The BMJ questions GMC’s commitment to regulate doctors’ financial and commercial interests

The UK doctors’ regulator, the General Medical Council (GMC), failed to act after receiving evidence of widespread payments to consultants in private practice in exchange for referrals to certain hospital groups, particularly in London, reveals a special report by The BMJ today (Wednesday 28 January).

It is based on an investigation by a major health insurance company, which uncovered “covert” schemes often worth “tens of thousands” of pounds, with some payments exceeding six figures.

The insurance company called on the GMC to “take a clear position on this,” but the regulator took no action.

The BMJ has learnt that the apparently widespread practice first came to light during an internal investigation launched by the insurance company in 2011.

Land Registry records showed that many independent practices were housed in expensive London properties owned by private hospital groups. One document seen by The BMJ showed 73 properties, many in West End locations, including Harley Street and Wimpole Street, owned by the giant American hospital corporation HCA alone.

In 2014, The Competition and Markets Authority (CMA) issued an order that prohibits inducement schemes. But The BMJ has heard evidence that some hospitals are continuing to “buy” referrals.

One senior surgeon told The BMJ that he had been approached by a hospital group hoping to attract his referrals away from a rival as recently as nine months ago.

A spokesperson for The London Clinic, London’s largest independent hospital and an opponent of consultant incentive schemes, told The BMJ that although the rules had been “tightened considerably” by the CMA order “we are still seeing consultants being approached by competitors.”

The GMC said it “would encourage anyone who has concerns about the conduct of a doctor or evidence of wrongdoing to share this information with us in order for us to investigate these concerns and, if appropriate, open an investigation.”

But the insurance investigator said he found it “staggering and totally unacceptable that the GMC, as the official regulator of the medical profession, can receive a report from a public body showing that one of the key duties of a doctor is being widely flouted and do nothing about it.”

It was, he added, “a sad day for the medical profession when a competition regulator has had to issue an order stopping such schemes because our own regulator, the GMC, has failed to do so.”

The GMC says that it didn’t receive a formal complaint against individual doctors and so could not investigate further.

Its Good Medical Practice does set standards on financial arrangements and conflicts of interest. But The BMJ’s Editor in Chief, Dr Fiona Godlee, says the investigation “shows an unwillingness to act on possible breaches of these standards.”

“The GMC’s belief that its role is limited to offering guidance on conflicts of interests is unsatisfactory,” she argues. “Its promise to review whether more can be done to help doctors manage potentially conflicting financial ties is vague and insufficient.”

She proposes that all UK doctors’ financial interests should be included in a publicly available and searchable central register, updated as part of annual appraisal, and warns that, “unless the GMC is serious about regulating doctors’ financial conflicts of interest, insidious inducement schemes will continue to reward private hospitals groups and some doctors at the expense of patients, the very people that the GMC is obliged to protect.”