Meeting: Governing Body - Bury Clinical Comissioning … … · Meeting: Governing Body Meeting...

Date:27 September 2017 Conflicts of Interest Policy of 2

Meeting: Governing Body

Meeting Date 27 September 2017 Action Approve

Item No. 9c Confidential No

Title Conflicts of Interest Policy

Presented By Mrs Lisa Featherstone, Deputy Director of Business Delivery

Author Mrs Lisa Featherstone, Deputy Director of Business Delivery

Clinical Lead -

Executive Summary

The Clinical Commissioning Group (CCG) needs to have in place a policy for managing conflicts of interest which Governing Body members, the CCG membership, and employees may or may potentially have when undertaking their duties within the strategic and operational functions of the CCG. The Conflicts of Interest Policy has been refreshed to take account of the latest guidance released by NHS England for Managing Conflicts of Interest within CCGs. As the Policy had been comprehensively updated in prior to this revised guidance being issued, the changes reflected within the policy are minor, as outlined below:

Clause 5.1 reflects the annual self-assessment and due regard over the reporting period for managing conflicts of interest. This process has been routinely undertaken however is now formally included within the Policy

Clause 7.4 has been updated to reflect the new guidance of updating declarations on an annual basis as a minimum, rather than the twice yearly updated referenced in earlier guidance

Clause 8.7 has been included to reflect that the CCG will request declarations of interest from all employees, contractors and members of the CCG, rather than limit the process to decision makers.

The Policy has been discussed through the Audit Committee, with colleagues from Internal Audit, Local Anti-Fraud and External Audit.

Recommendations

It is recommended that the Governing Body:

Approve the Conflicts of Interest Policy.

Links to CCG Strategic Objectives

To empower patients so that they want to, and do, take responsibility for their own healthcare. This includes prevention, self-care and navigation of the system. ☐

To deliver system wide transformation in priority areas through innovation ☐

To develop Primary Care to become excellent and high performing commissioners ☐

Date:27 September 2017 Conflicts of Interest Policy of 2

To work with the Local Authority to establish a single commissioning organisation ☐

To maintain and further develop robust and effective working relationships with all stakeholders and partners to drive integrated commissioning.

☐

To deliver long term financial sustainability in partnership with all stakeholders through innovative investment which will benefit the whole Bury economy.

☐

To develop the Locality Care Organisation to a level of maturity such that it can consistently deliver high quality services in line with Commissioner’s intentions. ☐

Supports NHS Bury CCG Governance arrangements ☒

Does this report seek to address any of the risks included on the Governing Body Assurance Framework? If yes, state which risk below:

No

GBAF – n/a

Governance and Reporting

Meeting Date Outcome

Senior Management Team

21/08/2017 Supported the policies for submission to Audit Committee

Audit Committee 01/09/2017 Reviewed and discussed the Policy and recommended it for ratification by the Governing Body

Implications

Are there any quality, safeguarding or patient experience implications?

Yes ☐ No ☐ N/A ☒

Are there any conflicts of interest arising from the proposal or decision being requested?


Are there any financial Implications? Yes ☐ No ☐ N/A ☒

Has an Equality, Privacy or Quality Impact Assessment been completed?


Is an Equality, Privacy or Quality Impact Assessment required?


Are there any associated risks? Yes ☒ No ☐ N/A ☐

Are the risks on the CCG’s risk register? Yes ☐ No ☒ N/A ☐

Failure to have up to date policies in place could impact on the reputation of the CCG through legal challenge and poor practice.

Date: August 2017

Conflicts of Interest Policy Page 1 of 52

Version: 2.1

Ratified by: Governing Body

Date ratified:

Name of originator /author (s):

Lisa Featherstone

Danny Lansley

Responsible Committee / individual:

Audit Committee

Date issued:

Review date:

Target audience: NHS Bury Clinical Commissioning Group Members and Staff

Impact Assessed: Yes

Conflict of Interest Policy

Date: August 2017


Further information regarding this document

Document name Conflicts of Interest Policy

Category of Document in The Policy Schedule Governance

Author(s) Contact(s) for further information about this document

Danny Lansley, Corporate Governance Manager

[email protected]

This document should be read in conjunction with

Standard of Business Conduct Policy

Joint working with Industry Policy

Gifts and Hospitality Policy

CCG Constitution

Whistleblowing Policy

This document has been developed in consultation with

Bury CCG Audit Committee

Mersey Internal Audit Agency

Senior Management Team

Published by

NHS Bury Clinical Commissioning Group

21 Silver Street

Bury

BL9 0EN

Main Telephone Number: 0161 762 5000

Copies of this document are available from

The corporate office, 1st Floor, Silver Street, Bury

Version Control

Version History:

Version Number Reviewing Committee / Officer Date

2.0 Approved by Governing Body 23 November 2016

2.1 Reviewed in light of new NHS England Guidance

June 2017

Date: August 2017


Contents

Introduction ........................................................................................................................4

Legislative Framework .......................................................................................................4

Aims and Objectives ..........................................................................................................5

Scope of the Policy ............................................................................................................6

Accountability, Roles and Responsibilities .........................................................................6

Managing Conflicts of Interest ............................................................................................8

When to make a declaration of interest ............................................................................ 11

Register of Interests ......................................................................................................... 12

Using the Register of Interests for Managing Conflicts of Interest in Meetings ................ 13

Declarations of interest in relation to procurement ........................................................... 14

Register of Procurement Decisions .................................................................................. 15

Designing service requirements ....................................................................................... 16

Declarations of Interest and Member Practices ............................................................... 17

Declarations of Interest for contractors and people who provide services to the CCG .... 17

Conflicts of Interest where GP practices are potential providers of CCG commissioned services .............................................................................................................................. 17

Managing conflicts to protect the integrity of the decision-making process ...................... 18

Dispute Resolution ........................................................................................................... 18

Breaches of the Policy ..................................................................................................... 20

Implementation and Dissemination .................................................................................. 21

Training ............................................................................................................................ 21

Monitoring and Review of the policy ................................................................................ 21

Other Associated Documents .......................................................................................... 22

References ....................................................................................................................... 22

Appendix 1 : Shared principles on Conflicts of Interest when CCGs are commissioning from Member Practices.................................................................................................. 23

Appendix 2: Examples of Conflicts of Interest .................................................................. 31

Appendix 3: Conflicts of Interest Flowchart .......................................................................... Appendix 4: Declarations of Interests Form ..................................................................... 37

Appendix 5: Register of Interests for Publication on Website ........................................... 39

Appendix 6 – Templates for Recording Interests at Meetings .......................................... 40

Template declarations of interest checklist ...................................................................... 44

Appendix 7: Bidders /potential contractors /service providers’ declaration form .............. 46

Appendix 8: Procurement Template ................................................................................. 49

Appendix 9 - Template Procurement Decisions and Contracts Awarded ......................... 52

Date: August 2017


1.0 1.1

Introduction NHS Bury Clinical Commissioning Group (CCG), as commissioners of healthcare, need to manage conflicts of interest in a way that demonstrates transparency, probity and accountability.

1.2 1.3 1.4 1.5

This is not a new requirement, but does present more challenges as a membership organisation, with GPs being involved in both the provision and commissioning of healthcare. Additionally, NHS Bury CCG has taken on an increased responsibility for the commissioning of Primary Care from NHS England. Whilst this enables more joined-up and coherent commissioning of care for its patients and population, it also exposes the CCG to a greater risk of conflicts of interest, both real and perceived. This policy reflects the updated guidance1 for the management of Conflicts of Interest, issued by NHS England, in light of the wider cross system guidance published earlier in 2017. This policy sets out how the CCG will manage conflicts of interest arising from the operation and functions of its Governing Body, Membership, employees and individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG.

2.0 2.1 2.2 2.3

Legislative Framework

As a public body, there are two separate pieces of legislation that require the CCG to manage conflicts of interest.

Section 14O of the Health and Social Care Act

The Health and Social Care Act 2006 (Section 14O, Conflicts of Interest, of the 2006 Act, as inserted by section 25 of the 2012 Act [Health and Social Care Act 2012]) sets out the minimum requirements for the CCG in managing conflicts of interest, including:

maintaining appropriate registers of interest;

publishing or making arrangements for the public to access the registers;

making arrangements for the prompt declaration of interests by the persons specified and ensure these are included in the relevant register;

make arrangements for managing conflicts and potential conflicts of interest; and

having regard to guidance published in relation to conflicts of interest.

The NHS (Procurement, Patient Choice and Competition) Regulations 2013

The NHS (Procurement, Patient Choice and Competition) Regulations 2013, and in particular regulation 6 requires that:

contracts for the provision of NHS health care must not be awarded where conflicts or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to

1 Managing Conflicts of Interest : Revised Statutory Guidance for CCGs 2017, 16 June 2017

Date: August 2017


2.4

affect the integrity of the award of that contract; and

appropriate records must be kept of how any such conflicts in relation to NHS commissioning contracts it enters into have been managed.

The CCG’s Constitution as published on the CCG website should also be read in conjunction with this policy.

3.0 3.1 3.2 3.3 3.4 3.5

Aims and Objectives Conflicts of interest are inevitable in public life. The aim of this policy is to protect both the CCG and the individuals involved from either committing or giving any appearance of impropriety, and to demonstrate transparency to the public and other interested parties. This policy and its supporting procedures provide advice on recognising where and how conflicts of interest arise and managing these within a proper governance framework to ensure that conflicts of interest do not affect, or appear to affect, the integrity of the CCG’s decision-making process. All stakeholders are reminded that the receipt of an offer of a Gift, Hospitality or any other benefit constitutes an Interest and should be declared. For guidance on the procedure in dealing with these circumstances, please refer to NHS Bury CCG’s Gifts and Hospitality Policy. The policy and its supporting procedures set out the safeguards which will be put in place by the CCG to ensure transparency, fairness and probity in decision making, including:

arrangements for declaring interests;

maintaining and either publishing or making arrangements for the public to access a register of interests;

maintaining and either publishing or making arrangements for the public to access a register of procurement decisions;

publishing or making arrangements for the public to access details of all contracts awarded by the CCG;

excluding individuals from decision-making when a conflict arises; and

engagement with a range of potential providers on service design.

The policy also reflects the seven principles of public life established by the Nolan Committee which are as follows:

selflessness;

integrity;

objectivity;

openness;

honesty; and

leadership.

3.6 The benefits of managing conflicts of interest are:

maintaining confidence and trust between patients and GPs;

enabling the CCG and the member practices to demonstrate that they are acting fairly and transparently and that members of CCGs will always put their duty to patients before any personal financial interest;

Date: August 2017


ensuring that CCG operates within a legal framework; and

achieving public confidence in the CCG.

4.0 4.1 4.2

Scope of the Policy This policy applies to the following people:

All CCG Employees (including apprentices, agency staff and seconded staff);

Any self-employed consultants or other individuals working for the CCG under a contract of services;

Members of the Governing Body and its committees including co-opted members, appointed deputies and those attending from other organisations;

All members of the CCG – this includes all providers of primary medical services. Declarations should be made by the following groups:

o GP partners (or where the practices is a company, each director);

o Any individual directly involved with the business or decision making of the CCG.

A copy of the policy will be made available to all individuals upon appointment.

5.0 5.1 5.2 5.3 5.4 5.5

Accountability, Roles and Responsibilities The Accountable Officer and the Audit Committee Chair (Lay Member with responsibility for Finance, Audit and Conflicts of Interest) are responsible for providing formal attestation and an annual declaration to NHS England on the CCG’s due regard and compliance with any guidance issued in respect of Conflicts of Interest2. The Governing Body is accountable, in line with the CCG’s scheme of reservation and delegation as published in its Constitution, for receiving declarations of interest in respect of the members of the Governing Body and seeks assurance through the Audit Committee that declarations of interests for members of Committees and Sub-Committees, the Membership and employees are in place. In certain circumstances the Governing Body will need to consider whether conflicts of interest should exclude individuals from being appointed to the Governing Body or to a committee or sub-committee of the CCG or Governing Body. In these circumstances the materiality of the interest (and any close associate) will be assessed against the usual business of the Governing Body or Committee to determine if the individual could benefit from any decision the CCG might make. This will be carried out on a case-by-case basis. The Audit Committee Chair (Lay Member with responsibility for Finance, Audit and Conflicts of Interest) will take the role of the Conflicts of Interest Guardian and will be supported by the Deputy Director of Business Delivery and the Corporate Governance Manager who have responsibility for the day to day management of conflicts of interest matters and queries. The Conflicts of Interest Guardian will:

2 The National Health Service Act 2006, as amended 2012, Section 14Z8

Date: August 2017


act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;

be a safe point of contact for employees or workers of the CCG to raise any concerns in relation to this policy;

support the rigorous application of conflict of interest principles and policies;

provide independent advice and judgement where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation: and

provide advice on minimising the risks of conflicts of interest.

5.6 The Audit Committee, under delegated authority from the Governing Body, will oversee the policy and ensure appropriate support is provided to all member practices and individuals who hold positions of authority or who can make or influence decisions to:

declare their interests for recording on the appropriate Register of Interests which will be published and made available to the public via the CCG website or on request;

declare any relevant interests throughout discussions and proceedings so that anything that is said is fully understood by all others within that context; and

ensure that where a conflict could have an effect on any decision or process, these have been appropriately reported and managed in accordance with this policy and its supporting procedures.

5.7 5.8 5.9

The Audit Committee will take such steps as it deems appropriate, and request information it deems relevant from individuals to ensure all conflicts of interest, and potential conflicts are declared.

The Primary Care Commissioning Committee Chair will be chaired by the Lay Member with responsibility for Quality and Performance, the vice chair is the Lay Member for Patient and Public Involvement. These arrangements allow appropriate oversight for managing conflicts and ensure the CCG’s Conflict of Interest Guardian position is not compromised in their requirements to report to the NHS England Board.

Should a situation arise where the Lay Member for Finance, Audit and Conflicts of Interest is needed to chair a meeting of the PCCC Committee, this must be clearly recorded in the minutes and appropriate safeguards put in place based on the agenda.

5.10 5.11

At an operational level, the Deputy Director of Business Delivery, the Corporate Governance Manager and the Conflicts of Interest Guardian will ensure that for every interest declared arrangements are put in place to manage the conflicts of interest or potential conflicts to ensure the integrity of the CCG’s decision making processes. Where necessary the Deputy Director of Business Delivery, the Corporate Governance Manager and the Conflicts of Interest Guardian will put in writing to the relevant individual, arrangements for managing the conflict(s) of interests or potential conflicts of interest within a week of declaration. This will confirm the following:

when an individual should withdraw from a specified activity, on a temporary or permanent basis; and

the arrangements for monitoring the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

5.12 The Corporate Affairs and Governance Manager is responsible for maintaining the

Registers of Interests and ensuring these are publicly available and are retained for a

Date: August 2017


period of 6 years.

5.13 5.14 5.15

All Directors and Deputy Directors must ensure that members of staff are aware of the policy and process to be followed. All Member Representatives, Governing Body Members and employees, must familiarise themselves and comply with this policy and its supporting procedures. In any transaction undertaken in support of the CCG’s exercise of its commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the declaration and management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either Corporate Governance Manager the relevant commissioner.

6.0 6.1 6.2 6.3 6.4 6.5 6.6

Managing Conflicts of Interest A conflict of interest occurs where an individual’s ability to exercise judgment, or act in one role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain any actual benefit, financial or otherwise, for a conflict of interest to occur. For the purposes of Regulation 6 [National Health Service (Procurement, Patient Choice and Competition)(No 2) Regulations 2013, a conflict will arise where an individual’s ability to exercise judgement or act in their role in the commissioning of services is impaired or influenced by their interests in the provision of those services3. Conflicts can arise in many situations, environments and forms of commissioning, with an increased risk in primary [medical] care commissioning, out-of-hours commissioning and involvement with integrated care organisations. A set of principles, developed by NHS Clinical Commissioners, the Royal College of General Practitioners, the British Medical Association and adopted by the CCG are set out at Appendix 1.

For a GP in the role of a commissioner, a conflict of interest may therefore arise when their judgement as a commissioner could be, or perceived to be, influenced and impaired by their own concerns and obligations as a provider. In the case of a GP involved in commissioning, an example of a conflict of interest would be the awarding of a new contract, or the extension of an existing contract, to a provider in which the individual GP has a financial stake. The CCG will ensure, through the arrangements set out in this policy, that all conflicts of interest are managed appropriately as follows:

Each member and all CCG staff (including full and part-time employees, staff on seasonal or short term contracts, students and trainees, agency and seconded staff, consultants or colleagues on contracts for services) will be required to

3 Monitor – Substantive guidance on the Procurement, Patient Choice and Competition Regulations (December 2013)

Date: August 2017


6.7 6.8 6.9

complete a declaration of interests form on appointment;

Each conflict of interest declared will be reviewed on a case by case basis, with due consideration of the materiality of the interest, in particular whether the individual (or family member or business partner) could benefit from any decision the Governing Body or sub-Committee with delegated authority might make; and

The extent of the conflict or potential conflict of interest will be determined, and where it is related to an area of business significant enough that the individual would be unable to make a full and proper contribution to the Governing Body, a Committee or sub-Committee that individual should not become a member of the CCG or its Governing Body.

Where a Governing Body member benefits from any decision where a conflict of interest has been declared, this will be reported in the annual report and accounts, as a matter of best practice. All payments or benefits in kind to Governing Body members will be reported in the CCG’s annual report and accounts, with amounts for each Governing Body member listed for the year in question. Additionally, CCG employees must obtain prior permission to engage in secondary employment which may conflict with their CCG work. NHS Bury CCG reserve the right to refuse permission where it believes a conflict will arise which cannot effectively be managed. CCG employees must, in the first instance, address any issues relating to the consideration of secondary employment with their line manager or HR. Where an employee thinks they may be at risk of a conflict of interest through arrangements before commencing in a post with the CCG this should be raised at the earliest opportunity. Interests can be captured in four different categories:

6.10 6.11

Financial interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A management consultant for a provider. This could also include an individual being:

In secondary employment;

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one-off payments, day allowances or travel or subsistence) from a provider;

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Date: August 2017


6.12

Non-financial professional interests This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

A member of a particular specialist professional body (although routine GP membership of the RCGP, British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE); and

A medical researcher.

6.13 GPs and practice managers, who are members of the Governing Body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

6.14

Non-financial personal interests This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment; and

A member of a lobby or pressure group with an interest in health.

6.15

Indirect interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above) for example:

A Spouse / partner

A close relative e.g., parent, grandparent, child, grandchild or sibling;

A close friend;

A business partner.

6.16 6.17 6.18

A declaration of interest for a “business partner” in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim).

Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG.

The above categories and examples are not exhaustive and NHS Bury CCG will exercise discretion on a case by case basis, having regard to the principles set out in

Date: August 2017


this policy in deciding whether any other role, relationship or interest which would impair or otherwise influence the individual’s judgement or actions in their role within the CCG. If so, this should be declared and appropriately managed.

6.19 6.20 6.21 6.22

Examples considered to be the most likely scenarios which Governing Body, Members and employees will face are attached at Appendix 2. These examples reflect situations that are most likely to arise, but are not an exhaustive list.

It is not possible, or desirable, to define all instances in which an interest may be a real or perceived conflict. It is for each individual to decide whether to register any interests that may be construed as a conflict. Individuals can seek guidance from the Deputy Director of Business Delivery, the Corporate Affairs and Governance Manager and the Conflicts of Interest Guardian, but if there is any doubt, the assumption should be made that a conflict of interest exists. The question of whether or not to declare an interest is an individual judgement but guided by this policy. In addition to the above, important points for those bound by this policy to remember are that:

a perception of wrongdoing, impaired judgement or undue influence can be as

detrimental as any of them actually occurring;

if in doubt, it is better to assume a conflict of interest and manage it appropriately rather than ignore it; and

for a conflict to exist, financial gain is not necessary as detailed in the list below.

This policy is not, nor does it purport to be, a full statement of the law.

7.0 7.1 7.2

7.3 7.4 7.5

When to make a declaration of interest A Declaration of Interests flowchart and meeting checklist is attached at Appendix 3 to illustrate the process set out within the Policy. Declarations of interest are required in the following circumstances:

on appointment; Applicants for any appointment to the CCG or its Governing Body will be asked to declare relevant interests using the pro-forma at Appendix 4. When an appointment is made, a formal declaration of interests should again be made and recorded.

annually when prompted by the CCG: All individuals who this policy applies to will be prompted to update their declarations of interest on an annual basis and where there are no interests or changes to declare, a “nil return” should be recorded. The Governing Body and Audit Committee will seek assurance that the Registers are up-to-date and accurate.

at meetings; All attendees should be asked to declare any interest they have as a standing agenda item, before the item for which the conflict exists is discussed or as soon as it becomes apparent. Even if an interest is declared in the Register of Interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interest will be recorded in the minutes of meetings as shown at Appendix 6.

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7.6

on changing role or responsibility; Where an individual changes role or responsibility, any change to the individual’s interests must be declared within 28 days of becoming known by that person.

7.7 7.8 7.9

on any other change of circumstances. Wherever an individual’s circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a role outside of the CCG or sets up a new business or relationship), a further declaration should be made to reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or a new one materialising.

Where an interest has been declared, either in writing or orally the declarer will ensure that before participating in any activity connected with the CCG’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Corporate Governance Manager o r Deputy Director of Business Delivery or the Conflicts of Interest Guardian. Failing to declare any interests that, had it been known, may have affected the decision-making process, will be considered a breach of this policy. Section 17 sets out how the CCG will approach breaches of this policy. This could result in disciplinary action being brought against an individual in line with the CCG’s HR policies.

8.0 8.1 8.2 8.3

Register of Interests The CCG will ensure that, when individuals declare interests, this includes all the interests of the relevant individuals within their organisation (e.g. GP partners in the GP practice or other practice individuals working with the CCG) who have a relationship with the CCG and who would potentially be in a position to benefit from the CCG’s decisions.

The Corporate Governance Manager, on behalf of the Chief Officer, will maintain a Register of Interests for each of the following:

All CCG employees;

All members of the CCG;

Members of the governing body;

Members of the CCG’s Committees; and

Any self-employed consultants or other individuals working for the CCG under a contract for services.

The Register of Interests will contain the following

the name of the person declaring the interest;

their position within, or relationship with, the CCG;

the type of interest, e.g. financial, non-financial, professional, etc.;

description of the interest, including for indirect relationships details of the relationship with the person who has the interest;

the dates from which the interest relates; and

the actions to be taken to mitigate the risk.

8.4

The Register of Interests will be renewed annually and maintained on an on-going basis. Quarterly audits will be undertaken to ensure the policy is being followed and that each Register is accurate and up-to-date.

Date: August 2017


8.5 8.6 8.7

The Registers, which will be published on the CCG website, made available for inspection at the CCG headquarters and integrated into the CCGs annual accounts, will be updated whenever a change is notified. Interests declared will remain on the public register for a minimum of 6 months after the interest has expired. In addition, the public register will detail where historic interests are held and who to contact to submit a request for information.

The Corporate Governance Manger will retain all historic private records of declaration for a minimum of 6 years after the date on which the interest has expired. The 2017 Statutory Guidance requires the CCG to only publish the interests of decision-making staff. The CCG considers however that the number who would be excluded from publication is minimal and so will continue to publish the interests of all staff and all those required to submit a declaration from within member practices.

9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7

Using the Register of Interests for Managing Conflicts of Interest in Meetings The Chair of each CCG meeting will have responsibility for overseeing conflicts of interest that are notified during meetings and the course of action, if not already agreed, which will be taken. The Chair of the meeting may decide to consult with the Conflicts of Interest Guardian or the Deputy Director of Business Delivery on the way forward. Where the Conflicts of Interest Guardian is not available and there is uncertainty on the appropriate action to take, the item may be deferred. All decisions, including how the conflict was managed, will be recorded in the minutes of meetings. Where no arrangements have been confirmed regarding the management of the conflict of interests the Chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these requirements which will be recorded in the minutes of the meeting. See example at Appendix 6. If an individual leaving the meeting impacts upon the quoracy, the Chair of the meeting reserves the right to adjourn and reconvene the meeting when appropriate membership can be ensured. Where the Chair of any meeting of the group, including the Membership, Governing Body and its committees and sub- committees, has a conflict of interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the Vice Chair of the meeting will act as Chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflict of interests in relation to the Chair of the meeting, the meeting must ensure these are followed. Where no arrangements have been confirmed, the Vice Chair of the meeting may require the Chair to withdraw from the meeting or part of it. Where there is no Vice Chair of the meeting, the members of the meeting will select one.

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9.8 9.9 9.10 9.11

Where more than 50% of the members of a meeting are required to withdraw from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the Chair, or Vice Chair will determine whether or not the discussion can proceed.

In making this decision the Chair of the meeting will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the CCG’s standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such a time as a quorum can be convened.

Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the Deputy Director of Business Delivery and the Conflicts of Interest Guardian on the action to be taken.

This may include:

requiring another of the CCG’s Committees, including the Membership, Governing Body or its sub-committees (as appropriate) to progress the item of business, or if this is not possible;

inviting on a temporary basis one or more of the following to make up the quorum so that the committee can progress the item of business:

o an employee of the CCG who would otherwise not be a member of the committee;

o an individual appointed by a member to act on its behalf in the dealings between it and the CCG;

o a member of a relevant Health and Well Being Board; o a member of a Governing Body of another CCG.

9.12 9.13

These arrangements must be recorded in the minutes of the meeting.

NHS Bury CCG insist on complete transparency in its decision making processes through the maintaining of robust records. Declarations of Interest is a standing item on the agenda of each meeting. The Chair of the meeting will ensure that Conflicts of Interest declared or otherwise arising in a meeting will be recorded in the minutes of the meeting, including the following information:

who has the interest;

the nature and extent of the interest and why it gives rise to a conflict;

the item on the agenda to which the conflict relates;

the actions taken to manage the conflict; and

evidence that the conflict was managed as intended (eg recording the points during the meeting when particular individuals left or returned to the meeting).

9.14 9.15

Guidance provided by NHS England will be given to committee administrators to support accurate recording of conflicts in the minutes.

The Committee Administrator will ensure the minuted details are passed to the Corporate Governance Manager for inclusion in the appropriate register.

10.0 Declarations of interest in relation to procurement

Date: August 2017


10.1 10.2 10.3 10.4

The CCG recognises the importance of making decisions about the services it procures / commissions in a manner which does not call into question the probity, transparency and accountability behind the procurement decision which has been made.

The NHS Act, the Health and Social Care Act and associated regulations4 set out the statutory rules which commissioners are required to comply with when procuring and contracting the provision of clinical services.

The Procurement, Patient Choice and Competition Regulations place a requirement on commissioners to ensure they adhere to good practice in relation to procurement, do not engage in anti-competitive behaviour that is against the interest of patients, and protect the right of patients to make choices about their healthcare.

The Regulations set out that commissioners must:

manage conflicts and potential conflicts of interest when awarding a contract by prohibiting the award of a contract where the integrity of the award has been, or appears to have been, affected by a conflict; and

keep appropriate records of how they have managed any conflicts in individual cases.

10.5 10.6 10.7 10.8

The CCG will commission and procure services, in accordance with its Procurement Strategy, in a manner which is open, transparent, fair and non-discriminatory.

Those taking part in the procurement will be expected to declare any interest early in any procurement process if they are to be a potential bidder in that process. Failure to do this could result in the procurement process being declared invalid and possible suspension of the relevant member from the CCG. Potential conflicts will vary to some degree depending on the way in which a service is being commissioned e.g. where a CCG is commissioning a service through Competitive Tender (i.e. seeking to identify the best provider or set of providers for a service) a conflict of interest may arise where GP practices or other providers in which CCG members have an interest are amongst those bidding or where the CCG is commissioning a service through Any Qualified Provider (AQP) a conflict could arise where one or more GP practices (or other providers in which CCG members have an interest) are amongst the qualified providers from whom patients can choose. Any conflicts which arise during a procurement exercise will be recorded for audit purposes. The CCG will use the procurement template (Appendix 8) to satisfy itself that the relevant factors have been considered when developing plans to commission services under delegated commissioning arrangements or other commissioning of services where GPs are current or possible providers of the service.

11.0 11.1

Register of Procurement Decisions The CCG will maintain a Register of Procurement Decisions5 taken either for the procurement of a new service or any extension or material variation of a current contract, which will include:

4 The NHS (Procurement, Patient Choice and Competition) Regulations (No 2) 2013, issued under section 75 of the HSCA

Date: August 2017


the details of the decision;

who was involved in making the decision (i.e. Governing Body or committee members and others with decision making responsibility);

a summary of any conflicts of interest in relation to the decision and how they were managed; and

the award decision taken.

11.2 11.3

The Registers, which will be published on the CCG website, made available for inspection at the CCG headquarters and integrated into the CCG’s annual accounts will be updated whenever a procurement decision is made. A template of the register to be used is included at Appendix 9.

The CCG will seek to ensure planned service developments and possible procurements are also recorded on a register which are transparent and available for the public to see, in keeping with good practice.

11.4 11.5 11.6

Designing service requirements The CCG recognises that it is good practice, and appropriate, to engage with providers, especially clinicians, when designing service specifications to meet patients need.

Whilst such engagement is entirely legal if done in an open and transparent way and in accordance with the three main principles of procurement law, conflicts of interest can occur where a commissioner is selective in the providers it engages with for a contract for which they may later bid (be they incumbent or potential new providers).

The CCG will endeavor to manage conflicts of interest in relation to service design by:

specifying outcome based service specifications rather than process driven deliverables to help prevent bias towards any particular provider;

advertising the service design / re-design exercise widely and invite comments from any potential providers;

engaging with a wide range of providers through the stages of design development;

engaging independent clinical advice as appropriate;

being transparent about processes to be followed;

ensuring at all stages that potential providers are aware of the commissioning process; and

maintaining commercial confidentiality of information received from providers.

11.7 11.8 11.9

Decision Making when a conflict arises in respect of primary medical care

commissioning

Procurement decisions relating to the commissioning of primary medical care will be made by the Primary Care Commissioning Committee, following recommendation by the Finance, Contracting and Procurement Committee.

Any conflicts of interest will be considered on a case-by-case basis, although membership of the Committee will be constituted to have a lay and executive majority.

The CCG’s arrangements for primary medical care commissioning do not preclude GP

5 Regulation 9 of the NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 requires a record of procurement decisions

is maintained.

Date: August 2017


11.10

participation in strategic discussions on primary care issues, subject to appropriate management of conflicts of interest, however, GPs will not have voting rights.

Due to the importance of managing conflicts of interest appropriately within the sub-committees and sub groups, sub-group minutes should be submitted to the Primary Care Commissioning Committee. The minutes should detail any conflicts and how they have been managed. The Primary Care Commissioning Committee should take any action where they have concerns.

12.0 12.1 12.2

Declarations of Interest and Member Practices The British Medical Association (BMA) has identified that a conflict of interest may arise in the following instances:

where GPs may refer their patients to a provider company in which they have financial interest;

where GPs make decisions regarding the care of their patients to influence the ‘quality premium’ they receive through their CCG;

where enhanced services are commissioned that could be provided by member practices.

The CCG will expect that member practices must continue to ensure that patients are referred to the service that they in their professional opinion believe is most appropriate for that patient’s condition, whilst responding to the wishes and choices of that patient. Where the most appropriate service to which the patient is referred is also one in which the GP has a vested interest the GP must inform them of this fact, in line with paragraph 76 of the General Medical Council Guidelines ‘Good Medical Practice (2006)’.

13.0 13.1 13.2 13.3

Declarations of Interest for contractors and people who provide services to the CCG Anyone seeking information in relation to procurement, or participating in procurement, or otherwise engaging with the CCG in relation to the potential provision of services or facilities to the CCG, will be required to make a declaration of any relevant conflict / potential conflict of interest.

Bidders will be asked to make a declaration of any relevant conflict or potential conflict of interest at the invitation to tender stage of the procurement process. This form is enclosed at Appendix 7.

Anyone contracted to provide services or facilities directly to the CCG will be subject to the provisions of this policy in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

14.0 14.1

Conflicts of Interest where GP practices are potential providers of CCG commissioned services When commissioning services from GP practices, the CCG will seek assurance on potential conflicts, and be ready to assure local communities, Health and Wellbeing Boards and auditors of open and transparent processes being in place and effective

Date: August 2017


arrangements for the management of these when commissioning services that may potentially be provided by GP practices.

15.0 15.1

Managing conflicts to protect the integrity of the decision-making process To support the CCG in delivering its statutory duties the following principles will need to be integral to the commissioning of all services. They will be particularly important at the key commissioning decision making points leading up to and after the actual procurement of services and in deciding whether to go out to procurement:

Doing business appropriately: ensuring needs assessments, consultation mechanisms, commissioning strategies and procurement procedures are right from the outset;

Being proactive, not reactive: identifying and minimising the risk of conflicts of interest at the earliest opportunity;

Be balanced and proportionate: clear and robust rules but not overly prescriptive or restrictive. Rules should ensure that decision making is transparent and fair whilst not being overly constraining, complex or cumbersome;

Assuming that individuals will seek to act ethically and professionally, but may not always be sensitive to all conflicts of interest: ensuring there are prompts and checks in place to reinforce the process for managing conflicts of interest, for instances where individuals do not volunteer information and exclude themselves from decision-making where conflicts exist; Openness: ensuring early engagement with patients, the public and Health and Well Being Boards in relation to proposed commissioning plans;

Transparency: a clearly documented approach will be taken at each stage of the commissioning cycle;

Responsive and best practice: commissioning intentions will be based on local health needs and reflect evidence of best practice;

Securing expert advice: plans will take into account advice from appropriate health and social care professionals;

Engaging with providers: there will be early engagement with both incumbent and potential new providers over potential changes to the commissioned services for the local population;

Create clear and transparent commissioning specifications: these will reflect the depth of engagement and set out the basis on which any contract will be awarded;

Proper procurement processes will be followed and there will be an even handed approach to providers;

Ensure sound record-keeping, including an up to date register of interests: best practice in sound record-keeping will be applied and appropriate information will be made available and accessible; a register of interest with a clear system for declarations of interests will be maintained;

Dispute resolution: having systems for resolving disputes clearly set out in advance;

Create a supportive environment and culture: where individuals feel confident in declaring relevant information and raising any concerns.

16.0 16.1

Dispute Resolution

It is anticipated that disputes arising as a result of conflicts of interest will normally be resolved informally, without recourse to a formal process. If, however, the dispute cannot be resolved informally, the process by which any perceived breach would be handled is set out below.

Date: August 2017


16.2

The procedure is based on the principle that disputes should be resolved at the most local level possible. If the dispute is not successfully resolved by the CCG, the complaint should then by heard by NHS England.

16.3

Objectives

The objectives of the procedures are as follows:

To provide the CCG with an appropriate mechanism for dealing with disputes about conflict of interests;

To resolve disputes transparently, fairly and consistently;

To assure bidders and service providers that the process is fair and transparent;

To mitigate risks and protect the reputation of the CCG; and

To prevent, where possible, legal challenge/expensive referral processes.

16.4 When handling disputes the CCG will:

Commit to transparency;

Communicate the process and decision making criteria widely and in advance;

Engage all relevant stakeholders;

Publish findings within and across the CCG to enable consistency;

Be objective and base the analysis and the decision on objective information and criteria; and

Maintain an audit trail.

16.5 16.6 16.7

Procedure

The CCG dispute resolution procedure in relation to conflicts of interests is made up of the following stages:

Stage 1: Making the Complaint-Any complaint must be submitted to the Conflicts of Interest Guardian in writing. The complaint will be acknowledged within five working days;

Stage 2: Triage –Following receipt of the complaint, the Conflicts of Interest Guardian may contact the complainant to request clarification or further information. If the complaint is not deemed by the Conflicts of Interest Guardian to warrant proceeding further, the complainant will be notified that the complaint will not progress.

If the complaint should be fast tracked to another organisation for legal, governance or safety reasons, the complainant will be informed of the course of action.

Where a complaint is in scope and not subject to fast tracking, it will proceed to the next stage. In most cases, the triage process should be carried out within five working days.

Stage 3: Conflicts of Interest Guardian Review – Following triage, the CCG’s Conflicts of Interest Guardian will review the complaint to determine whether a swift resolution can be achieved without the need to involve the Audit Committee. The Conflicts of Interest Guardian may call a meeting of the parties concerned to discuss the matter informally and without prejudice. If the Conflicts of Interest Guardian is unavailable or if the complaint involves the Conflicts of Interest Guardian, the Chief Finance Officer will review the complaint and act in

Date: August 2017


accordance with this procedure as appropriate.

Stage 4: The Audit Committee –If the complaint cannot be resolved by the Conflicts of Interest Guardian, the Audit Committee will formally review the complaint (with external advice as required).

Stage 5: The Decision – Following review of the complaint, the CCG will notify the complainant of the decision, explaining the rational and, if necessary, any required course of action.

16.8 16.9

It is expected that the procedure as a whole should not take longer than three months. Independent external mediation will be used where conflicts cannot be resolved through the usual procedures.

Right of Appeal

The CCG expects that most complaints will be successfully resolved. However, if the complainant is unsatisfied by the results of this procedure, they can refer the complaint to the NHS England process. Appeals to the NHS England must be made within three months of the complainant being notified of the CCG’s decision

17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7

Breaches of the Policy All suspected breaches in policy and concerns in respect of Conflicts of Interest should be reported in the first instance to the Conflicts of Interest Guardian. The Conflicts of Interest Guardian will investigate the concern to see if a breach of the policy has occurred. They will be supported in this process by the Deputy Director of Business Delivery or Corporate Governance Manager.

Where a breach has occurred, the Conflicts of Interest Guardian will determine the most appropriate course of action to take. The Deputy Director of Business Delivery will arrange for the notification to NHS England. Any non-compliance with the CCG’s Conflicts of Interest Policy will be handled in line with the CCG’s Whistleblowing Policy. Anyone who wishes to report a suspected or known breach of the policy, who is not an employee or engaged with the CCG, should ensure that they comply with their own organisation’s whistleblowing policy, since most policies provide protection from detriment or dismissal. All breaches will be reported on the CCG website with anonymised details for the purposes of learning and development.

Failure to comply with the CCGs policy, which is based on statutory guidance can have serious implications for the CCG and any individual concerned. A breach of the policy may give rise to:

Civil Implications Where the CCG could face a civil challenge to any decisions made.

Criminal Implications criminal proceedings for offences like bribery, corruption or fraud. The outcomes of such

Date: August 2017


17.8 17.9

proceedings have serious implications for the CCG or any individual. For example fraud convictions carry a maximum of 10 years.

Disciplinary The CCG will ensure that any disclosure of relevant interests that is subsequently revealed and which compromises decisions is investigated and dealt with through disciplinary procedures where it is deemed appropriate.

Professional Regulatory Implications Clinicians that work for the CCG who are statutorily regulated with regard to conflicts of interest may be reported to that body if it is clear that they have acted improperly. Fitness to practice proceedings could ensue.

18.0 18.1 19.0 19.1 19.2 19.3 19.4

Implementation and Dissemination Following approval by the Governing Body, this policy will be disseminated to whom it applies and published on the CCG website. It will all be made available to those persons and organisations subject to its terms.

Training The CCG has responsibility for ensuring training on Conflicts of Interest is provided to try and ensure that all individuals act in an ethical way. Training will be provided to all members, employees, governing body members and members of CCG committees and sub-committees at induction and with completion of the on-line conflicts of interest training package, completed annually. Additional training will be provided to members where required. This may be directly provided or in participation with partners or other agencies as appropriate.

Training will comprise:

what is a conflict of interest;

why is conflict of interest management important;

what are the responsibilities of the CCG in relation to conflicts of interest;

what should you do if you have a conflict of interest relating to your role, the work you do or the organisation you work for (who to tell, where it should be recorded, what actions to take and what are the implications for your role);

how conflicts of interest can be managed;

what to do if you have concerns that a conflict of interest is not being declared or managed appropriately;

what are the potential implications of a breach of the CCG’s rules and policies for managing conflicts of interest.

20.0 20.1

Monitoring and Review of the policy Compliance with the policy will be monitored continuously and annually there will be an Internal Audit review which will be reported to the Audit Committee. The results of the audit will be reflected in the CCG’s annual governance statement and will be discussed

Date: August 2017


20.2 21.0

in the end of year governance meeting. The policy and supporting procedures will be reviewed annually or earlier should the CCG become aware of changes in practice, changes to statutory requirements, revised professional or clinical standards and local / national directives that affect, or could potentially affect the policy. Other Associated Documents The following documents should also be considered in respect to Conflicts of Interest:

NHS Bury Clinical Commissioning Group Constitution

Standards of Business Conduct Policy

Anti-Fraud, Bribery and Corruption Policy

Procurement Policy

Whistleblowing Policy

Gifts and Hospitality Policy

22.0 References NHS England Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (2017, June)

NHS Commissioning Board Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-Commissioned services. (2013, April)

Towards Establishment: Creating Responsive and Accountable Clinical Commissioning Groups, (2012) NHS Commissioning Board

Towards Establishment: Creating Responsive and Accountable Clinical Commissioning Groups, Frequently Asked Questions (2012) NHS Commissioning Board

Managing Conflicts of Interest Technical Appendix 1, (2012) NHS Commissioning Board

Ensuring Transparency and Probity, (2011) British Medical Association Managing Conflicts of interests in Clinical Commissioning Groups, (2011) Royal College of General Practitioners / NHS Confederation

Date: August 2017


Appendix 1 : Shared principles on Conflicts of Interest when CCGs are commissioning from Member Practices6

1. Introduction The ability for CCGs to become involved in co-commissioning General Practice and primary care services has the potential to bring many benefits but it also brings with it the potential for perceived and actual conflicts of interest.

NHS Clinical Commissioners (NHSCC), the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) have decided to collectively outline their high level starting principles in managing conflicts of interest when CCGs commission from member practices. In large part this has brought together principles articulated in previous lines/guidance/steer from the above organisations and NHS England.

Our principles are applicable to each of the three primary care commissioning models open to CCGs and should not be seen as being directive or be interpreted to mean that we prefer one model over another. These decisions need to remain a local, professionally led, decision.

In developing these shared principles we would like them to sit alongside NHS England’s updated guidance on Managing Conflicts of Interest Revised Statutory Guidance (June 2016). We are on a journey regarding the co-commissioning of primary care and we will review these principles when needed and as CCGs work through the guidance.

It should be noted that this paper is not designed to address the issue of perceived or actual conflicts of interest in CCGs holding and performance managing GP contracts under co-commissioning arrangements.

2. Our headline shared principles around conflicts of interest We collectively agree the following in relation to managing conflicts of interest when CCGs commission from member practices:

If CCGs are doing business properly (needs assessments, consultation

mechanisms, commissioning strategies and procurement procedures), then

the rationale for what and how they are commissioning is clearer and easier to

withstand scrutiny. Decisions regarding resource allocation should be

evidence-based, and there should be robust mechanisms to ensure open and

transparent decision making.

CCGs must have robust governance plans in place to maintain confidence in

the probity of their own commissioning, and maintain confidence in the

integrity of clinicians.

CCGs should assume that those making commissioning decisions will behave

ethically, but individuals may not realise that they are conflicted, or lack

awareness of rules and procedures. To mitigate against this, CCGs should

6 NHS Clinical Commissioners, Royal College of General Practitioners and British Medical Association,

December 2014

Date: August 2017


ensure that formal prompts, training and checks are implemented to make

sure people are complying with the rules. As a rule of thumb, ‘if in doubt, disclose’

CCGs should anticipate many possible conflicts when electing/selecting

individuals to commissioning roles, and where necessary provide

commissioners with training to ensure individuals understand and agree in

advance how different scenarios will be dealt with.

It is important to be balanced and proportionate – the purpose of these tools is

not to constrain decision-making to be complex or slow.

3. Addressing perceived as well as actual conflicts of interest

Conflicts of interest in the NHS are not new and they are not always avoidable. The documents we reviewed to produce this paper were all clear that the existence of a conflict is not the same as impropriety and focus on how to avoid potential or perceived wrongdoing. Most importantly all acknowledge that perceived wrongdoing can be as detrimental as actual wrongdoing, and risks losing confidence in the probity of CCGs and the integrity of wider clinicians such as GPs in networks/federations, individual practices and partners.

The RCGP/NHS Confederation also notes evidence from the BMJ that people think they aren’t biased by potential conflicts but often are, so the common theme is - if in any doubt it’s important to disclose.

The RCGP/NHS Confederation and NHS England Guidance identify four types of potential conflict of interest:

direct financial;

indirect financial (for example a spouse has a financial interest in a provider);

non-financial (i.e. reputation) and;

loyalty (i.e., to professional bodies).

The BMA recognises that for CCGs there will be situations where the best decision for the population and taxpayers is not in the best interest of individual patients (for whom GPs are required to advocate) and that this can create a perceived conflict. The RCGP/NHS Confederation paper acknowledges this but in terms of the governance when commissioning services.

4. Planning for populations

CCGs must always demonstrate that their commissioned services meet the needs of their local populations, as such CCGs will need to work with their Health and Wellbeing Board’s or other local strategic bodies to ensure there is alignment to local strategic plans.

What is clear from all the existing guidance is that CCGs will need to identify the situations where they are involving their governing body clinicians to strategically

Date: August 2017


plan for their population, and situations where their governing body clinicians need to be separated from procurement, planning and decision-making processes. In the former it is critically important to secure clinical expertise. In the latter, the CCG will need to manage risks around perceived and actual conflicts in relation to the tendering of services.

The BMA outlines that decisions regarding resource allocation should be evidence based, and there should be robust mechanisms to ensure open and transparent decision making. As such, GP involvement must be agreed at each stage of the commissioning and procurement process so that potential risks of conflicts are appropriately defined and mitigated early on.

5. Good practice – for CCGs

All the guidance suggests CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.

The RCGP/NHS Confederation suggests using existing NHS guidance as a starting point:

Identify potential conflicts

Declare interests in a register

Exclude individuals from discussion or decision making if financial interest

exceeds 1% equity in the provider organisation - depending on the nature of

the discussion (we would also add that includes considering the share of the

contract value to make sure there are no loopholes, this might also apply to

practices with profit sharing arrangements).

Continue to manage conflicts post-decision i.e. contract managing (carefully

separating overall strategy development for populations from individual

procurement processes. The former will be important for CCG lay involvement

will be important and include secondary care clinicians and non-executive

board nurses, the latter can be managed by managers).

NHS England guidance also says that an individual with a ‘material interest’ in an organisation which provides or is likely to provide significant business should not be member of CCG governing body. The BMA suggests anything above 5% equity is a material interest. The RCGP/NHS Confederation reference this threshold but also say that something lower than a 1% stake could also be a material interest (if the size of the bid is significant).

Clearly these thresholds need to be considered in relation to individual practices and GP partners once co-commissioning is in place. The perceived risks must be recognised early on and we feel some worked case study examples would be helpful for CCGs as they work through the updated guidance. NHSCC, the RCGP and the BMA are planning to work with NHS England and Monitor to identify these examples.

Date: August 2017


NHSCC believe that CCG lay members, secondary care doctors and nurses on governing bodies play a vital role in the design, implementation, leadership and monitoring of conflicts of interest systems and processes. They can provide robust challenge and ultimately a protection for GPs working in both the commissioning and provision of health care. Enabling them to carry out their roles in this regard is vital.

CCGs should also be proactive in their approach when considering conflicts when electing/selecting people, doing a proper induction (i.e. include continuous training and review at both Governing Body and membership (assembly level) and ensuring understanding from individuals, and agree in advance how different scenarios will be dealt with. The CCG should ensure individuals are prompted to declare an interest but not absolved from their responsibility to declare as well. Again, CCG lay members, secondary care doctors and nurse members of the governing body have a critical role in this process, as an independent arbiter and as those providing appropriate scrutiny and oversight.

NHS England’s Code of Conduct guidance specifically explores when CCGs are commissioning services from their own GP member practices. When CCGs are commissioning from federations of practices, the same guidance should apply.

As practical support NHS England have also produced an updated code of conduct template for use when drawing up local plans (see their updated guidance). The template asks a series of questions to provide assurance to Health and Wellbeing Boards that the service meets local needs, and to the Audit Committee or external auditors that robust process was used to commission the service, select the appropriate procurement route and address potential conflicts of interest.

6. Good practice - for individuals

The current guidance suggests that individuals making decisions in CCGs do so with the Nolan principles of public life in mind: selflessness, integrity, objectivity, accountability, openness, honesty, and leadership.

They also refer to the guidance the General Medical Council (GMC) has produced for doctors including:

You must not allow any interests you have to affect the way you prescribe for,

treat, refer or commission services for patients.

If you are faced with a conflict of interest, you must be open about the conflict,

declaring your interest informally, and you should be prepared to exclude

yourself from decision making.

You must not try to influence patients’ choice of healthcare services to benefit you, someone close to you, or your employer. If you plan to refer a patient for

investigation, treatment or care at an organization in.

NHS England guidance indicates that individuals must declare an interest as soon as they become aware of it, and within 28 days. More informally, the RCGP/NHS Confederation also suggested the simple ‘Paxman test’ - whether explaining the situation to an investigative reporter/journalist like Jeremy Paxman would cause

Date: August 2017


embarrassment. We think it would be helpful to develop this type of text into a tool for CCGs to use locally.

Finally, the BMA suggested that commissioner doctors:

Declare all interests, even if they are potential conflicts or the individual is

unsure whether it counts as a conflict, as soon as possible.

Update a register of interests every three months.

Doctors must be familiar with their organisation’s formal guidance. If individual doctors have any questions, they should seek advice from

colleagues, err on the side of being open about conflicts of interest, or seek

external advice from professional or regulatory bodies.

In addition to the above, the RCGP suggests there should also be a requirement to update the register of interests if a material difference arises in the circumstances of an individual at any point.

7. Procurement processes – CCGs and member practices

According to the BMA guidance, when CCGs are procuring community level services, these contracts are often below threshold requiring a competitive tender process.

There are a number of procurement options for CCGs in this situation – for example a few may include: 1. Competitive tender where GP practices are likely to bid 2. AQP where GP providers are likely to be among the qualified providers 3. Single tender from GP practices

From the guidance that exists, different questions arise around conflicts of interest when the above procurement processes are used. For example:

Identifying whether approaches such as AQP are being used with the

safeguards to ensure that patients are aware of the choices available to them.

If single tender is the route used, CCGs will need to demonstrate a few things

depending on the nature of the procurement. For example that there are no

other capable providers, why the successful bid was preferred to the others

and the impact of disproportionate tendering costs. (Monitor’s procurement guidance provides many useful steers on what CCGs will need to

demonstrate)

For primary care co-commissioning, NHSCC believes one of the elements to include on procurement processes are the issues around standing financial orders and schemes of delegation which should not allow CCGs to divide primary care budgets into smaller budgets to circumvent the procurement process. NHSCC’s lay member network will have examples/steer on the correct wording to use from previous local experiences.

Date: August 2017


Regardless of what the local application is the most important part of this process is transparency. NHS England says to set out the details, including the value of all contracts on the CCG website. If they are using AQP, the types and prices of services they are commissioning should be on the website. All of this information should also be in the CCG’s annual report.

When making procurement decisions, the current guidance suggests that anyone with a perceived or material conflict should be excluded from decision making, either both excluded from voting or from discussion and voting. What is not clear in the guidance is how far back this rule goes – i.e. to the planning stage or just the development of the specification and procurement. CCGs will need to agree that line locally.

According to the reviewed guidance if all GPs and practice representatives due to make a decision are conflicted, then the CCG should be:

Referring decisions to the governing body, so that lay members / the nurse / the secondary care doctor can make the final decision. However this may weaken GP clinical input into decision making.

Co-opting individuals from the HWB or another CCG onto the governing body, or invite the HWB / another CCG to review proposal to provide additional scrutiny (these individuals would only be able to participate in decision making if this was set out in the CCG constitution)

Ensure that quoracy rules enable decisions to be made in this circumstance

Plan ahead to ensure that agreed processes are followed.

Use an appropriately constituted arms-length external scrutiny committee to ensure probity (recommended by the BMA)

CCGs can use commissioning support services (CSS) to reduce potential conflicts, for example a CSS can help select the best procurement route and prepare bids etc. However, this cannot completely eliminate the conflict as CCGs are responsible for signing off specification and evaluation criteria, signing off which providers to invite to tender, and making the final decision on the selection of the provider. The CCG is responsible for ensuring that their CSS or other third parties are compliant with regulations in the same way that the CCG must be.

NHS England also suggest any questions about the service going beyond the scope of the GP contract should be discussed with NHS England area teams, clearly that would need review in light of new delegated co-commissioning arrangements.

Networks and Federations We note that the increasing number of GP networks and federations could potentially present an added complication to local procurement processes. If most or all CCG member practices are part of the local federation, then this could mean that a practice not part of the federation/excluded from a federation may not have the opportunity to win contracts through competitive tender – because the process is more suited to federated organisations. One way to mitigate this would be for the CCG to always design and procure service specifications according to best practice (with openness and transparency), thereby supporting all practices to bid. One area to be careful about is when all the GPs on a governing body have a declared

Date: August 2017


interest in local federations – this makes decision making and accountability complex and the CCG will need to work that through carefully with the input of its lay members and wider clinicians on the governing body. Again, an external scrutiny committee with non-conflicted clinicians such as from a neighboring CCG may be helpful.

8. Local engagement

Separately, the BMA suggests that LMCs should be involved in CCGs either by formal consultation, a non-voting seat on governing body, or as an observer on governing body. They indicate that a non-voting governing body seat would be the best option. Neither of the other two papers we reviewed addresses this.

9. Other conflicts of interest issues for consideration

Personal conflict The RCGP/NHS Confederation highlight that in CCG governing bodies a personal conflict can arise because CCG leaders are elected by their constituent GP members. There could be a perception that CCG governing bodies are favoring the most vocal or influential of their GP practice members. Related to this is the potential indirect interest for elected GPs to build a constituency of supporters within their CCG.

The CCG is responsible for ensuring that their CSS or other third parties are compliant with regulations in the same way that the CCG must be.

NHS England guidance suggests that in the case of every GP governing body member being conflicted, the lay members, registered nurse and secondary care doctor make the decision (and that the constitution is written so that this is quorate). This could however mean that decisions would be taken without a GP perspective. Alternatively, CCGs may bring in members of the Health and Wellbeing Board or another CCG to provide oversight, or as the BMA suggests use an external scrutiny committee to make decisions.

Use of primary care incentive schemes In its guidance, the BMA highlights its concerns about the professional and ethical implications of CCGs applying incentive schemes to reduce referral or prescribing activity. The BMA urges any doctor, whether commissioner or provider, to consider the schemes carefully and ensure that scheme is based on clinical evidence. NHSCC suggests that one solution is to ensure the expertise of secondary care clinicians and nurses on governing bodies plays an important part in providing clinical input and lay members can scrutinize commercial/ financial and performance data.

The RCGP acknowledge that it is not ethical to under-treat or under-refer for financial gain, but is not unethical to ‘review and reflect’ on variations in referral/prescribing rates and try to reduce referrals in line with evidence or best practice.

Date: August 2017


Note to the reader:

This appendix has been developed from a review of three guidance documents and brings together previous lines/guidance from NHSCC, NHS England, the RCGP and the BMA.

BMA ‘Conflicts of interest in the new commissioning system: Doctors in commissioning roles’ April 2013

RCGP/NHS Confederation ‘Managing conflicts of interest in clinical commissioning groups’ September 2011

NHS England ‘Managing conflicts of interest: Revised Statutory Guidance for

CCGs – June 2016 (preceded by the same of March 2013 and the prior

Commissioning Board Document).

NHSCC have also supplemented the principles raised in this paper with some points for steer that have been raised by members of its lay member network.

Date: August 2017


Appendix 2: Examples of Conflicts of Interest

The following examples are considered to be the most likely scenarios which Governing Body members will face, albeit that the list is indicative rather than definitive.

In certain circumstances, the categorisation of the interest will be determined by materiality, and this will need to be determined on a case-by-case basis by the Chair of the meeting concerned.

Interests will be clearly recorded in the minutes of each meeting, showing clearly when members participation started and ended, the dates from which the interest relates, and how each member voted.

1. Consideration of the contract with the Out of Hours Service Provider. GB Member is

owner/director of the service provider. Member must declare an interest and withdraw from the debate and decision.

2. Consideration of the contract with the Out of Hours Service Provider. GB Member is employee of the service. Member must declare an interest, materiality to be discussed on a case by case basis.

3. Consideration of a contract in an area where a GB Member is currently employed as

a “GP with Special Interests”. Member must declare an interest, materiality to be discussed on a case by

case basis.

4. Consideration of a contract for services for which GP practices have AQP status. Member must declare an interest and withdraw from the debate or decision.

5. Consideration of a contract for services for which some GB Members are shareholders, with a holding of below 5% of the total shareholding Members must declare an interest and can take part in the debate. Decision

to take part in voting on a case by case basis.

6. Consideration of a contract for services for which some GB Members are

shareholders, with a holding of 5% or more of the total shareholding Members must declare an interest and withdraw from the debate and

decision.

7. Consideration of a contract where the AQP listing includes private companies or

voluntary organisations whose governing body includes CCG Governing Body Members and staff in senior posts. Members must declare an interest and withdraw from the debate and decision.

8. Governing Body to discuss implementation of a Local Enhanced Services Scheme

for which all GP Practices have AQP status, and benefit equally from its implementation.

Date: August 2017


Members must declare an interest, can take part in the debate but must withdraw from the decision.

9. Governing Body to discuss implementation of an Incentive Scheme for which all GP

Practices have AQP status, and benefit equally from its implementation. Members must declare an interest, can take part in the debate but must

withdraw from the decision. It does, however, lie within the CCGs purview to

amend and veto participation in the debate; or amend and allow voting if they

consider it to be prudent.

10. Governing Body is being asked to accept and agree minutes of the Remuneration Committee, at which payments to a specific staff group have been proposed. Member must declare an interest and withdraw from the debate and decision.

11. Governing Body is discussing the allocation of IT resources to individual practices

from the IT Hardware Budget. Members must declare an interest and can take part in the debate. Decision

to take part in voting on a case by case basis.

Additional Scenarios

The following Scenarios are courtesy of The NHS Confederation and the Royal

College of General Practitioners 2011:

12. Three GPs and a practice manager who are members of the Governing Body of a clinical commissioning group have recently bought a small number of shares in GP Provident – a company set up by an investor and 16 local GP practices to provide tier-2 community health services.GP Provident has recently paid for two local GPs to be trained as GPs with a special interest (GPwSI’s) in gynaecology and has agreed to invest in the extension of a local surgery (where a commissioning group lead is a partner) and in purchasing ultrasound equipment so that a new GPwSI service can be set up. The CCG has recently published its strategic commissioning plan, which indicates that the group intends to see a shift of up to 30 per cent of outpatient gynaecology services from acute hospitals to community-based settings over the next three years, and that the CCG will be developing a specification for these community services to be delivered by Any Qualified Provider. Discussion Although the GPs and practice manager are not major shareholders in GP Provident, a conflict clearly exists as they could have made personal financial gain as a result of the CCG’s commissioning strategy. There is also a possibility that there could be a perception of actual wrongdoing. The CCG has to consider whether GP Provident has been given a competitive advantage over other providers or if these individuals have put themselves in a position to make a financial gain – due to access to insider knowledge about local commissioning intentions – and if it has put sufficient measures in place to avoid or remedy this.

Date: August 2017


The individuals concerned should have declared their interest in GP Provident when they bought the shares, and again at the point when the CCG began to discuss its commissioning strategy. The CCG should have a policy that clearly identifies circumstances under which members of the governing body should not participate in certain activities. The governing body may have decided to exclude these members from certain decisions about the commissioning strategy in line with its policy, although in this case that would have removed four key decision- makers from a central part of the group’s business. A decision to simply record the interest so that it is transparent might also be appropriate. Even if not excluded from discussion of the strategy, these individuals may well be excluded by the group’s policies from being involved in the development of the GPSI gynaecology service specifications (other than to the extent any other potential supplier might be involved in such service planning), or from any subsequent contract monitoring. The CCG may wish to consider whether or not involvement with a provider company likely to develop services and bid for contracts in this way is compatible with being a CCG board member at all, as this scenario is likely to arise again. However, this situation should have been identified and dealt with at the point when individuals were being selected to join the CCG. A decision should have been taken at that point on whether or not it would be appropriate for owners, directors or shareholders of local community service providers to be members of the governing body. If not, these individuals could not have been selected, or would be required to resign at the point when they decided to buy the shares.

13. The diabetes lead of a CCG has been working on a community diabetes project for two years and has a plan to reduce diabetes outpatient’s activity by 50 per cent and to reinvest in primary care education, patient education, more specialist nurses and community consultant sessions. A cornerstone of this new service is a proposal to fund local practices for participating in GP and nurse education, and improving the prevention, identification and management of diabetes within primary care. Discussion Rather than benefiting a particular organisation, in this scenario all GP practices/primary care providers in the area could potentially benefit from the proposals being developed by primary care-based commissioners, at the expense of existing secondary care providers. The CCG may have to deal with the perception and challenge that the GP commissioners were favouring their ‘electorate’. However, there is nothing wrong with the proposal if it can demonstrate that it is possible and appropriate to reduce the number of people being referred to hospital for the management of diabetes and related complications, that it is likely to improve patient experience and outcomes overall, and that the service improvement required to achieve this relates specifically to general practices with registered lists of patients.

Date: August 2017


The CCG should have set out and communicated the case for change and the rationale for the proposed service model clearly and transparently before taking, or recommending, the final decision to proceed. When developing the diabetes commissioning strategy, the group should have consulted on, and then been absolutely clear about, who would have the opportunity to provide the service model. This should have been consistent with an existing commissioning strategy and procurement framework and with the Joint Strategic Needs Assessment and health improvement plans of the relevant health and wellbeing board. Other qualified providers should be given the opportunity to provide those elements of the new service model not specifically embedded in general practice, for example, specialist nursing and community-based consultant sessions.

14. Dr X is the chair of a local commissioning group. He is married to Dr Y. Dr Y is the clinical director for Health R Us, a company which has developed risk stratification software designed to enable primary care providers to identify vulnerable patients at risk of going into hospital and help them to put measures in place to address this. Health R Us has offered to supply the software to Dr X’s CCG free of charge for one year to help develop it. It will then be offered at a discounted price because of the work that the group would have done in developing it and acting as a demonstration site. Discussion There is no immediate financial gain to Drs X and Y from the decision to accept the software free of charge for a year. However, there is potential future gain to Dr Y (and therefore to her husband) as the clinical director of a company that could profit from a product that her husband’s CCG has helped to develop, and from a preferential position as an incumbent supplier to that group. Dr X should declare an interest and he should exclude himself from any decision-making about this project. Any decision subsequently taken by the rest of the group should depend on whether or not the product on offer would help them to achieve an existing, stated commissioning objective (that is to say they should not accept it just because it is on offer), and whether or not the deal being offered was in line with the group’s existing policies for partnership working/joint ventures/sponsorship, etc. If the CCG had a clear, prioritised commissioning strategy and policies for working with other organisations, from the outset, this decision should be fairly straightforward. However, there is a question as to whether or not the group should accept this offer at all. Although it may meet an explicit commissioning objective, it may not be appropriate even then to simply accept the offer without, at least, some kind of analysis of whether other companies might be willing or able to offer the same or better. The concern is not necessarily about the personal relationships involved, but more generally about whether this is an acceptable way for a public body to do business.

15. Dr A is a member of a CCG with a longstanding interest in and commitment to improving health and social care services for older people. She has worked closely with local geriatrician, Dr B, for many years, including working as her clinical

Date: August 2017


assistant in the past. They have developed a number of service improvement initiatives together during this time and consider themselves to be good personal friends. Recently, they have been working on a scheme to reduce unscheduled admissions to hospital from nursing homes. It involves Dr B visiting nursing homes and doing regular ward rounds together with community staff. It has been trialled and has had a measure of success which has been independently verified by a service evaluation. They would now like to extend the pilot, and the foundation trust that employs Dr B has suggested that a local tariff should be negotiated with the CCG for this ‘out-reach’ service. The CCG has decided instead to run a tender for an integrated community support and admission avoidance scheme, with the specification to be informed by the outcomes of the pilot. Discussion Due to her own involvement in the original pilot, association with the incumbent provider and allegiance to her friend and colleague, Dr A has a conflict of interest. She should not be involved in developing the tender, designing the criteria for selecting providers or in the final decision making even though she is a local expert. If the CCG has clear prompts and guidelines for its members, this should be obvious to Dr A, who should decide to exempt herself. If the CCG is clear at the outset about its commissioning priorities and strategy and its procurement framework (setting out what kind of services would be tendered under what circumstances), its decision to tender for the service should not come as a surprise to the trust, or to the individuals involved. The CCG need to ensure that they do not discourage providers, or their own members, from being innovative and entrepreneurial by being inconsistent or opaque in their commissioning decisions and activities.

6 Monthly Declarations In Year Changes

You should complete a Declaration of Interest twice per

year

I have a new interest

I need to change my declaration

I have just been

appointed

Do you know what to include?

You must provide details in writing, as soon as you become

aware and no later than 28 days after becoming aware to

the Corporate Governance Manager

You should complete a

Declaration of interest Pro-

Forma Y N

Declarations are collated and the register of Interests updated:

Membership

Governing Body

Statutory Committees and

Sub Committees

Employees

Review by Corporate Governance Manager to

determine arrangements for managing conflicts

Reported to Audit Committee

Refer to Pro-Forma

PUBLISH ON WEBSITE

The Register will be amended and the change reflected in the next quarterly refresh

Review by Corporate

Governance Manager or Deputy Director to determine

arrangements for managing conflicts

What type of Interest do you have?

Could YOU financially benefit including as a shareholder? Financial Interest

Could you benefit from a decision in a professional capacity Non-financial Professional

Interest

Could you benefit from a decision in a personal capacity (could include membership of local voluntary organisations including board membership

Non-financial Personal Interest

Any of the above 3 which could affect family or close associate Indirect Interest

The Chair of the meeting will determine if there is a conflict of interest and the course of action to take (YOU should advise of the arrangements already agreed for managing the conflict)

In a Meeting

I have an interest in an agenda item

Is this on the Register of Interests?

N You need to

declare in the meeting

Y

Are you aware of the potential

conflict before the meeting?

Y N

You should declare at the start of the meeting and any arrangements for managing the conflict should be

implemented and noted in the minutes.

You need to update your declaration of

Interest Form

Are more than 50% of members affected?

The type and details of the interest and the course of action taken to be recorded in the minutes Chair to refer to CCG Constitution (P39

Clause 8.4.8 – 8.4.11) to determine next steps

N Y

Written notification of declarations made and course of action taken to be submitted to Governance Manager and

recorded on register of interests

Appendix 3: Conflicts of Interest Flowchart

Date: August 2017


Appendix 4: Declarations of Interests Form Declaration of Interests for CCG Members and Employees

Name: Position with, or relationship with the, the CCG:

Details of interests held (complete all that are applicable):

Type of Interest See attached guidance for details

Description of Interest (including for indirect interests details of the relationship with the person who has the interest)

Date interest relates to

Details of actions to be taken to mitigate risk (to be agreed with line manager or Corporate Governance Manager)

From To

The information submitted will be held by the CCG for personnel and other reasons specified in this form and to comply with the organisations policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that the CCG holds. I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal or internal disciplinary action may result. I do/do not give my consent for this information to be published on registers the CCG holds. If consent is not given please give reasons: Signed: Date: Signed (Line Manager): Date:

Date: August 2017


Types of interest

Type of Interest

Description

Financial Interests

This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;

A shareholder (or similar owner interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing,

or which is likely, or possibly seeking to do, business with health or social

care organisations.

A management consultant for a provider;

In secondary employment;

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Non- Financial Professional Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

A member of a particular specialist professional body (although routine GP

membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);

A medical researcher.

Non- Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure groups with an interest in health.

Indirect Interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:

Spouse / partner;

Close relative e.g., parent, grandparent, child, grandchild or sibling;

Close friend;

Business partner.

Date: August 2017


Appendix 5: Register of Interests for Publication on Website

Name Current Position

Declared Interest

(Name of organisation and nature

of the business)

Type of Interest Is this indirect of

direct?

Nature of Interest Date of Interest

Action taken to mitigate risk

Fin

an

cia

l

Inte

res

t

No

n-F

ina

ncia

l

Pro

fes

sio

na

l

No

n-F

ina

ncia

l

Pe

rso

nal

Date: August 2017 Conflicts of Interest Policy Page 40 of 52

Appendix 6 – Templates for Recording Interests at Meetings (Based on Template provided by NHS England Guidance)

XXXX Committee

ATTENDANCE

Other organisations in attendance

Apologies

MEETING NARRATIVE & OUTCOMES

1 CHAIR’S WELCOME

ID Type Risk/Issue/Action/Decision/Outcome

Description Owner

DC/00/00/0/00 Decision

AC/00/00/0/00 Action

2 DECLARATIONS OF INTEREST

SK reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of XXX clinical commissioning group. Declarations declared by members of the Primary Care Commissioning Committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: http://xxxccg.nhs.uk/about-xxx-ccg/who-we-

MINUTES OF MEETING

xxxxday xx XXXX 2016

Chair – XX XXXXX XXXXX

http://xxxccg.nhs.uk/about-xxx-ccg/who-we-are/our%20-governing-body/



are/our -governing-body/

Declarations of interest from sub committees. None declared Declarations of interest from today’s meeting The following update was received at the meeting:

With reference to business to be discussed at this meeting, MS declared that he is a shareholder in XXX Care Ltd.

SK declared that the meeting is quorate and that MS would not be included in any discussions on agenda item X due to a direct conflict of interest which could potentially lead to financial gain for MS. SK and MS discussed the conflict of interest, which is recorded on the register of interest, before the meeting and MS agreed to remove himself from the table and not be involved in the discussion around agenda item X.

ID Type Risk/Issue/Action/Decision/Outcome Description

Owner



4 AGENDA ITEM

MS left the meeting, excluding himself from the discussion regarding xx. <conclude decision has been made> <Note the agenda item xx> MS was brought back into the meeting.

ID Type Risk/Issue/Action/Decision/Outcome Description

Owner





Template for Recording Interests During Meetings

Report from [Insert details of sub-committee/work group]

Title of Paper

Meeting Details

Report Author and Job Title

Executive Summary

Recommendations

Outcome of Impact Assessments

Provide details of QIA/EIA. If this section is not relevant state not applicable.

Outline Engagement – clinical, stakeholder and public/patient

Insert details of any patient, public or stakeholder engagement activity. If this section is not relevant to the paper state no applicable.

Management of Conflicts of Interest

Include details of any conflicts declared. Where declarations are made include details of the conflicted individual, name, position; the conflict details, and how these have been managed in the meeting.

Confirm whether or not the interest is recorded on the register of interests – if not what the agreed course of action is.

Assurance departments/organisations who will be affected have been consulted

Insert details of the people you have worked with or consulted during the process:

Finance – Insert job title

Commissioning - – Insert job title

Contracting – Insert job title

Medicines Optimisation – Insert job title

Clinical Leads – Insert job title

Quality – Insert job title

Safeguarding – Insert job title

Other – Insert job title

Report previously presented to

Insert details including the date of any other meeting where this paper has been presented and the outcome

Risk Assessments: Insert details of how this paper mitigates risk: including conflicts of interest


Meeting Date of Meeting

Chair’s Name Administrator Name

Name of person declaring interest

Agenda Item Details of Interest declared

Action taken during meeting


Template declarations of interest checklist

Timing Checklist for Chairs Responsibility

In advance of the meeting

1. The agenda to include a standing

item on declaration of interests to enable individuals to raise any issues and/or make a declaration at the meeting.

2. A definition of conflicts of interest

should also be accompanied with each agenda to provide clarity for all recipients.

3. Agenda to be circulated to enable attendees (including visitors) to identify any interests relating specifically to the agenda items being considered.

4. Members should contact the Chair as soon as an actual or potential conflict is identified.

5. Chair to review a summary report

from preceding meetings i.e., sub-committee, working group, etc., detailing any conflicts of interest declared and how this was managed.

A template for a summary report to present discussions at preceding meetings is detailed below.

6. A copy of the members’ declared

interests is checked to establish any actual or potential conflicts of interest that may occur during the meeting.

Meeting Chair and secretariat Meeting Chair and secretariat Meeting Chair and secretariat Meeting members Meeting Chair Meeting Chair

During the meeting

7. Check and declare the meeting is

quorate and ensure that this is noted in the minutes of the meeting.

8. Chair requests members to declare any interests in agenda items- which have not already been declared, including the nature of the conflict.

Meeting Chair Meeting Chair


Timing Checklist for Chairs Responsibility

9. Chair makes a decision as to how to manage each interest which has been declared, including whether / to what extent the individual member should continue to participate in the meeting, on a case by case basis, and this decision is recorded.

10. As minimum requirement, the following should be recorded in the minutes of the meeting:

Individual declaring the interest;

At what point the interest was declared;

The nature of the interest;

The Chair’s decision and resulting action taken;

The point during the meeting at which any individuals retired from and returned to the meeting - even if an interest has not been declared;

Visitors in attendance who participate in the meeting must also follow the meeting protocol and declare any interests in a timely manner.

A template for recording any interests during meetings is detailed below.

Meeting Chair and secretariat Secretariat

Following the meeting

11. All new interests declared at the

meeting should be promptly updated onto the declaration of interest form;

12. All new completed declarations of interest should be transferred onto the register of interests.

Individual(s) declaring interest(s) Designated person responsible for registers of interest


Appendix 7: Bidders /potential contractors /service providers’ declaration form This form is required to be completed in accordance with NHS Bury CCG’s Constitution

Notes:

All potential bidders/contractors/ service providers, including sub-contractors, members of a consortium, advisers or other associated parties (Relevant Organisation) are required to identify any potential conflicts of interest that could arise if the Relevant Organisation were to take part in any procurement process and / or provide services under or otherwise enter into any contract with the CCG.

If any assistance is required in order to complete this form then the Relevant Organisation should contact the Corporate Governance Manager of NHS Bury CCG. .

The completed form should be sent to the Corporate Governance Manager of NHS Bury CCG. .

Any changes to interests declared either during the procurement process of during the terms of any contract subsequently entered into by the Relevant Organisation and the CCG must be notified to the CCG by completing a new declaration form and submitting to the Corporate Governance Manager of NHS Bury CCG. .

Relevant organisations completing this declaration form must provide sufficient detail of each interest so that a member of the public would be able to understand clearly the sort of financial or other interest the person concerned has and the circumstances in which a conflict of interest with the business or running of the CCG might arise.

If in doubt as to whether a conflict of interests could arise, a declaration of the interests should be made.

Interests that must be declared:

The Relevant Organisation or any person employed or engaged by or otherwise connected with a Relevant Organisation (Relevant Person) has provided or is providing services or other work for the CCG;

A Relevant Organisation or Relevant Person is providing services or other work for any other potential bidder in respect of this project or procurement process;

The Relevant Organisation or any Relevant Person has any other connection with the CCG, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG‟s or any of its members‟ or employees’ judgments, desires or actions whether such interests are those of the Relevant Person themselves or of a family member, close friend or other acquaintance of the Relevant Person.

Date: August 2017


Bidders / potential contractors / service providers’ declaration form: financial and other interests

Name of Relevant Organisation

Interests

Type of Interest Details

Provision of services or other work for the CCG

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgments, decisions or actions.

Date: August 2017 Managing Conflicts of Interest Policy Page 48 of 52

Name of Relevant Person Complete for all relevant persons

Interests

Type of Interest Details Personal interest or that of a family member, close friend or other acquaintance

Provision of services or other work for the CCG

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgments, decisions or actions.

Declaration To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information. Signed On behalf of Date

Date: August 2017


Appendix 8: Procurement Template

(to be used when commissioning services from GP practices, including provider consortia, or organisations in which GPs have a financial interest)

Service:

Question Comment/Evidence

How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits? How does it reflect the CCG‟s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?

How have you involved the public in the decision to commission this service?

What range of health professionals have been involved in designing the proposed service?

What range of potential providers have been involved in considering the proposals?

How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?


What are the proposals for monitoring the quality of the service?

What systems will there be to monitor and publish data on referral patterns?

Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available?

In respect of every conflict or potential conflict, you must record how you have managed that conflict or potential conflict. Has the management of all conflicts been recorded with a brief explanation of how they have been managed?

Why have you chosen this procurement route?

What additional external involvement will there be in scrutinising the proposed decisions?

How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process and award of any contract?

Additional question when qualifying provider on a list or framework or pre-selection tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)


How have you determined a fair price for the service?

Additional question when qualifying provider on a list or framework or pre-selection tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers

How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for direct awards to GP providers

What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?

In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

Date: August 2017


Appendix 9 - Template Procurement Decisions and Contracts Awarded

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To the best of my knowledge and belief the above information is complete and correct. I undertake to update as necessary the information. Signed: On behalf of: Date:

Meeting: Governing Body - Bury Clinical Comissioning … … · Meeting: Governing Body Meeting...

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