October 7, 2007

UK: GMC Advises UK Docs To Commit Fraud over MMR

The GMC is Britain's medical ethics council that is currently trying Andrew Wakefield over alleged ethics violations in regards to his research on the MMR.

Apparently they are encouraging doctors to remove children who refuse the MMR from their list of patients to fraudulently raise the MMR uptake statistics.

The docs can then get payments for seeming to have met the governments MMR uptake goals.

So the GMC, whose job it is to maintain ethical medical practices, is apparently giving the nod for docs to commit fraud to prop up vaccine uptake stats and to get cash payments.

I am sure that Wakefield will get a fair hearing.

From UK Lawyer, Clifford Miller:

GMC Advises UK Docs To Commit Fraud over MMR

Is medicine institutionally corrupt? Here you will see the UK's General Medical Council advising UK medical doctors how to commit fraud on the UK's National Health Service for personal financial gain.

The GMC's role is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine by medical doctors. This includes prosecuting UK medical doctors when their behaviour may bring the medical profession into disrepute. Dishonesty, financial impropriety and fraud fall within its purview. This link [1] provides an example of a decided case from its website.

The GMC is a statutory body independent (allegedly) of the NHS and of Government, with responsibility for maintaining the medical register for the United Kingdom. The GMC has statutory powers under the Medical Act 1983 to take action where there are concerns about the fitness to practise of a registered medical practitioner. Where the GMC finds that a doctor is not fit to practise, it has powers to erase that doctor's name from the medical register, to suspend the doctor from the register or to place conditions on the doctor's practice. These restrictions apply to practice in any sector of employment in any part of the UK. [2]

In the UK if doctors meet target levels for numbers of MMR and other vaccinations administered they can claim bonus payments for doing so. If they fail, they cannot claim those payments. One way of claiming the payments is to make a false return.

So how can it be that the GMC advises doctors on how to commit fraud? The GMC pose the question "Can GPs remove some children from their lists, temporarily, for the purpose of calculating the MMR target payment?" Here you will see that its currently available advice is to the effect that "it's OK provided you have patient consent" [3], [4]. It seems it also happens to be OK if it helps to increase the MMR uptake figures. The advice does not appear to be offered for other vaccinations.

And notice how they fail to make any mention of the financial and moral impropriety of doing so when they answer the question they pose like this:-

"This must not be done without the parents' agreement. Parents must be given a full explanation of what was proposed and why, their child's rights as an NHS patient, and the implications for their child's future care. Doctors working within the NHS must treat all patients entitled to NHS services on an equal footing. So temporarily removing a child from a GPs list must not adversely affect their care, for example in accessing secondary care and out-of-hours services, or in providing relevant information to ensure continuity of care and allow effective working with other agencies. Doctors must act honestly in their financial dealings. So GPs must ensure that any arrangement to remove a child from their list and re-register them for ‘immediately necessary treatment', or on some other basis, would be in line with their contractual obligations to the NHS."

Notice that provided the doctor does what the GMC advises and ensures "that any arrangement ... would be in line with their contractual obligations to the NHS" it is fine as "Doctors must act honestly in their financial dealings". Am I missing something or is this starting to look like we need the "men in white coats" to take away the men in white coats?

Not only that but the GMC advice is that if the evidence is available this is not contrary to GMC guidance on good medical practice:-

"Are temporary removals from a GPs list acceptable to the GMC? In the absence of evidence that ‘temporary removals' satisfy the concerns outlined at Q5, we cannot give any reassurance that such arrangements would be seen as consistent with our guidance on good practice."

GMC advice to UK doctors is that doctors "must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients." [7] But it seems the GMC do not mind when it comes to MMR, even where the inducement is so strong it encourages fraud on the NHS. But then, the GMC does not seem to mind about that either.

So now you know. If it concerns getting MMR uptake up, fraud is fine. But you had better make sure you implicate the parents and what better way to do that than to pressure them into agreeing their children become temporary patients possibly for emergency treatment only or else be dumped from the patient roster completely. Naturally, I am not saying that is happening nor am I saying the GMC advice is taken to suggest that be done - as it does not, but it could encourage that kind of behaviour. As a lawyer advising pro bono I have direct experience of patients being removed from an NHS doctor's roster after objections to childhood vaccinations.

The GMC has an agreement on cooperating and coordinating with the NHS Counter Fraud service [5]. And "GMC Today" newsletter carried a story ironically titled "Is the NHS immune to fraud?" about reducing and reporting fraud in the National Health Service [6]. The story gives a number to call the confidential NHS Fraud and Corruption Reporting Line and an email address too. It reports:-

"If you have a concern about a fraud taking place within the NHS, please call the confidential NHS Fraud and Corruption Reporting Line on 0800 028 40 60. All calls will be dealt with by trained staff and professionally investigated. Lines are open Monday to Friday 8 am–6 pm. You can also email us at nhsfraud@cfsms.nhs.uk at any time."

I haven't got the heart to tell 'em. Have you?

[1] http://www.gmc-uk.org/concerns/hearings_and_decisions/ftp/ftp_panel_islam_20061013.asp

[2] http://www.gmc-uk.org/about/partners/national_health_service_counter_fraud_service.asp

[3] http://www.gmc-uk.org/guidance/current/library/targeting_preventative_measures.asp

[4] http://www.gmc-uk.org/guidance/archive/Target_payments_for_preventative_health_measures_2003.pdf

[5] Memorandum of Understanding between the General Medical Council (GMC) and the National Health Service Counter Fraud Service (NHS CFS)

[6] Is the NHS immune to fraud? - GMC Today - Oct 2005

[6] Paragraph 74 Good Medical Practice


Unknown said...

hi ginger - have u seen this yet?
its amazing how our culture turns parents into social pariahs for questioning the safety of injecting metals, toxins, animal dna/tissue & diseases into the bodies of infants... i am continuing my research and trying to be as 'balanced' as possible.

qchan said...

If you actually read the document, it's clear the GMC is not encouraging fraud at all. The gist of its position is that under certain circumstances it MIGHT be OK to temporarily remove a patient from the rolls, but that the GMC will look with skepticism at such actions as they relate to good medical practice.

Seriously, how likely is it that if the agency wanted to encourage fraud, it would publicly post a notice to that effect on a Web site?

It's also almost hilariously ironic that these assertions are being made in part to defend the reputation of Andrew Wakefield. This is the guy, you'll remember, who accepted the equivalent of more than $800,000 from lawyers trying to make a case that the MMR vaccine was unsafe.
( http://briandeer.com/mmr/st-dec-2006.htm )

Mark said...

I am guessing that you are not in the UK. the health service in the UK is free! GP receive money from the government depending on the service they provide, service is measured by the practices ability to reach targets set by government.
if they reach targets then they receive extra money.
For example patients are required to be seen within 48hrs of booking an appointment.
surgeries quickly adopted the practice of asking you to call back later or to call tomorrow early to work around this.
A financial incentive is offered for vaccination targets and I expect some doctors will find ways to massage the figures for these too.
The GMC may not be encouraging this practice but they are certainly not discouraging it.

I'm sure you appreciate the conflict of interest that happens when health care is target and not patient care based.

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