07","date_gmt":"2018-03-26T23:32:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjopen\/?p=1246"},"modified":"2018-03-22T16:23:21","modified_gmt":"2018-03-22T16:23:21","slug":"poor-practice-on-conflict-of-interest-in-nhs-may-be-damaging-trust-in-clinicians","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjopen\/2018\/03\/26\/poor-practice-on-conflict-of-interest-in-nhs-may-be-damaging-trust-in-clinicians\/","title":{"rendered":"Poor practice on conflict of interest in NHS may be damaging trust in clinicians"},"content":{"rendered":"

US-style statutory body needed to ensure all trusts have strong policies in place, say researchers<\/em><\/span><\/p>\n

Many NHS trusts in England are failing to log, track, or disclose information on conflicts of interest (COI) for their staff, so potentially undermining public trust in health professionals, suggests research<\/a> published in the online journal BMJ Open<\/em><\/a>. <\/strong><\/span><\/p>\n

A statutory body, along the lines of the US model, is now needed to ensure that all NHS trusts have strong policies in place to tackle this issue, say the researchers.<\/span><\/p>\n

Direct gifts and inducements have been banned by pharma trade body, the Association of the British Pharmaceutical Industry ABPI), since 2010. But pharmaceutical companies can still pay clinicians to deliver continuing professional development lectures, sponsor their attendance at conferences or educational events, and provide training to other clinicians.<\/span><\/p>\n

In 2015 the pharma industry reported this spend as \u00a3115 million.<\/span><\/p>\n

Doctors and other healthcare professionals are required to declare all financial COI so that their appropriateness, and any possible impact on professional behaviour, can be assessed independently and transparently.<\/span><\/p>\n

The doctors\u2019 regulator, the General Medical Council, also requires healthcare providers to declare any potential COI to both their patients and their employers, while NHS England has issued standards to NHS trusts. <\/span><\/p>\n

These standards stipulate that all NHS staff should declare potential conflicts of interest to their employers, and that these should be recorded in a gifts and hospitality register. Although many trusts do include these in local guidance, these standards are not mandatory. <\/span><\/p>\n

The researchers therefore set out to look at how many NHS trusts in England record and share their employees\u2019 COI disclosures. They submitted Freedom of Information (FoI) requests to all trusts in England and received responses from 217 out of \u00a0236 (92% response rate).<\/span><\/p>\n

The FoI questions were designed to assess all disclosures for completeness and openness, for each of five measures of transparency to find out if trusts: responded on time to the FoI request; provided a gifts and hospitality register; specified the donor, recipient, and cash amount in the register; provided a register in a format that permitted further analysis; and had their register publicly available online.<\/span><\/p>\n

The responses were then scored on each of the five measures to create a \u2018transparency index.\u2019<\/span><\/p>\n

Some 71 trusts didn\u2019t respond within the 28-day deadline required by the FoI Act, and 19 didn\u2019t respond at all. <\/span><\/p>\n

More than three out of four (78%) of 185 trusts provided a gifts and hospitality register \u2013 also described as a COI register. <\/span><\/p>\n

Seven trusts described or returned no entries for their register, but a search of the ABPI disclosure database turned up 230 records for these trusts relating to payments to individual employees amounting to \u00a3119,851.35. <\/span><\/p>\n

What\u2019s more, the researchers found 107 records of payments made directly to these trusts, averaging out at \u00a322,293 per trust.<\/span><\/p>\n

The responses showed that most COI registers were incomplete by design; only 31 of them contained enough information to assess conflicts of interest.<\/span><\/p>\n

Around two thirds (68%) of the 185 trusts that said they provided a register didn\u2019t record the names of recipients.<\/span><\/p>\n

One in four (47) didn\u2019t record the cash value of the gift or hospitality, while only 16 percent (31) included the names of recipients and donors, as well as the sums received.<\/span><\/p>\n

One in 10 of the registers didn\u2019t contain recipient or donor names, or the cash amount. And only 15 (6%) trusts had their disclosure register publicly available online.<\/span><\/p>\n

The transparency index revealed the average score to be 1.9 out of 5. No trust met all five criteria.<\/span><\/p>\n

There are various barriers to transparency around conflict of interest, say the researchers. These include the absence of a centralised system for disclosures to employers; poor auditing of records; variation in the types of information disclosed, suggesting confusion about what constitutes a COI; and the general lack of public availability of COI records.<\/span><\/p>\n

\u201cDespite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and tracking such disclosures is not functioning adequately,\u201d they write.<\/span><\/p>\n

The Physician Payment Sunshine Act (PPSA) in the US requires that all payments to doctors are declared onto a single central database that is openly accessible. A similar system should be adopted in the UK, they argue.<\/span><\/p>\n

\u201cThe ongoing absence of transparency around COI in the UK may undermine public trust in the healthcare professions. Simple clear legislation and a requirement for open disclosure of COI to a central body, similar to that in the US, would present a simple and effective solution,\u201d they conclude.<\/span><\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

US-style statutory body needed to ensure all trusts have strong policies in place, say researchers Many NHS trusts in England are failing to log, track, or disclose information on conflicts of interest (COI) for their staff, so potentially undermining public trust in health professionals, suggests research published in the online journal BMJ Open. A statutory […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2470,511],"tags":[],"class_list":["post-1246","post","type-post","status-publish","format-standard","hentry","category-content","category-in-the-news"],"yoast_head":"\nPoor practice on conflict of interest in NHS may be damaging trust in clinicians - BMJ Open<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjopen\/2018\/03\/26\/poor-practice-on-conflict-of-interest-in-nhs-may-be-damaging-trust-in-clinicians\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Poor practice on conflict of interest in NHS may be damaging trust in clinicians - BMJ Open\" \/>\n<meta property=\"og:description\" content=\"US-style statutory body needed to ensure all trusts have strong policies in place, say researchers Many NHS trusts in England are failing to log, track, or disclose information on conflicts of interest (COI) for their staff, so potentially undermining public trust in health professionals, suggests research published in the online journal BMJ Open. 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