First of all you need to be aware of what is, in reality, a threefold conflict of interest:- between your prime role as patient advocate, your public role in terms of making the most cost effective use of scarce resources (within your Clinical Commissioning Group) and your personal financial interest as an investor in the local private provider. When deciding to refer, you must be able to show that your decision (with the patient) was based on the first two considerations and be immune in every sense to any accusation that you might have put personal profit before your patient.
The new GPC Guidance (based upon existing GMC Guidance) is quite clear. When making a decision to refer, you must tell the patient about your financial interest in the local provider. You should also make sure that your Clinical Commissioning Group is aware of your financial interest in the provider. It would also be wise to make a note on the patient's record, when such a conflict of interest arises.
You should aim for maximum transparency and make it clear both to individual patients and your practice population that their interests come first. Carefully worded information in the waiting room or in a patients newsletter might show that there is a potential conflict of interest, that you take it seriously but your commitment to your patients will always come first. Similarly, with your Clinical Commissioning Group, you must be able to show that your referrals to the provider, in which you have a financial interest, are appropriate and that your quantity of referrals could not be related to your personal financial interest. If you are able to benchmark your personal referrals to that provider against other GPs, who had no interest, then that would help.
The new GP Guidance (which is really very good) is not designed to make things more difficult for you but to ensure that your business interest does not harm your reputation or relationship with your patients as that crucial bond of trust that must be preserved at all costs.
Dr Michael Dixon is chair of NHS Alliance and a GP in Cullompton, Devon
