Feature Drug Prescribing

Partnerships: pharma is closer than you think

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3688 (Published 23 July 2015) Cite this as: BMJ 2015;351:h3688
  1. Margaret McCartney, general practitioner, Glasgow, UK
  1. margaret{at}margaretmccartney.com

Nurses and pharmacists employed by drug companies are working in general practices to review prescribing, often without patients’ knowledge. Margaret McCartney investigates

“Partnerships” between the NHS and industry can be win-win. Drug companies profit from NHS prescribing but also encourage safe use by paying professionals to educate NHS staff and patients, minimising waste, diminishing harm, and promoting prescribing in line with guidelines. At least, that’s the idea.

No fewer than 36 English clinical commissioning groups (CCGs) have been involved in medicines management programmes paid for, either directly or indirectly, by the drug industry, according to responses to 186 requests I made under the Freedom of Information Act (see data supplement on thebmj.com).

In some areas, drug company staff have worked in general practices to review patients. More typically, other companies act as intermediaries, employing nurses or pharmacists to assess patients’ records and make recommendations in keeping with prescribing guidelines. The companies are paid by drug companies for specific pieces of work around prescribing. For example, more than 1000 general practices in the UK have accepted funding in the past year from Bayer to pay for “medicines optimisation work” regarding new anticoagulant drugs in patients with atrial fibrillation.

English primary care spends £8.6bn (€12bn; $13bn) a year on drug prescriptions,1 and, of course, doctors should prescribe efficiently, usually generically, and using evidence and wisdom. But how much can industry help? In 1995 a parliamentary inquiry concluded, “The Department of Health has for too long optimistically assumed that the interests of health and industry are as one . . . The consequences of lax oversight is [sic] that the industry’s influence has expanded and a number of practices have developed which act against the public interest.”2

The inquiry cited drug promotions to professionals and patient groups, inadequate trial design, and …

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