Conflicts of Interest Rules Tightened
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this week JOEL GOODMAN/LNP/REX JOEL Conflicts of interest rules tightened NHS England will introduce tougher rules or involvement with an organisation that NHS England’s chief executive for managing conflicts of interest in clinical benefits financially from contracts awarded Simon Stevens said the commissioning groups (CCGs) as part of an by a commissioning group. changes “will benefit patients and protect taxpayers” NHS-wide overhaul of its policies. The new measures and guidance were In a strengthening of its statutory outlined in NHS England’s board papers on guidance to GP led bodies, NHS England 31 March, and they will be introduced later will require all CCGs to nominate a conflicts this year subject to consultation. of interest guardian to ensure “firmer and NHS England said that the strengthening more consistent” decision making. of its policies would bring “a stronger, The changes were announced after more consistent approach” to managing a recent joint investigation by The BMJ conflicts of interest, to give patients and and the Times newspaper, which found the public “full confidence” in how NHS significant variation in the management funds are spent. The organisation said that of conflicts and the levels of transparency. the proposals would move the NHS in line They will also advise CCGs to increase lay with “sunshine” rules that exist in other member numbers on their governing body countries, such as the United States. from two to a minimum of three to provide Simon Stevens, NHS England’s chief extra scrutiny for decisions involving executive, said, “In a tax funded health NEWS ONLINE potentially conflicted board members. system, the public rightly demand high • Royal College urges All commissioning groups will be standards of probity from both NHS staff CCGs to reconsider required to publish registers of gifts and and healthcare suppliers. Recent cases plans to restrict hospitality that members have received and in the UK, and indeed worldwide, have access to surgery produce annual audits demonstrating how underscored the need for action. • Lamotrigine may not they have managed conflicts of interest. “‘Sunshine’ rules to bring greater increase risk of birth The revised guidance adds that CCGs transparency, tougher restrictions on defects, study shows should also consider asking board conflicts of interest, and clearer guidelines • Healthy people need members with “profound and acute” on industry partnerships and influence will fewer preoperative conflicts of interest to step down from one benefit patients and protect taxpayers.” tests, says of their roles. It said that this could include Gareth Iacobucci, The BMJ NICE conflicts such as secondary employment Cite this as: BMJ 2016;353:i1885 the bmj | 9 April 2016 43 SEVEN DAYS IN Nine in 10 general practices struggle to find locums Almost nine in 10 general practices in England struggle to find locum doctors to fill staffing gaps, a BMA survey has warned. The poll of 2814 general practices in England (roughly a third of the total number) also found that only one in 10 practices did not need to use locum services. Almost half of the practices surveyed (46%) reported that they “frequently” have trouble finding locum cover, while a further 40% said that they “occasionally” have problems. The south and south west regions reported the most difficulties in finding locum doctors, with 61% and 57% respectively saying that they “frequently” had problems covering shifts. And the south west (5%) and the West Midlands (6%) had the lowest numbers of general practices reporting that they never needed locum cover. GP leaders said that the figures provided fresh evidence of the strain that general practice is under. Chaand Nagpaul (left), the chair of the BMA’s GP committee, said, “In this climate, it is clear that there are no longer enough GP locums to cover the widening gaps in the GP workforce. The government needs to begin tackling this crisis and to deliver its promised support package for general practice. We need a long term, well financed plan to prevent GP services from collapsing.” Gareth Iacobucci, The BMJ Cite this as: BMJ 2016;353:i1940 NHS Signatories included Mind, expensive meals as kickbacks Research news NHS launches new Action for Sick Children, Epilepsy from 2002 until at least January Endometriosis increases whistleblowing policy Action, Bliss, the Men’s Health 2011 in return for prescribing risk of heart disease NHS employers must ensure Forum, and Sue Ryder. the company’s drugs and that staff can speak out and billing various public payers. must set out the steps they will Report calls for pause on The government claimed that take to investigate concerns, large NHS contracts thousands of meetings that under a new whistleblowing An independent report into the Novartis described as speaker policy launched by NHS England. collapse of one of the largest programmes were really just paid Organisations must appoint a outsourcing deals ever in the NHS entertainment for physicians. It “freedom to speak up” guardian, called for any similar contracts is seeking as much as $3.4bn who will advise staff at any to be put on hold until they have (£2.4bn) in damages. Women with endometriosis stage of raising a concern. The been reviewed. The report for had a higher risk of myocardial policy also states that NHS England looked at GSK loosens patents infarction, angina, and surgery or investigations a £725m deal awarded GlaxoSmithKline (CEO Andrew stenting to open blocked arteries, will be evidence to the provider Witty, below) said that it will a study found. The highest risk for based and led UnitingCare not file for patents in the least these endpoints combined was in by someone Partnership to developed and lowest income women who had endometriosis “suitably deliver older countries, to enable their drug diagnosed at age 40 or younger. independent” people’s companies to produce generic The researchers found that 42% within the healthcare and versions of its products. Rohit of the association between organisation. adult community Malpani, from Médecins Sans endometriosis and heart disease services in Cambridgeshire, Frontières’ campaign for access was accounted for by the greater Health charities urge talks which collapsed after just eight to medicines, said, “The G20 frequency of hysterectomy or to halt juniors’ strikes months of operation in December countries [where full licences oophorectomy (full BMJ story A coalition of 36 charities wrote 2015 because the contract will apply] are a very doi:10.1136/bmj.i1851). to England’s health secretary and was “no longer financially broad mix and include the BMA in a last minute appeal sustainable.” India, Brazil, China, Audit highlights to get the two parties to resume and South Africa. This importance of early talks and avert this week’s junior Pharma news is not going to mean referral for foot ulcers doctors’ strike, the Guardian Novartis faces $3.4bn anything if the The first national diabetes reported. They called on Jeremy fine in US countries that foot care audit in England Hunt to drop his threat to impose Novartis is fighting a demand produce these and Wales showed that the junior doctors’ contract from US attorneys for thousands products are patients who are expertly and warned that walkouts of documents detailing 80 000 unable to assessed within two were now so common that they events in which doctors develop or weeks are more likely were becoming “normalised.” allegedly received money and export them.” to be free of foot ulcers 44 9 April 2016 | the bmj SIXTY SECONDS MEDICINE ON . THE at 12 weeks than those who have DIGITAL NHS to wait longer for assessment. WHATARETHEPLANSTODIGITISE The audit of 5215 patients found THENHSISTHERESOMETHINGICAN that, of the 2029 patients seen DOWNLOADANDPRINT? within two weeks, half were ulcer- Wrong already. The NHS will be paperless free 12 weeks after assessment, Just 13% of by 2020, says Jeremy Hunt, health secretary compared with 43% of those those polled for England. Printing anything is so 1980s. seen after two weeks to two identified the months and 34% of those seen link between HASN’THEPROMISEDTHATBEFORE? after two months (full BMJ story alcohol and cancer Well, yes. In 2013 he said that the NHS doi: 10.1136/bmj.i1820 ). would be paperless by 2018. WHAT’SHOLDINGITUP? It’s very diffi cult. Don’t forget the National Programme for Information Technology, Public is unaware of which spent nearly £10bn before it was alcohol’s link to cancer OUT OF terminated in 2011. It had some successes, Most people do not link the such as creating NHSmail, Choose and consumption of alcohol with an BREATH Book, and the Picture Archiving and increased risk of cancer, a report Communications System. But it failed to by Cancer Research UK found. Just digitise the acute and community sectors. of In the dock 13% of respondents to a survey of 48% SOWHAT’SDIFFERENTTHISTIME? women and Surgeon is struck off after 2100 adults in England identified Ambitions are more modest, as is funding: third fitness to practise cancer as a condition that can £4.2bn over the next fi ve years. And that’s a hearing result from drinking too much 42% of men notional fi gure, with no clarity over whether A surgeon whose patient died alcohol. When asked about seven say they would it’s new money, recycled money, or even after he attempted an operation different cancer types, 80% of get out of breath virtual money. beyond his competence and then respondents said they thought running for the ANDTHETARGET? failed to call for help after causing that alcohol caused liver cancer, Rather ill defi ned. The biggest chunk— a haemorrhage was struck off but only 18% were aware of a link bus, shows a poll £1.8bn—is supposed to create a paper- the UK medical register at his with breast cancer (full BMJ story free NHS and remove outdated hardware third fitness to practise hearing doi: 10.1136/bmj.i1881 ).