Experts say that doctors have nothing to fear from the introduction of central register listing money

BMJMay 21 2021

UK doctors have nothing to fear from the introduction of a central register listing money or benefits they receive in addition to their NHS salary, say experts today ahead of a public meeting on the issue hosted by the All-Party Parliamentary Group for First Do No Harm and The BMJ.

Last year the Independent Medicines and Medical Devices Safety Review, chaired by Baroness Julia Cumberlege, investigated harmful side effects caused by the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate, and pelvic mesh.

During the review, she heard from patients who were concerned that clinicians had been paid or otherwise incentivized by manufacturers in a way that might influence their practice.

A key recommendation was that patients should have the right to know if their doctor has links with pharmaceutical or medical device companies.

The accompanying report called for the General Medical Council (GMC) to expand its register to include a list of financial and non-pecuniary interests for all doctors. It also said manufacturers should take responsibility to ensure that they publish details of payments they make to teaching hospitals and research institutions.

In 2019, pharmaceutical companies spent over £160 million on non-research and development collaborations with healthcare organizations and healthcare professionals. Yet there is currently no central register of clinicians’ financial and non-financial interests in the UK, unlike in the US.

Doctors' interests are often collected by their employer, while Sunshine UK hosts a voluntary register of doctors’ interests (whopaysthisdoctor.org).

The Association of the British Pharmaceutical Industry (ABPI) also has its own voluntary database called Disclosure UK. However, under data protection laws, healthcare professionals can refuse to have their name published on it.

In addition to the Cumberlege review, there is increasing support from the medical community for a central register. A survey conducted by The BMJ found that nearly 90% of medical professional bodies agree that the UK should have a mandatory and public register of doctors’ interests.

And in response to the view that any register should cover all clinical decision-making staff, not just doctors, Cumberlege said “doctors are the principal decision makers in patient care, they determine the treatment, they perform surgery. So it is with doctors that we must start.”

Both Margaret McCartney, a GP and health journalist, and Susan Bewley, chair of Healthwatch UK and a co-founder of Sunshine UK, believe the GMC is the only organization suitable to hold a register of doctors’ interests as it is the only organization that holds a list of all registered doctors in the UK.

For McCartney, the aim of any central register should be to decrease bureaucracy for healthcare professionals and increase transparency for professionals and patients.

Neil Mortensen, president of the Royal College of Surgeons of England, agrees that the register would need to be easy to use and not cost doctors a lot of money.

We’d need to be convinced that it was light touch, effective and that it was going to make a difference.”

Neil Mortensen, President, Royal College of Surgeons of England