Financial independence and conflicts of interest: the criterion that decides a DPC file

Of the six blocks of criteria that decide whether a DPC provider is registered, only one is expressly described as a major element of the assessment: financial independence. It is also the one providers deal with last, often at the end of drafting, as an administrative annex. That is exactly the wrong order.

What the scheme says

The registration criteria are set by the order of 14 September 2016, made under decree no. 2016-942 of 8 July 2016. They include the financial resources guaranteeing the provider’s independence, particularly from companies manufacturing or distributing health products, together with the policy on managing links and conflicts of interest.

The weight given to this criterion is explicit: assessing the financial independence of DPC providers, notably from companies in the health-products sector, is a major element of the assessment carried out by each of the scientific commissions, and it is intended to guarantee strictly the independence of the content of continuing professional development programmes.

Two words are worth noting. “Each”: every commission responsible for the professions you target applies this requirement, none delegates it. And “strictly”: the text is not looking for a reasonable balance, it is looking for a guarantee.

Why the scheme insists

This requirement is not an abstract precaution. It answers a risk documented in the scientific literature.

The systematic review and meta-analysis by Hneine Brax, Racha Fadlallah and colleagues, published in PLOS ONE in 2017 (reference), examined the association between physicians’ interactions with pharmaceutical companies and their clinical practices. The authors find an association between those interactions and prescribing practices, measured across a body of observational and experimental studies.

A scheme whose purpose is to improve care practices cannot ignore such a finding. That is the criterion’s rationale: if continuing education changes practice — which is precisely what it is meant to do — then whatever steers the content of the training steers practice. Hence the emphasis on where the money comes from and on controlling the interests of the people who write and deliver.

What is actually examined

The criterion breaks into two distinct strands, which are best handled separately in the file.

The organisation’s independence. Where does the provider’s money come from, in what proportions, and over what period? A provider deriving most of its resources from companies in the health-products sector is in a position it will have to document with particular care. The question is not only “do you receive funding?” but “does your economic balance depend on partners whose products you describe?”.

The individuals’ independence. The interests of designers and speakers — consultancy work, paid interventions, participation in trials, invitations to congresses, shareholdings. They are the ones who determine and deliver the content; so it is their interests that count, not only the organisation’s.

The two strands must hold together. A structurally independent provider that entrusts an activity to a speaker with strong industry ties on the subject taught has not solved the problem; nor has an impeccable speaker inside a dependent structure.

A policy, not a form

The most common mistake is to answer the criterion with a blank declaration of interests signed by the speakers. That is necessary but not sufficient: what the text asks for is a management policy.

A management policy answers four questions, in this order:

1. Record. Which links exist, for whom, on which topics, over what period. A declared link is not a problem; an unrecorded one is.
2. Declare. Through what procedure, how often, with what updating. A declaration signed once on joining ages badly.
3. Handle. This is the strand files forget. What actually happens when a link is declared on the subject being taught? Standing the speaker down on that specific topic, having the content reviewed by an independent third party, informing participants: this calls for written rules, not case-by-case judgement.
4. Trace. Who decided what, when, on what basis. Without a trace, the policy cannot be verified.

An organisation that can answer those four questions naturally produces the material a commission expects. An organisation that has only the declaration form produces a document, not a demonstration.

What transfers from Qualiopi — and what does not

Providers that are already certified often hope to recycle their evidence. On this criterion, it needs saying plainly: the national quality framework contains no equivalent of financial independence from the health industry, nor of conflict-of-interest management.

These sections therefore have to be built from scratch, even for a provider in perfect order on the vocational-training side — one of the substantive differences between the two schemes, which we set out in our comparison, DPC or Qualiopi. What does help directly is the culture of evidence acquired while preparing a quality audit: knowing that an assertion without a document is worth nothing is exactly the right reflex here.

Six questions to ask before filing

• Can I describe the structure of my resources over the last three financial years, by origin?
• Does an industry partner have any say, even informal, over the content of an activity?
• Has each designer and each speaker declared their interests, on the precise subject they cover?
• Does my procedure set out what happens when an interest is incompatible with the subject?
• Who decides, and does that decision leave a trace?
• Are participants informed of speakers’ interests?

If any of these questions has no written answer, the file is not ready — whatever the quality of the rest. Recall the scoring mechanism: each criterion is scored from 0 to 10 and the pass mark is required in every section, with no netting out between them. A weak “independence” section cannot be made up elsewhere. That mechanism is detailed in our article on the registration criteria and scientific-commission assessment.

Take action

Deal with this criterion first, not last: it is the only one that can sink an otherwise solid file, and the only one whose remediation sometimes means turning down funding or changing speaker — decisions that are not taken the day before filing. The full profile of the scheme is here: Registration as a DPC provider.