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Drug companies to work with CCGs on care pathways and case finding under DH-backed scheme

GPs will be expected to work with drug companies on commissioning screening services and designing care pathways, under a Government-backed plan to promote partnerships between CCGs and the pharmaceutical industry.

A new scheme aims to make it easier for pharmaceutical companies to ‘move beyond sponsorship’ in working with CCGs and funding NHS case finding projects. The guide to ‘joint working agreements’ has been drawn up by the Association of the British Pharmaceutical Industry with the support of the Department of Health.

But GP leaders warned the plans were fraught with conflicts of interest and could badly skew the priorities of emerging CCGs – and pile additional work on GPs.

‘Popular areas for joint working you may wish to consider include identification of undiagnosed patients, reviewing uncontrolled patients, improving patient adherence to medicines and treatment pathway redesign,’ the document says.

Pulse revealed last year that the ABPI had altered its code of practice to allow pharmaceutical companies to develop so-called ‘risk-sharing agreements’ with CCGs, which would only pay full price for drugs if targets on clinical outcomes were met.

The new document aims to expand on this, and help to break down the barriers to joint working between CCGs and the pharmaceutical industry. It lists a number of current joint projects between drug companies and the NHS, including review of patients with COPD, a GP-led clinic for angina and provision of care managers for patients with CVD.

A spokesperson for the ABPI said it wanted to ensure collaborations like these could continue after CCGs were authorised: ‘We would encourage CCGs to engage with local pharmaceutical representatives and highlight areas where patients could benefit from combining the skills and resource of the NHS and pharmaceutical industry.’

A DH spokesperson said: ‘We have worked with the ABPI for a number of years to promote joint working between the NHS and industry. It is up to each individual project to establish governance arrangements.’

But Dr Richard Vautrey, GPC deputy chair, said there was a clear conflict of interest when involving drug companies in planning care, and that CCGs should get independent advice before making any agreements: ‘They should not simply use this as a way to make short-term cost savings, as the long-term adverse consequences might be greater.’

Dr Clare Gerada, chair of the RCGP, said pharmaceutical companies had something to offer, but the potential benefits were often ‘dubious’: ‘We have had pharma funding, and it has been very good, but pharma now as a main funder will skew priorities.’

Dr Des Spence, a GP in Glasgow whose BMJ column is often critical of the pharmaceutical industry, said: ‘If there is under-diagnosis this should only be judged by someone who has no vested interest in the outcome. CCGs are naive if they can’t see this is bad idea.’

Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee, said the involvement of pharmaceutical companies in pathway redesign was ‘something I would not be happy about’.

He said: ‘Would you allow tigers to design their own cage at the zoo, and be confident they wouldn’t design a little hatch for them to pop out and mingle with the crowds when they felt like a snack?’

Case study

A joint project between GSK and the Wearside Consortium aimed to improve the review and treatment of patients with COPD in line with NICE guidelines.

Both parties contributed funds and managed the project jointly.

GSK contributed £91,000 and the local NHS contributed £162,300. As part of their investment, GSK provided an audit tool, resource to provide action plans for practices and a consultant to measure the outcomes of the project.

The project resulted in a 12% reduction in COPD admissions compared with the previous year, and a 6% increase in the proportion of patients receiving high-dose treatment.

Source: ABPI