Conflict is something that faces society in many different forms. We hear about conflict at a global level that has resulted in many thousands of casualties. Conflicts can also exist in dentistry and could arise between colleagues, with patients or with others. Increasingly organisations and individuals are worried about conflicts of interest and how they can affect the decisions we make and the decisions of others. The issue is not unique to dentistry but in other industries, such as law, the issue is more commonly examined due to the impact of failure to manage these conflicts.
Most committees and boards of both private and public organisations seem to seek declaration of interests, for those involved in this type of work they are probably familiar with the need to make this type of disclosure. In the public sector, these declarations are designed to protect the public and help ensure that decisions made by public bodies are transparent and free from bias or undue influence. It can work in both ways, if a senior public sector worker moved to the private sector there are circumstances when their prior knowledge could put their new employer at an unfair advantage. The civil service has a prescriptive set of rules in place that require ex-civil
servants to seek approval for up to two years from the point they leave office.
Senior civil servants are more likely to hold commercially sensitive knowledge about a particular industry and developments in that industry. They are also likely to be more closely connected to policy makers and decision makers, which could result in indirect bias. The Government has a responsibility to ensure that the market place is not distorted when an individual moves to the private sector and whilst the rules may seem bureaucratic they are equally necessary to provide safeguards. For example, if a chief dental officer left office and went to work for dental corporate we would probably all want a process in place that would allow senior public officials to determine when that was appropriate and how much time should elapse before it was permitted.
In a niche industry such as dentistry, it would be impossible to eliminate conflicts of interest and we may have to accept that these will exist. The important aspect is how we manage them and create rules and processes that prevent them from interfering with our work. They exist at every level from situations within individual practices all
the way through to senior appointments in regulatory bodies. Public bodies, such as the GDC, generally abide by the Nolan Principles for standards in public life. These principles help those officials working in these bodies conduct
themselves in a way which compatible with public life. For example, a GDC official would not be able to place themselves under obligation to outsiders that may unduly influence their behaviour.
Our GP colleagues in clinical commissioning groups (CCGs) are often faced with this dilemma as they are often service providers at a local level but also commissioners. Most of the work of CCGs was inherited from former PCTs, however as the commissioning cycle progresses some services are now being recommissioned and during that
process the GPs working for CCGs are sometimes finding themselves conflicted between their two roles. However, the assurance processes and external scrutiny over CCGs has meant that there are processes in place for identifying these conflicts.
As administrative boundaries in the NHS become bigger, it’s not unlikely that some dentists will work in practices which fall into the same administrative boundaries as other roles they may have such as dental practice advisors, public health dentists or even other commissioning roles. In my view, we are unlikely to ever be free of conflicts of interest in dentistry but we do need rules and processes in place to recognise and manage conflicts when they arise.