Identifying and managing conflicts of interest

Identifying and managing conflicts of interest

1

Good medical practice sets out the principles, values, and standards of care and professional behaviour expected of all medical professionals registered with us. Identifying and managing conflicts of interest builds on Good medical practice to provide more detail on our expectations of medical professionals in this area.

2

The professional standards describe good practice, and not every departure from them will be considered serious. You must use your professional judgement to apply the standards to your day-to-day practice. If you do this, act in good faith and in the interests of patients, you will be able to explain and justify your decisions and actions. We say more about professional judgement, and how the professional standards relate to our fitness to practise processes, appraisal and revalidation, at the beginning of Good medical practice

About this guidance

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This guidance is for all medical professionals whatever their field of medicine or practice setting. The UK healthcare system is complex, with medical professionals working flexibly across public and independent sector settings. 

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It sets out a general framework for identifying and managing situations where there’s a risk that a medical professional’s interests could have an impact on their professional responsibilities. It does not address medical professionals’ personal beliefs (including political and religious beliefs) or personal values, and the influence these may have on the way they practise medicine. For guidance on that topic, please see Personal beliefs and medical practice.

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We also give context-specific guidance on conflicts of interest in the following more detailed guidance: Good practice in prescribing, Acting as a witness, Good practice in research, Using social media as a medical professional, and Guidance for doctors who offer cosmetic procedures

Three guiding principles

  • When interests compete, prioritise patient care.
  • Never abuse your position for financial gain.
  • Be open and honest about all your interests. 

What is a conflict of interest?

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A conflict of interest occurs when a medical professional’s interests (financial or otherwise) compete with their professional responsibilities, and there’s a risk (real or perceived) that the medical professional will prioritise these interests above the care of patients.  

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Conflicts of interest may arise in a range of situations and can include: 

  1. direct financial interests (see Appendix B)
  2. indirect financial interests (see Appendix B)
  3. other direct or indirect personal or professional interests. (See Appendix B)
8

Patients must be able to trust medical professionals with their lives and health. And trust can be damaged by the perception that a medical professional may be prioritising their own interests above patient care, even if the medical professional is confident their interests have no influence over the way they practise.  

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For this reason, you should treat a potential or perceived conflict of interest the same as you would an actual conflict of interest. And you should not rely solely on your own assessment of whether a conflict exists, but seek advice – eg from a colleague who doesn’t have the same interest. 

Managing potential conflicts of interest

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To justify patients’ trust you must manage potential conflicts of interest by:

  1. avoiding conflicts of interest wherever possible
    1. being open about your interests 
    2. with your employer or contracting body
    3. with patients
  1. when communicating publicly as a medical professional
  2. formally declaring conflicts of interest – and updating declarations if there is a change – in line with local and national arrangements
  3. taking mitigating steps to prevent your interests affecting – or being seen to affect – the way you propose, provide or prescribe treatments, refer patients, or commission services. 

Avoiding conflicts of interest where possible

11

You must not ask for – or accept – any fee, gift, hospitality or any other incentive that may affect (or be seen to affect) the way you prescribe for, advise, treat, refer, or commission services for patients. You must not offer such incentives to colleagues. 

12

You should consider the potential impact on your professional responsibilities before investing in, agreeing to, or accepting something that may affect or be seen to affect the way you practise. 

13

Conflicts of interest are not always avoidable. Some policies or systems can create inherent conflicts. If you’re prevented from prioritising patient care because of a policy or process that you’re expected to follow, you must follow our more detailed guidance on Raising and acting on concerns about patient safety.

Being open about your interests

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If an employer or a patient asks you directly about an interest you have that may conflict – or be seen to conflict – with your professional responsibilities, you must be open and honest in response.

Being open with your employer or contracting body

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You must be open and honest with your employer about your interests and how these may conflict – or be seen to conflict – with your professional duties.

16

You should regularly review your interests – and assess whether new conflicts arise – whenever your circumstances change. This includes when you join an organisation, whenever you take on new responsibilities, and when a new opportunity presents itself. You should update any declarations of interest promptly after any change. Annual appraisal is a good opportunity to discuss your interests and identify potential conflicts with the help of your appraiser.

Being open with patients about your interests, sharing alternative options, and respecting patients' right to choose

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You must be open and honest with patients about any interests you have that may affect (or could be seen to affect) the way you propose, provide, or prescribe treatments, or otherwise care for, or refer patients. 

18

In line with more detailed guidance on Decision making and consent you must give patients the information they want or need to make decisions about their care.1 This will usually include the options for treating or managing the condition, including the option to take no action.  

1

See paragraphs 10-13 of Decision making and consent.

19

You should tell patients if you're aware of a reasonable alternative option that has greater potential benefit for them than anything you can offer. 

20

You must not mislead patients about the availability of reasonable alternative options, or the likely waiting times for those options through publicly funded services. 

21

You should tell patients if you’re aware that the investigation or treatment you are offering privately would be available to them for free, and you have reason to believe they don’t know.

22

If one of the options you propose is something you would benefit from (eg because you or someone close to you has a financial or commercial interest in an organisation, product or device associated with the option) you must:

  1. Tell the patient about this interest
  2. explain your reasons for proposing the option 
  3. share information about reasonable alternative options, including the option to take no action
  4. make sure the patient knows they have a right to choose whether to accept your advice
  5. respect their right to seek a second opinion.
23

You must not try to influence patients’ choice of healthcare or services to benefit you, your employer or someone close to you. If you suggest that a patient use a specific pharmacy or other health or social care provider that you have (or your employer or someone close to you has) an interest in, you must tell the patient about this interest.

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You must not recommend an investigation or treatment that doesn’t meet a patient’s needs, to fulfil a target, or benefit financially (or otherwise). 

25

You should make a note of any discussion about conflicts of interest in the patient’s medical record.

Being open with patients about your fees and charges

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You must be open and honest in any financial arrangements, and must not exploit patients’ vulnerability or lack of medical knowledge when charging fees for treatments and services.  

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If you charge fees, you must tell patients about them before starting any investigation or treatment. This means being clear about how much the patient needs to pay for each investigation or treatment and when. If you don’t know the total cost to the patient of each option (including any additional fees – eg to the hospital or other provider), you should explain this to them and make sure they know how to find out.

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You must comply with the legal requirement to provide information about your fees to the Private Healthcare Information Network.2 

Being open about your interests when communicating publicly as a medical professional

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You must be clear about any financial or commercial arrangements you have with any products, services, companies, or devices you communicate about in a public domain. 

30

You must follow the guidance in paragraphs 89–91 of Good medical practice as well as more detailed guidance on Using social media as a medical professional which says the following at paragraph 12:

“If you use social media to advertise your services, or use your professional position to promote or endorse any other services or products, you must be open and honest about any interests you have that may influence (or could be seen to influence) the recommendations you make. You must also comply with relevant law, guidance and regulatory codes including those from the Committee of Advertising Practice, the Advertising Standards Authority, and the Competition and Markets Authority.”

Mitigating the impact of a conflict of interest

31

When faced with a conflict of interest, you must:

  1. make the care of patients your first concern
  2. be open about your interests with patients and employers
  3. declare them in line with local and national arrangements, updating declarations promptly when circumstances change
  4. be prepared to exclude yourself from decision making
  5. be prepared to refer a patient to another medical professional who doesn’t have the same interest, as long as this meets the patient’s needs.
32

The following paragraphs give information and guidance about how to meet the professional standards in specific situations which give rise to conflicts of interest.

Gifts, bequests and donations

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You must not encourage patients to give, lend, or bequeath money or gifts that will directly or indirectly benefit you (or those close to you or your workplace). This includes encouraging patients or their families to make bequests or donations to other people or organisations, such as charitable organisations.

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If a patient asks to make a donation, or says they want to bequeath or donate money to you or someone close to you, you should explain that you can’t accept.

35

If a patient or someone close to them presents you with an unsolicited gift you should explain that you can’t accept it – unless the gift is of minimal value.3 

36

If you have been offered, or accepted a gift, bequest, or donation, you must declare it in line with local and national arrangements, and you should make a note in the patient’s records. 

Commissioning services

37

If you have responsibility for, or are involved in, commissioning services, you must: 

  1. formally declare any interests that you have – or someone close to you, or your employer has – in a potential provider company, in accordance with local and national governance arrangements
  2. avoid potential conflicts of interest by excluding yourself from the decision-making process and any subsequent monitoring arrangements 
  3. take steps to manage any conflict between your duties as a medical professional and your commissioning responsibilities
  4. keep up to date with and follow the guidance and codes of practice that govern the commissioning of services where you work. 

Target payments and health service financial incentives

38

National incentive programmes (such as the NHS Quality and Outcomes Framework for general practices in England, Wales and Northern Ireland) operate on the assumption that preventative health measures, such as immunisation and screening programmes, and health monitoring schemes have benefits for both individual patients and society. Target payments are offered to General Practitioners (GPs) with the aim of increasing the number of patients who take part in the programme.

39

If you take part in an incentive or target payment programme: 

  1. you must consider the safety and needs of individual patients
  2. you must be confident that every patient invited knows they have a choice whether to participate in the programme or not
  3. you must be confident that patients are given the information they need to decide whether to take part in the programme, including other options available to them and the risks, benefits and uncertainties relating to each.
40

Taking part in national programmes to improve the cost-effective use of medicines – for example by switching from branded to generic medications – can deliver savings that benefit the wider community of patients. 

41

If you have been asked to switch your patients’ medication in line with such a programme, you must consider the safety and needs of individual patients before switching. This means that you should: 

  1. consider risks and benefits to the patient if you change their medication for cost reasons (eg frequent switching can mean that patients are less likely to continue taking the medication as prescribed)
  2. inform patients that you’ve been asked to change their medication, explain why, and give them any further information and support they need, including any difference in how the medication should be taken and what to do if they experience side effects.
42

If you are responsible for making decisions about switching patients from branded to generic medications, you must make sure that their doctors are able to carry out the steps in paragraph 41a–b above. 

43

If you believe that patient safety is or may be seriously compromised by the way that a financial incentive or similar scheme operates, you must follow the guidance in Raising and acting on concerns.

Relationships with the commercial healthcare industry including pharmaceutical, medical technology and other healthcare companies

44

Medical professionals’ relationships with commercial healthcare companies – including pharmaceutical, medical technology and other healthcare companies – take many forms, some of which may conflict, or be seen to conflict, with their professional responsibilities towards patient care. 

45

If you work for, accept funding from, or otherwise benefit from a relationship with a commercial healthcare company, you should:

  1. follow the advice of the Prescription Medicines Code of Practice Authority (PMCPA), including in relation to inducements4 
  2. support efforts to bring greater transparency to the relationships between the pharmaceutical industry and healthcare professionals, for example by cooperating with disclosure schemes required under the PMCPA code.
46

If you are involved in advertising or promoting medicines or healthcare products, you must: 

  1. follow the guidance in the Medicines and Healthcare products Regulatory Agency’s Blue Guide 
  2. follow any relevant guidance from the Advertising and Standards Agency
  3. follow our more detailed guidance Using social media as a medical professional.
47

If you work with a private healthcare provider (whether you are directly employed or have practising privileges) you should review your activity data held by the private provider to help them meet their legal duty to report accurate activity data to the Private Healthcare Information Network (PHIN).

Recommending services outside healthcare

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Some organisations providing services outside healthcare (such as insurance companies or solicitors) run schemes where payment is offered according to the number of customers referred. Generally, doctors will not have the professional expertise to make recommendations or refer to a particular organisation; their chief interest in such schemes is financial. You should not accept fees for referring patients to, or recommending the services of, particular organisations or individuals.