Hot topic: Conflicts of interest

In the second part of his four-part series exploring elements of the new Good Medical Practice, Professor Sir Peter Rubin, chair of the GMC, looks at conflicts of interest

Conflicts of interest are not new to general practice, and the GMC addresses these issues in our ethical guidance; but as we are all aware, times are changing. Many GPs in England are taking on considerable additional responsibilities, which could make them both the buyer and seller of medical services.

A recent BMJ investigation found conflicts of interest ‘rife’ on commissioning boards, with 36% of the 1,179 GPs in executive positions having a financial interest in a for-profit provider from which they could potentially commission services. I also know from our own Regional Liaison Advisers, who are out talking to doctors across the country, that there is some concern about this issue. 

The latest version of our core guidance for doctors, Good Medical Practice (GMP), is more concise and we have published eight pieces of explanatory guidance to show how the principles of GMP should work in practice. One of these covers commissioning services, as well as incentives and inducements, fees, gifts and hospitality.

The Health and Social Care Act places a duty on NHS England to publish guidance for Clinical Commissioning Groups (CCGs) and CCGs need to set out arrangements for managing conflicts of interest in their constitutions. As we make clear in our guidance, doctors must be open about any financial and commercial interests linked to their work. So, if a doctor has an interest in a case being considered by their CCG, then they must declare it and exclude themselves from the process. 

Doctors’ relationships with the pharmaceutical industry take many forms, and many GPs also have business interests in pharmacies, nursing homes and medical device companies. Our guidance is clear that they must not allow this interest to affect the way they prescribe, advise, treat or refer patients.

"Be honest about fees, including if part of that fee goes to another professional"

Finally, we make it clear that they must refuse any gifts that could be seen as potentially influencing decisions on care and treatment or be an abuse of trust.

We also offer a series of tips to help put these principles into practice – a checklist that’s worth going through whether or not you think you may be at risk. So, for example:

• Keep up to date with any regulations and national codes of conduct relating to conflicts of interest
• Be honest about fees, including if part of that fee goes to another professional
• If you do have to refer a patient to a provider in which you have a financial stake, be clear about it and record it.

There are no new principles here. This remains an issue of honesty and integrity, reaffirming that patients must come first.

Polls consistently show that there is a high level of trust in doctors, and our guidance is there to help us maintain the trust and the confidence of our patients. 

Useful links

• Our online test offering scenarios in which you can put GMP into action is available at: www.gmc-uk.org/gmpinaction/index.asp
• NHS England’s Code of Conduct