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Poor practice on conflict of interest ‘damaging trust in clinicians’

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Many NHS trusts in England are failing to log, track, or disclose information on conflicts of interest for their staff, so potentially undermining public trust in health professionals, suggests research.

Those behind the study argue that 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.

“The current system for logging and tracking such disclosures is not functioning adequately”

Study authors

Direct gifts and inducements have been banned by pharma trade body the Association of the British Pharmaceutical Industry since 2010.

But firms can still pay clinicians to deliver continuing professional development lectures, sponsor their attendance at conferences or educational events, and provide training to other clinicians.

Clinicians are required to declare all financial conflicts of interest so their appropriateness, and any possible impact on professional behaviour, can be assessed independently and transparently.

NHS England has issued standards that stipulate that all health service staff should declare potential conflicts of interest to trusts, 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, noted the researchers in the journal BMJ Open.

They, therefore, set out to look at how many NHS trusts in England record and share their employees’ conflict of interest disclosures.

They submitted Freedom of Information requests to all trusts in England and received responses from 217 out of 236.

The 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

The responses were then scored on each of the five measures to create a “transparency index”.

Some 71 trusts did not respond within the 28-day deadline required by the FOI Act, and 19 not at all. More than three out of four of 185 trusts provided a gifts and hospitality register – also described as a “COI register”.

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 £119,851.35.

What is more, the researchers found 107 records of payments made directly to these trusts, averaging out at £22, 293 per trust.

The responses showed that most COI registers were incomplete by design; only 31 of them contained enough information to assess conflicts of interest.

Around two thirds of the 185 trusts that said they provided a register didn’t record the names of recipients.

“The ongoing absence of transparency around COI may undermine public trust in the healthcare professions”

Study authors

Forty seven did not record the cash value of the gift or hospitality, while only 31 included the names of recipients and donors, as well as the sums received.

One in 10 of the registers didn’t contain recipient or donor names, or the cash amount. And only 15 trusts had their disclosure register publicly available online.

The transparency index revealed the average score to be 1.9 out of five. No trust met all five criteria, said the researchers.

“Despite 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,” said the researchers.

They highlighted the Physician Payment Sunshine Act in the US that required that all payments to doctors are declared onto a single, openly accessible central database.

“The ongoing absence of transparency around COI in the UK may undermine public trust in the healthcare professions,” claimed the researchers.

“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,” they said.

The researchers have created a website sharing all of their data and findings. It includes a page for every NHS trust in the country, showing their disclosure documents in full. 

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Readers' comments (1)

  • Should birthday cakes be included in the list/register mentioned in this article?

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