Intended for healthcare professionals

Education And Debate

Commercial partnerships in chronic disease management: proceeding with caution

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:566
  1. Trisha Greenhalgh, senior lecturer in primary health care (,
  2. Andrew Herxheimer, clinical effectiveness adviserb,
  3. Anthony J Isaacs, consultant in public healtb,
  4. Mike Beaman, pharmaceutical adviserb,
  5. Jenny Morris, public health specialistb,
  6. Stephen Farrow, director of public healthb
  1. a Department of Primary Care and Population Sciences, University College Medical School, London N19 3UA
  2. b Clinical Effectiveness Review Group, Barnet Health Authority, London NW9
  1. Correspondence to: T Greenhalgh

    The spirit of “new Labour” strongly supports efforts to align commercial and NHS interests. The use of private funding for capital projects, such as building hospitals, is now well established, although this practice is not without controversy.1 We discuss a different form of private finance initiative—the development of packages for disease management in collaboration with commercial companies. We describe our preliminary experiences from a health authority perspective.

    The Clinical Effectiveness Review Group was established in 1995 at Barnet Health Authority to address the implementation of evidence based practice at health authority level. The Director of Public Health (SF) noted that he occasionally received offers from independent organisations of “free” packages of services, directed ultimately at general practices, hospital departments, or community pharmacies. These organisations were pharmaceutical companies, producers of medical equipment, or their agents, which, despite a clear conflict of interests were perceived as offering a potentially important contribution to the health of the population (box 1). Somewhat confusingly, these offers were often presented as “managed care” packages, a term that generally implies a different approach aimed at centralised control and cost containment.2

    Summary points

    Commercial companies, especially the manufacturers of drugs and medicines, increasingly seek to work in collaboration with NHS service providers to manage particular diseases or problems

    With such relations there are risks, but also potential benefits, and it may be more realistic to require all parties to be explicit about their potential conflicts of interest than to impose a blanket ban on negotiations

    One London health authority developed and used a set of standards for collaborating with the commercial sector in “managed care” initiatives

    The draft proposals could be used with a view to developing definitive guidance for health authorities, primary care groups, and trusts when considering such collaborative relations

    Box 1 : Examples of “disease management packages” offered by commercial companies to a London health authority 1997-9

    • Asthma care service for primary care …

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