The GMC: “The differences between our guidance and a compulsory register”

This is the General Medical Council’s response to my Petition for a Sunshine Act to the Scottish Government:

PE1493/I

9 January 2014
To: petitions@scottish.parliament.uk
Andrew Howlett
Assistant Clerk
Public Petitions Committee
The Scottish Parliament

Dear Mr Howlett,
Scottish Parliament Public Petition PE1493 on a Sunshine Act for Scotland

Thank you for giving us the opportunity to submit our views on the proposed introduction of a ‘Sunshine Act’ for Scotland, creating a searchable record of all  payments (including payments in kind) to NHS Scotland healthcare workers from Industry and Commerce.

I have set out below how our guidance to doctors applies in this area, as well as some work that we will be taking forward which is relevant to the issues raised in the petition.

The status of GMC guidance
The standards we expect doctors to abide by are set out in our ethical guidance. Good medical practice and all its explanatory guidance, including that on Financial and commercial arrangements and conflicts of interest, describes what doctors must do when faced with a conflict of interest, including offers of payment or hospitality made by pharmaceutical or other healthcare companies.

Doctors must demonstrate, through the revalidation process, that they practise in line with the principles and values set out in our guidance. Serious or persistent failure to follow the guidance will put their registration at risk, because these are the standards they’ll be judged by if their fitness to practise is called into question.

The differences between our guidance and a compulsory register
Our guidance for doctors makes clear that they must be open and honest about  any financial and commercial interests, and they must not allow these to affect the  way they treat or care for patients. The guidance also sets out that doctors must  be open about any conflict, declaring interests formally, and should be prepared to  exclude themselves from decision-making.

This guidance on conflicts of interest is not limited to payments (including payments in kind) from Industry and Commerce as proposed in the Petition. Nor is  it restricted to doctors working in the NHS. Rather our guidance:

• applies to all doctors, regardless of their grade, specialty and whether they work in the NHS or the independent sector;

• relates to any conflict of interest, not just payments or payments in kind;

• says doctors must not accept any inducement, gift or hospitality that may affect or be seen to affect the way they care for patients, ie it covers perceived, potential conflicts as well as those that are recognised and current.

Publishing research results
In the Official Report of 12 November 2013 Dr Gordon made reference to the failure to publish trial data. Our guidance on research1 makes clear that:

• we expect doctors to be open and honest about their research;

• financial interests must not affect completion of research;

• doctors should publish research results, including adverse findings, through peer review journals.

We also state that, as well as reporting adverse findings to the affected participants, and those responsible for their medical care, doctors must report adverse findings to the research ethics committee, and bodies – such as the Medicines and Healthcare products Regulatory Agency – responsible for protecting the public.

Fitness to practise cases relating to conflicts of interest
We can confirm that over the past seven years (since April 2006) over 200 (240) doctors were referred to us with allegations about conflicts of interest (from a total of over 25,000 cases). In 33 cases the doctors were referred to panel hearings. Of those doctors who were referred to panel hearings, 5 were erased, 6 suspended and 4 had conditions put on their licence. As at 21 November 2013, there were also a number of doctors (14) with open cases relating to conflict of interest allegations.

A compulsory register would require legislative change
We do not currently have any powers in the Medical Act 1983 to require doctors to disclose financial interests to us, and any scheme to publish details of doctor’s financial interests would need to be voluntary.

A change in legislation would be needed to establish a compulsory register of doctors’ interests. If this were not implemented across the UK simultaneously, it is not clear whether and how a change in legislation in Scotland – as proposed in this Petition – might impact on our regulation of doctors across all four UK countries. As it happens, in the light of a recent review of professional regulatory legislation undertaken by the Law Commission, we understand that a Bill is likely to be brought before the UK Parliament during the course of 2014 which would replace the 1983 Act with a new Act applicable to all the professional regulators.

Next steps
We recognise that there is scope for us to promote our guidance on good practice, to continue to raise awareness of it and do what we can to ensure compliance with it. Throughout 2014 we will continue to look for ways to embed the principles in doctors’ day to day practice.

We will also assess conflicts of interest and the practicality of keeping a list of doctors’ interests attached to the Register. Through our Corporate Strategy for 2014-2017 we are committing to considering if there are any changes that we could make to the medical register to make it as relevant, accessible and useful as possible. This review will provide a timely opportunity to address this important matter.

We would welcome information about the progress of this Petition and would be glad to offer a meeting if that would be helpful.

Yours sincerely
Paul Buckley

Director of Strategy & Communication

Annex A: Extracts from GMC guidance