The NHS 10-Year Health Plan promises to reshape how care is delivered, moving towards more integrated, community-based systems through neighbourhood health services and new neighbourhood and GP contracts. That shift gives general practice a stronger voice in how local care is organised, but it also introduces new layers of responsibility and decision-making for those working within it.
As these new structures take shape, GPs will play a wider part in planning, managing and leading services that extend well beyond their own practice walls. With that influence comes greater complexity.
The more integrated the system becomes, the more chance there is that personal, practice and network interests will overlap, increasing the risk of conflicts of interest.
The best way to avoid or minimise these risks is to recognise potential conflicts of interest early and stay alert to the practical ways doctors can manage and protect themselves as their roles continue to expand.
More hats, more chance of risk
For decades, being a GP was primarily about clinical care. Today, it is much more than that. General practice has quietly become a portfolio career, where many doctors are simultaneously clinicians, employers, business owners, property holders and, increasingly, system leaders within organisations such as primary care networks (PCNs), federations, integrated care boards (ICBs) and local medical committees (LMCs).
These additional responsibilities are vital. GPs bring the frontline experience that is essential to shaping services around patients.
But with more roles come more points of potential conflict.
A GP who is both a partner in a practice and a director in a federation, for example, may be involved in funding or staffing decisions that affect both entities. A doctor who owns the premises their practice operates from might also sit on a board that decides on local premises investment.
In some meetings, the same individual could be a GP, a partner and a network director all at once.
Recognising which hat they are wearing at any given moment is the first line of defence against conflicts of interest.
Why it matters
Even when conflicts arise accidentally, the consequences can be significant.
When transparency slips, trust between partners, colleagues and networks can quickly be impacted. From a financial perspective, it can be even more damaging.
Disputes over decision-making or perceived bias can lead to expensive legal challenges, not because of wrongdoing, but because of how those decisions appear.
As practices become more embedded in neighbourhood networks, the boundary between independent business and collective system will blur, with financial and legal exposure growing with it.
Transparency is the best protection
Some might argue that the simplest answer is to limit secondary roles altogether, but that would be a mistake. The NHS needs GPs at every level to design services, shape policy and lead innovation.
The right answer lies in good governance and financial protection.
Being transparent about personal and practice interests builds trust and reduces the risk of misunderstanding, while encouraging constructive challenge within teams helps ensure decisions are balanced, transparent and defensible.
Alongside good governance, GPs should make sure financial safeguards are in place. Management liability or directors and officers (D&O) insurance can help cover the cost of defending claims linked to leadership or partnership decisions, while specialist advice ensures there are no protection gaps.
Practical steps to take
Managing conflicts of interest is not about eliminating risk entirely, but about recognising it early and planning for it.
Here are some simple, time-efficient steps that can help:
- Understand your multiple roles: List every formal position you hold, from partnership to PCN or federation involvement, and identify where responsibilities overlap.
- Document and declare: Keep clear records of any potential conflicts and ensure declarations are stored and updated. Even perceived transparency makes a big difference.
- Review your protection: If you are a partner or director in an incorporated entity, make sure you have management liability insurance. This can help cover legal costs if your decisions are challenged.
- Seek specialist advice: Financial advisers and legal counsel who understand medical careers can help you identify exposures you might not see and recommend protection that fits your situation.
- Encourage openness: Promote an environment where potential conflicts are discussed without blame.
Staying ahead of change
As the NHS 10-Year Health Plan unfolds, GPs will find themselves more connected to, and responsible for, the wider health system than ever before. It is a positive step, but it also means the lines between personal, practice and system-wide decision-making will continue to blur.
The doctors and practices that thrive will be those who plan ahead, ask the right questions early and take steps to protect themselves.
Conflicts of interest do not have to mean conflict of integrity. By recognising them early, staying transparent and putting financial protection in place, GPs can lead confidently into the next decade of NHS change, knowing their professional futures are secure.
By Graham Leyfield, group locum account manager, Wesleyan Financial Services.
