Conflicts of interest and Royal College Guidelines

They are everywhere

Mine are declared on my home page. I hope my conflicts haven’t dulled my thinking, I’ll let others decide that. Maybe they aren’t inherently bad, I learned some useful ideas from the meetings from where my conflict arises, that I may not otherwise have learned.
NHSE have just published guidance on the matter. It’s excellent, comprehensive, wide ranging and very very practical.
Managing Conflicts Of Interest In The NHS: Guidance For Staff And Organisations

And the press release
From the blurb

“aims to strengthen the management of conflicts of interest within the NHS and to ensure transparent and accountable health care. The guidance permits NHS staff to receive small tokens or gifts but will require them to decline anything that could be seen to affect their professional judgement. It will also be standard practice for NHS commitments to take precedence over private practice, and for any member of staff – clinical or non-clinical – to declare outside employment and the details of where and when this takes place although not earnings at this stage.

It applies to NHS practice. This is great.
However…………There are things beyond NHS practice that have a massive bearing on NHS practice, namely clinical guidelines prepared by Royal Colleges (accepting that NICE is part of the NHS)

Often Royal College guidelines are viewed with more weight and gravitas my consultants than NICE (tell me if I’ve got that wrong)…. 

often I’ve seen College Guidelines with either 1) blatant non declaration of interests (which are well known and have sometimes been declared elsewhere) or 2) COI lists that are longer than the guidance itself (!)
Here’s two little ideas, courtesy of a friend of mine – who will remain nameless that might redress some of this and so reduce undue influences on the process of writing College guidelines
Firstly make it a GMC offence for non declaration of COI if there is an expectation of a declaration
Secondly, a default expectation that Royal college guideline development processes have same standards of COI management as NICE do (strict, rigorous and relentlessly enforced)
Just saying



  1. Fascinated to know why RC Guidelines are viewed by consultants as better than NICE equivalent when they may be far less robust by comparison (COI the tip of the iceberg). My experience has been that staff involved in both are amazed at the thoroughness of the NICE process when they are part of it. Maybe there is a lesson there: the perception is born out of a misunderstanding of how the guidelines are produced. The systematic review work in particular is world-class.


    • Hi agree on all fronts
      The College v NICE thing…..just a consistent observation of mine over the years
      “We don’t know nor trust NICE but we sort of own the College” etc etc…..agree 100% with you


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