Intended for healthcare professionals

Rapid response to:

Feature Investigation

The truth about cash for referrals

BMJ 2015; 350 doi: (Published 28 January 2015) Cite this as: BMJ 2015;350:h396

Rapid Response:

The GMC takes very seriously the issue of conflicts of interests. That is why we have clear and unambiguous guidance in Good Medical Practice that doctors must be honest in financial and commercial dealings. Our guidance states that doctors “must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.” Our explanatory guidance on Financial and commercial arrangements and conflicts of interest expands on this. We set out that doctors “must be open and honest with your patients about any such interests that could be seen to affect the way you prescribe for, advise, treat, refer or commission services for them.”

Our guidance is comprehensive and clear in respect of the responsibilities of individual doctors and we have taken appropriate action against individual doctors in the past where there has been evidence that our guidance has been breached. This has included suspending or removing a doctor’s right to practise in the most serious cases when doctors have failed to follow our guidance.

We have completed an internal review of the Competition and Markets Authority report, which is an important piece of work that highlights the potential for conflicts of interest to arise when doctors refer patients for medical treatment. It is a complex document and following our own review we have asked Counsel (an independent senior lawyer) to advise on whether there is any action we should take in relation to individual doctors.

However, when that is complete, we will be writing to all independent healthcare providers and their Responsible Officers seeking assurances from them that they have responded to the report and that they are not operating any schemes that could place their doctors in a position where they could be acting outside our guidance. This includes the offer of any incentives that could affect the way doctors prescribe, treat, refer or commission services for patients.

At our annual accountability hearing before the Health Select Committee three weeks ago we responded to understandable concerns about incentive schemes. We will, as also stated to the Committee, continue to explore the possibility of recording doctors’ commercial interests on the register as part of our review of how the Medical Register could be more useful for all our key interest groups. However, this would require a change in primary legislation, and is therefore in the hands of Parliament.

The Medical Act does not give us a general inspectorate role. Parliament has not given us powers to carry out speculative industry-wide enquiries to see what evidence of impaired fitness to practise we might find. We also do not have the power to investigate incentive schemes run by organisations or other such systemic matters. This is the role of system regulators, such as the Care Quality Commission in England.

We are nonetheless determined to play our part in helping to ensure that the wider system in which doctors work enables them to follow our guidance. We are currently actively engaged with the BMJ and the Royal College of Physicians (RCP) on a working group looking at a project on conflicts of interests for doctors. Our liaison teams work with doctors, employers, educators and patients – we are determined that this guidance should be understood, followed and, where any concern exists, there are clearly understood ways of seeing that it is escalated.

We understand the strength of concern in this area and will continue our discussions with NHS England, the CQC and others and work with them to address any system wide developments in this area.

Competing interests: No competing interests

29 January 2015
Niall Dickson
Chief Executive, General Medical Council
Regent’s Place, 350 Euston Road, London NW1 3JN