GP commissioners should tell a patient if budgets or referral policies mean he or she cannot access healthcare, and also raise the issue with their commissioning group, the doctors regulator has said.
General Medical Council chief executive Niall Dickson told HSJ clinical commissioning did not introduce any “fundamental new principles” for medical practice. However, Mr Dickson said it would mean many doctors – mainly GPs – faced conflicts of interest more often, something which was already provoking “quite a lot of anxiety”.
Concerns have been raised about the heightened conflict of interest for GPs as commissioners since the government published its plans last year.
Last week Royal College of GPs chair Clare Gerada increased the focus on the issue when she told HSJ GPs involved in commissioning could be compromising their professional duty to individual patients.
She said: “I would caution GPs about signing any document which conflicts with the General Medical Council’s Good Medical Practice. [The guidance] makes the patient – you in front of me – my first priority, not managing a budget or making ends meet.”
In an interview with HSJ, following Dr Gerada’s comments, Mr Dickson said GP commissioning did not conflict with GMC guidance but doctors would increasingly have to take steps to manage conflicts.
He said doctors “need to be able to show you have acted to stop any decision being affected by the conflict of interest. The patient has to come first. You have to uphold patients’ interests and the quality of care”.
Asked about the situation raised by Dr Gerada, Mr Dickson said: “If there is a policy within an organisation which is directly contrary to a patient’s interests the doctor has to raise that as a matter of concern.
“But also, they have to manage within the resources with which they are working.
“Above all, transparency is important. [If] a commissioning budget [means] they haven’t got any more money to do hip operations, [the doctor] must be honest with the patient about that.
“[For example they should] say, ‘We are faced with this situation, I don’t think your’s is an urgent case.’ Of course there will be situations where budgets are constrained – that is not new.”
Mr Dickson said the GMC’s existing conflict of interest guidance – particularly Good Medical Practice paragraphs 72-76 and supplementary guidance from 2008 – could be applied to the new commissioning situations.
But he said the GMC planned to publish a restatement of the issue including “some examples of situations people might find themselves in” in the near future; and an imminent consultation on updating Good Medical Practice may also address the issue. If necessary the regulator may also do further work on how to manage conflicts in commissioning, he said.
Mr Dickson said: “Our view from what we know is there is no fundamental new principle involved here that will somehow change our guidance in a very fundamental way. But we recognise more GPs in England are likely to face situations where there are conflicts of interest and to face them more often.
“[In addressing the conflicts] the principles are the same. One should be able to identify where there is a conflict. You need to be transparent and declare the conflict of interest as soon as possible.
“You need to act in order to handle the conflict of interest if you are [making] the decision.
“We won’t spell out in every situation this is what you must do. It has to be a mature and professional judgement. People need to apply common sense.”