Paragraph 85 of the GMC accountability hearing with the House of Commons Health Committee may not have been top of anyone’s reading list last week, but it contains a very significant statement:
‘The Committee believes that there is a compelling case for the GMC to hold a public register of doctors’ interests.’
The problem with conflicts of interests, you see, is that for regular foot soldiers the idea of an annual declaration of financial interests is of little significance – having to state ‘nothing to declare’ would be all that most GPs and junior doctors would have to do. Few of us are offered the opportunity to boost our income by speaking on behalf of industry.
Our leaders, however – the captains and brigadiers at our Royal Colleges or within the Department of Health, may be in a very different position. So-called ‘key opinion leaders’ may not look so key if they have to own up to significant industry-funded income, and we may be less inclined to follow their lead once we see how the money flows. The very people we will have to rely upon to bring about change in this area, are the ones who may have the most to lose if a register is established.
It could be argued that we already have transparency – after all don’t most major journals require that authors make a statement of declaration of interests prior to submitting their work?
This system is better than nothing, but it is very much dependent on self-declaration, and there is no comeback for failing to declare. More importantly, there is no easy way of telling if a doctor has competing interests when they give interviews to the media or – more importantly – when they prescribe you medication as a patient.
I was a speaker at three conferences last autumn, including the RCGP annual conference, and none asked me to make a declaration. In each case the organisers were very positive when I suggested the idea, but it seemed like a novel concept when it should have been standard practice.
A single, publically available list would get around all this. It would be easier for doctors, since they would only ever have to make an annual declaration and could simply supply journals with their GMC number whenever they publish.
What is more, the list needs to be bold enough to break one of our nation’s taboos – talking about our income. There is a world of difference between receiving a few hundred pounds of expenses from industry linked to a research project, and the regular receipt of large fees for speaking purposes; only if we know the actual figures can we make an informed judgment.
While the GMC considers setting up an official register of interests, a website has been set up where doctors already have the opportunity to make a public declaration, entitled whopaysthisdoctor.org.
I have to declare an interest of my own here – I have had a small part to play in its creation and am the first to admit that it is far from perfect. But making a declaration will be good for your appraisal, good for your patients, and important to send a signal to the GMC that there are doctors out there who are more than willing to be open to public scrutiny.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.