How do I handle conflicts of interest in private practice?

What counts as a conflict of interest

The GMC defines a conflict of interest as arising when a medical professional’s interests, financial or otherwise, compete with their professional responsibilities, and there is a real or perceived risk they will put those interests above patient care. It lists three kinds: direct financial interests, indirect financial interests, and other personal or professional interests.

In private practice the most obvious one is built in: you are paid for what you do. That is not wrong in itself. It becomes a conflict when it could steer what you recommend. The GMC also says to treat a potential or perceived conflict the same as an actual one, and not to rely only on your own judgement about whether one exists.

Common conflicts for private GPs

Situation	Why it is a conflict
Recommending tests or follow-up you will charge for	You earn more the more you recommend
Selling medicines, supplements or products you prescribe or advise	Your income depends on the patient buying from you
Referring to a clinic, scanning service or laboratory you own shares in	You benefit from the referral itself
Directing patients to a pharmacy linked to you or your employer	It limits the patient’s choice for your benefit
Payments, meals or sponsorship from pharmaceutical or device companies	They may influence what you prescribe or use
Offers from private hospitals linked to where you refer	They may influence where you send patients
Treating friends, family or business contacts	Personal ties can affect clinical judgement

Your employer can create conflicts too, for example targets for bookings or add-on sales. The GMC is clear that your duty to patients comes first.

What the GMC expects

Good medical practice (2024) says you must not allow any interests you have to affect, or be seen to affect, the way you propose, provide or prescribe treatments, refer patients or commission services. You must not ask for or accept any incentive, payment, gift or hospitality that may affect or be seen to affect those decisions, and you must not offer such incentives to others.

The GMC’s conflicts of interest guidance, in force since January 2024, says you must manage potential conflicts by:

1. avoiding them wherever possible
2. being open about your interests with your employer or contracting body, with patients, and when you speak publicly as a doctor
3. formally declaring them, and updating declarations when things change, in line with local and national arrangements
4. taking steps to stop your interests affecting, or being seen to affect, your decisions

Where a patient is involved, you must be open and honest about any interest that may affect how you treat or refer them, and you should record that discussion in the notes. If you charge fees, tell patients before any investigation or treatment what they will pay and when.

Referrals to private hospitals: the CMA Order

The Competition and Markets Authority’s Private Healthcare Market Investigation Order 2014 applies to “referring clinicians”, defined as any healthcare professional with practising privileges at a private hospital or the ability to refer patients there for tests or treatment. That includes private GPs who refer.

• Private hospital operators must not offer incentives that are intended to, or may reasonably be seen to, induce you to refer to or treat patients at their facilities. You must not ask for or accept them.
• Paying per referral, or by the share or value of your referrals, is prohibited.
• Low-value items such as in-house training, basic workplace amenities and proportionate general hospitality are allowed, and the hospital must publish a description of them.
• Services such as consulting rooms or secretarial support must be paid for at fair market value, on the same terms as for other clinicians.
• There are strict limits on holding shares alongside a private hospital operator. These limits do not apply to facilities used only for primary care by a GP.

If a private hospital offers you something linked to where you refer, check it against the Order before you accept.

Pharmaceutical and device companies

The ABPI Code of Practice bans gifts or benefits to health professionals as an inducement to prescribe or recommend medicines. Payments and benefits in kind from companies that sign up to the Code, such as speaker fees and sponsorship for events, are published on the Disclosure UK database. Assume any payment you accept could be public, and declare it.

Paid advisory or speaking work is allowed, but tell patients about it if it touches the treatments you recommend to them.

Gifts and the law

The Bribery Act 2010 makes it an offence to offer or accept an advantage intended to induce someone to act improperly. Most gifts from grateful patients are not bribes, but gifts from suppliers or referral partners need more care. In England, the GMS contract regulations require NHS GP contractors to keep a register of gifts worth more than £100 from patients, their relatives or suppliers. NHS England’s guidance for NHS staff uses a lower £50 limit for gifts. Neither is written for private services, so set your own threshold and apply the same principle. For gifts from patients, see professional boundaries in a private setting.

A practical system for a small practice

1. Keep a register of interests. Record shares, directorships, paid roles, sponsorship, and links between you, your family and any supplier, laboratory, pharmacy or provider you use. Review it every year and whenever something changes.
2. Publish what patients need to know. A short statement on your website about any ownership links to services you refer to lets patients see them before they book.
3. Tell patients at the point of decision. If you suggest a service you have an interest in, say so, offer at least one alternative and record it.
4. Write a policy. Cover gifts, hospitality, industry contact and sales. Make sure staff and contracted clinicians follow it. See clinical governance in private practice.
5. Audit your own patterns. Check whether your rates of testing, prescribing or referral to linked services look different from what you would expect.
6. Declare at appraisal. Your appraisal should cover your whole scope of practice, including business interests. See appraisal and revalidation as a private GP.

When you are unsure

Ask a colleague who does not share the interest, as the GMC suggests, or call your medical defence organisation. If the interest is large enough that no declaration would reassure a patient, the answer may be to give up the interest or step away from the decision.

Across the UK

The GMC guidance, the CMA Order and the Bribery Act apply across the UK. NHS England’s conflicts of interest guidance does not bind private providers, and the BMA notes there is no national equivalent in Scotland, Wales or Northern Ireland. So your own written policy is what shows a regulator how you manage conflicts.