• Schedule 5

• Schedule 6 Paragraph 124

GP Partnership Agreement

Each GP practice has a Partnership Agreement (essentially a constituition) outlining financial policy. If, in this policy, extra earnings are shared communally between partners, the GP must ensure that his partners are happy to endorse the dvd as well because by accepting payment, their endorsement is implied.

From the GMC Good Practice Guidance [2] "64. you must always be honest about your experience, qualifications and position.." It is not unreasonable to question the expertise of a GP in the area of sports science. It is unlikely that the GP will have the appropriate depth of knowledge in this area.

Is there any clinical evidence supporting/opposing the methods in the DVD?

GMC Good Practice Guidance [2] "65. You must do your best to make sure any documents you write or sign are not false or misleading. This means you must take reasonable steps to verify the information in the documents and that you must not deliberately leave out relevant information."

The GP must make an informed decision on the merits of the exercise programme. He must differentiate between a medical and personal endorsement - if there is supporting research it is a medical endorsement, if not it is only a personal endorsement. He must take steps to ensure a personal endorsement is not mis-leadingly portrayed as a medical one. This is further compounded by the GMC Good Practice Guideline "63. You must be honest and trustworthy when writing reports..."

Ethically the GP must declare any financial interest he has in an enterprise to his patients when recommending the product.

GMC Guidance [2] states "before taking part in any discussions about buying or selling goods or services you must declare any relevant financial or commercial interest that you or your family might have in the transaction."

Will the Dr-Patient Relationship by affected?

By entering into a financial agreement with the patient the GP is putting his professional relationship with the patient at risk.

From the GMC Guidance "Maintaining Boundaries" (2006);."In most successful doctor-patient relationships a professional boundary exists between doctor and patient. If this boundary is breached, this can undermine the patient's trust in their doctor, as well as the public's trust in the medical profession."

Also, "The doctor-patient relationship may involve an imbalance of power between the doctor and the patient." In this case, by accepting payment from a patient the balance of power may shift towards the patient, which could cause difficulties for the GP in the future when dealing with this man, or his family. This is of particular concern in this scenario, where the patient has long-standing mental health issues which the GP is supporting him with.

Will the public's trust in the Dr be affected?

GMC Guidance states; "you must make sure that your conduct at all times justifies your patients trust in you and the publics trust in the profession."

The GP should consider that by endorsing a commercial product of this nature he may be seen to be "selling-out". This may cause patients to question his judgment and clinical decision making. If in the future the DVD is proved to be unsafe/inadequate this may also undermine patient confidence in his practice.

Would this scenario be more acceptable if the GP did not receive payment for his endorsement?

• NHS General Medical Services Contract (2004)
• GMC: Duties of a Doctor
• GMC: Conflicts of Interest (September 2008)
• Medical Act (1983)
• Public Interest Disclosure Act (1998)
• Health Service Circular (1999/198)
• GMC: Maintaining Boundaries - Guidance for Doctors (November 2006)