Richard Hough examines the potential pitfalls of collaborative working practices

The General Pharmaceutical Council (GPhC) recently published a joint statement alongside eight other health and care professional regulators to give new guidance on “avoiding, declaring and managing conflicts of interest”. This statement comes at a prudent time, with NHS England stating in April last year that it would boost funding by £112m to facilitate collaborative working practices including the employment of a projected extra 1,500 pharmacists in GP practices by 2020. Indeed, the move to the adoption of more collaborative working between the healthcare professions has been welcomed by many, with benefits of increased efficiency and an easing of pressure on GPs. However, this “increasing move towards multi-disciplinary teams” is not without its pitfalls.

Joint ventures
Historically, pharmacies have operated independently from influence by GPs, with patients free to choose where their prescription is dispensed based on proximity and service. Recently, however, we have advised a number of pharmacists who have sought to protect (a defensive move) and/ or grow (an aggressive move) their business by forming joint venture-type arrangements with GP practices. Such arrangements can easily lead to conflicts of interest and unlawful behaviour.

For example, a GP may choose to recommend to a patient a pharmacy in which it has a financial interest, on the basis that the GP would directly benefit from the pharmacy’s increased business. The conflicts of interest can range from something as seemingly innocent as a misjudged suggestion from a GP’s receptionist, to the more serious matter of GPs lying to patients about their options. Both of these examples represent placing financial or personal gain above patient care – a clear conflict of interest for the doctor.

Previous guidance was limited to the General Medical Council’s advice on ‘financial and commercial arrangements and conflicts of interest’, which encouraged honesty and instructed doctors to tell patients about any financial or commercial interest they might have when referring a patient. This guidance does little to help pharmacists, particularly those working for doctors in a GP practice.

Clarifications
The recent GPhC’s joint statement attempts to gives clarification to pharmacists and other healthcare professionals on what does, or does not, constitute a conflict of interest and includes the following expectations:
• Put the interests of people in their care before their own interests, or those of any colleague, business, organisation, close family member or friend.
• Maintain appropriate personal and professional boundaries with the people they provide care to and with others.
• Consider carefully where conflicts of interest may arise – or be perceived to arise – and seek advice if they are unsure how to handle this.
• Be open about any conflict of interest they face, declaring it formally when appropriate and as early as possible, in line with the policies of their employer or the organisation contracting their services.
• Ensure their professional judgement is not compromised by personal, financial or commercial interests, incentives, targets or similar measures.
• Refuse all but the most trivial gifts, favours or hospitality if accepting them could be interpreted as an attempt to gain preferential treatment or would contravene your professional code of practice.
• Where appropriate, ensure that patients have access to visible and easy-to-understand information on any fees and charging policies for which you are responsible.

The joint statement also includes the following case study on prescription direction to accompany the guidance: Dr Williams is a GP in a private practice whose employer owns a local pharmacy. She has been instructed to encourage patients to take their prescriptions there as they will get “better service and faster processing times”. Dr Williams realises that she must always put the interests of her patients before her own or her employer’s interests, and that it would be inappropriate to make recommendations. She knows that directing prescriptions to her employer’s pharmacy would be likely to constitute a conflict of interest. The responsible course of action taken by Dr Williams is to make sure her patients know and understand that they can choose where to get their prescription. When advice is sought, she would continue to give a range of options and, if any patients asked her about that particular pharmacy, she would be open and honest about her employer’s interest in it.

Those pharmacy businesses which have GP involvement should ensure that staff are aware of and abide by such guidance on conflicts of interest, as competing businesses will be keen to ensure that professional standards and regulatory requirements are not breached. Gifts, for example, should not be offered to any staff within the GP practice, no matter how trivial. Personal boundaries between colleagues should be maintained and relationships should be professional at all times. It is important to remember that professional judgement may also be compromised by personal interest, in addition to financial or commercial.

The joint statement represents a shift in regulatory focus towards highlighting the potential dangers of adopting collaborative working practices and engaging joint ventures between pharmacies and GP practices. The GPhC’s statement makes it clear that in cases of conflict the best course of action is to be honest and when in doubt, we would always recommend seeking expert legal advice.

Richard Hough is partner, pharmacist, and head of healthcare at Brabners LLP. Contact him on 0151 600 3302 or email richard.hough@brabners.com