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All organisations in the NHS have a 'duty of candour'. One of the requirements is letting you know about any contacts with other organisations. We necessarily work with a lot of these to provide your health care and we do so in line with NHS codes of practice.
In the past it was very simple. If a patient needed care outside the practice we referred you to the appropriate NHS organisation – usually a community nurse or Salisbury Hospital. Now there is an internal market and lots more ‘providers’ all wanting these referrals. It means we have to be aware of potential conflicts of interest. Below are some of the ways to try and ensure we are not inappropriately influenced and ensure probity all the time.
The main ways we spend NHS money are by prescribing and by referring. Each prescription or episode of care has a cost (the average cost of a prescribed drug is about £10, of an out-patient appointment about £160, of an in-patient stay about £2,500). We are especially careful to avoid our clinical decisions being influenced by anything apart from providing the best care for our patients. Our prescribing budget is about £330,000 and our indicative budget for hospital care about three times this.
For prescribing we avoid inappropriate marketing influences from drug companies:
•We do not see and have not seen for many years any representatives of drug companies who are promoting their products, although we may obtain specific help like information booklets or dummy inhaler devices.
•We do not have involvement with drug company sponsored clinical initiatives like audits to change from one medicine to another.
•Drug companies are sometimes involved with the hospital or CCG to provide a beneficial service (like a detailed review and consultant appointment for a specific illness or a non-promotional educational event). Where we feel these are beneficial to patient care or where the training is a compulsory requirement by the CCG we will attend or use the service but will hold the organisers to account about any inappropriate promotional aspects.
•We do not attend educational meetings organised by drug companies.
•We do not attend social meetings organised by drug companies or health care organisations providing care for our patients (like private hospitals with NHS contracts).
•We do accept gifts of a trivial nature (ball point pens and post-it pads) if within the current national guidance.
•The dispensary staff have periodic meetings with our drug wholesalers as part of normal business practice.
For contact with other organisations who may provide care for our patients:
•We work closely with other NHS organisations and Wiltshire Council according to national contracts and guidelines
•We are members of Wiltshire Clinical Commissioning Group which is the NHS organisation responsible for commissioning the care for our patients and Dr Craig-McFeely has a leadership role in this helping the local practices work together to improve patient care.
•We are members of a local Federation of these local practices so that we can provide more care for our patients in community settings that currently take place in hospital (like follow up appointments) and to share back office functions more efficiently. Dr Sally Hayes is the practice representative on this group.
•We do not accept hospitality or attend corporate events run by health care providers like private hospitals with NHS contracts.
As well as telling our patients about possible conflicts of interest we also have a duty of candour when we make a mistake whether or not any harm resulted. Should this happen we will contact the patient and explain what happened, why it happened, what we will do to reduce the risk of it happening again and apologise.