Competing interests: GMC rejects calls to establish central register for doctors

The UK General Medical Council has rejected calls for it to set up a central register of doctors’ declared interests, saying that it lacked the legal power to enforce such a move and arguing that conflicts were much better managed at a local level.

However, the GMC said that it supported moves by some NHS trusts to establish publicly available registers on which doctors must declare their interests and added that it would be willing to discuss how to roll these out more widely and extend them to GPs.

Last month 11 senior doctors wrote to the GMC’s chair, Clare Marx, urging the regulator to establish a central register to improve transparency.1 Their letter argued that current declarations of UK doctors’ interests were incomplete, inaccessible, and lacking in reliability.

In a response to the letter shared with The BMJ Marx said that the GMC agreed that “more can be done to manage conflicts of interest” but did not think a central register was the right approach. Marx wrote, “Firstly, we do not have the legal powers to make mandatory declarations a condition of registration. Secondly, we think that the effective management of conflicts of interest is much better held, monitored, and maintained at a local level, where the context of a doctor’s work and role is better understood.”

Marx said that when the GMC last consulted on whether to include information about doctors’ conflicts of interest on the UK medical register in 2016, “the overwhelming majority” of respondents did not believe that this was the right place to collect this information. “A key argument was the challenge of interpreting individual interests and judging whether they constitute a conflict without local context. We are also not sure that patients and others would find it helpful for us to include such information on a national register or would necessarily consult it,” Marx wrote.

The GMC said that it backed moves by some NHS trusts to develop their own registers. “There is a case for GP surgeries developing something similar which is made available to patients,” she wrote.

She added, “We would be happy to facilitate a meeting between the signatories to your letter and ourselves, with input from NHS organisations that operate local registers, to discuss how this model can be taken forward.”

In addition to publishing professional guidance, Marx said that the GMC had sought to tackle conflicts of interests in several ways, including working with the Association of the British Pharmaceutical Industry to encourage doctors to disclose transfers of value on the association’s Disclosure UK database (www.abpi.org.uk/our-ethics/disclosure-uk). She added, “We acknowledge this won’t cover the wide variety of interests that doctors may need to disclose.”

Margaret McCartney, a GP in Glasgow and one of the authors of the letter to the GMC, said that she and her co-signatories would discuss the GMC’s proposals.

She said, “Finding declarations of interest—or being sure that there isn’t one—is difficult and imprecise. Declarations are hidden behind paywalls, in hard-to-find spreadsheets, and in commissioning meeting minutes.

“The GMC tells us to be open about our interests, but unless we can do that openly and easily, doctors are in an invidious position. The GMC should help us get to a place where declarations are easy to make and easy to find. We hope to work with relevant organisations to improve the system for the benefit of us all.”