Intended for healthcare professionals

Feature Investigation

NHS joint working with industry is out of public sight

BMJ 2019; 364 doi: (Published 27 March 2019) Cite this as: BMJ 2019;364:l1353
  1. Tom Moberly, UK editor
  1. The BMJ
  1. tmoberly{at}

Trusts’ working arrangements with drug companies are meant to be open and transparent. But, as Tom Moberly reports, details of many deals are not available to patients and the public

NHS organisations are entering into working partnerships with drug companies, but the details, and even existence, of many of these deals are not being made available to the public, a BMJ investigation has found.

With government encouragement, the number of “joint working arrangements” is growing in England, and they brought more than £7.5m (€8.7m; $9.9m) into the health service in 2016 and 2017. Examples include several projects to review the medications of people with attention-deficit/hyperactivity disorder and more than 20 that focus on patients with age-related macular degeneration. But many of these agreements ignore official guidance that urges openness and transparency (box 1).

Box 1

What are joint working arrangements?

Joint working arrangement is the term used to refer to initiatives that involve shared investment by the NHS and drug companies. They are designed to bring benefits to patients, the NHS, and the companies. They were proposed in the 2006 white paper Our Health, Our Care, Our Say as a new way for the industry to collaborate with the NHS.1 In 2008 the NHS and Department of Health for England published guidance on how the arrangements should work.2 And in 2010, the NHS, the health department, and the Association of the British Pharmaceutical Industry published a toolkit to support their development.3


The BMJ, working with a team of university researchers, used freedom of information (FOI) requests to get details of these arrangements (box 2). It found that a fifth of trusts would not release details of the deals. In one concerning example, a contract allowed for a drug company to be informed of any FOI request relating to the joint working arrangement, …

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