Identifying and managing conflicts of interest

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 propose, provide or prescribe treatment for, advise, treat, refer, or commission services for patients. You must not offer such incentives to colleagues. 

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. 

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.

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.

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.

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.

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. 

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.  

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. 

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

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.

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.

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.

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). 

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

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.  

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.

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

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. 

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.”

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.

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.

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 

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. 

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. 

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.

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.

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. 

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.

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. 

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.

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. 

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.

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.

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).

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.