These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Initiatives Highlight Potential of Community Pharmacy

Pharmacy First in Forth Valley One Year On

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Tuesday, September 20, 2016: Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

On the last day of June this year a website went live allowing anybody to find out how much any healthcare professional had been paid by pharmaceutical companies during 2015.

Despite the best efforts of the medicines industry trade body, the ABPI, and its member companies, there was little coverage of the site’s launch. Coming just days after the Brexit vote and the spiral of political upheaval that was going on at the time, the industry’s move was simply not seen as momentous enough.

Speaking as someone who spent much of last year working as a communications person for one of the big pharmaceutical companies, trying – and generally failing – to get the mainstream media interested in the issue of disclosure of payments, the lack of positive coverage of the initiative did not come as a surprise to me.

The fundamental difficulty was that, to be interesting in news terms, such an initiative had to be dealing with a real problem, not just a potential one. Without evidence that any clinical decision has been inappropriately influenced by a prescriber getting money from a medicines maker, nobody could be named and shamed by the media. In short, the conflict of interest that disclosure seeks to make patients aware of is far more likely to be ‘potential’ and ‘perceived’ than real.

Today’s revelation by the chairman of NHS England, Sir Malcolm Grant, that NHS consultants working in England will have to declare their income from private work is explained by him as also being about transparency and avoiding conflicts of interest. He says it is not an attempt to restrict doctors’ non-NHS work[i].

It would be remarkable if ‘private work’ did not include consultancy for the pharmaceutical and medical devices industries.

One assumes that the non-NHS earnings of England’s 46,000 consultants will be published in a publicly searchable database. If not, and the information is only to be available to NHS managers, then the argument that it’s about transparency rather than keeping tabs on doctors will be a bit flimsy.

However, if such a database is to be open to public scrutiny there will be the small matter of data protection to address – as the pharmaceutical industry’s experience demonstrates.

If you should choose to search the ABPI website[ii] to see whether a particular healthcare professional or healthcare organisation received some of the £340 million in payments from industry in 2015, you may only get half of the picture.

Your search may indeed reveal that a particular individual received income from one or more named companies, and for what activity. Such an individual should immediately gain your respect because he or she will have taken the principled stance that they have nothing to hide. They are comfortable that their practice and knowledge is better as a result of being supported to attend a scientific meeting or to undertake some research with funding support from industry. Or they see no reason to hide the fact that they have received a payment for the time they have taken away from other activities to share their real-world-informed opinion on a new medicine that a company is looking to bring to market.

You may, equally, find that a healthcare professional is not listed in the database. Unfortunately, this does not mean they have not received any money. He or she may instead have played the data protection trump card (even if they have previously signed a contract agreeing to the information being disclosed) by refusing to give permission for their personal information to be used. Nothing can be reported as industry publishing the fact that someone has withheld consent is, in itself, likely to let slip the dogs of law.

The result is that those who have never accepted a payment from industry are treated in the same way on the database as the estimated 30%[iii] who have simply refused to allow the information to be published.

Sir Malcolm Grant’s move towards declarations of income for private work, assuming that it includes private work done for medicines companies, may actually be good news for industry where doing the right thing has not been universally popular. 

Polling of healthcare professionals by ABPI published in May of this year[iv] suggested 87% believed payments from pharmaceutical companies to individually named healthcare professionals should be transparent, with around two thirds (64%) saying that the information should be publicly declared. Which means a third did not want public declaration and 13% thought it was all a bad idea.

This reticence has not been helped in Scotland by the fact that much of the media coverage in the mainstream press has been limited to cross referencing the ABPI database with the names of people who sit on national NHS decision-making bodies and suggesting a conflict of interest for those declaring payments. At the beginning of last month, the Sunday Herald in an editorial said “The time has come for Holyrood to legislate for a mandatory declaration scheme for all our health staff”.[v] 

While professional and regulatory bodies agree with the principle of transparency, none has yet required it of those they represent or rule. The non-lawyer in me suspects that data protection will again outrank transparency for Sir Malcolm’s plans, unless Westminster or the General Medical Council make disclosure mandatory.

Meanwhile, Sir Malcolm’s recommendation may have put a wee cat amongst the Scottish pigeons at St Andrews House, home of the Scottish Government’s health team.

Scottish ministers have been able to look good for months simply by not being Jeremy Hunt and not falling out with junior doctors. One cannot imagine any appetite for upsetting consultants either: having to declare income from private work – be it clinical or for industry – might not please those who have something to disclose. But, equally, not supporting a register of private income for consultants in Scotland if there’s to be one in England could be difficult for Scottish ministers to justify given NHS staffing pressures and the SNP’s active dislike of private healthcare.

So much better, then, if the regulators were to come in behind Sir Malcolm and, with their UK-wide remit, take any decision out of the hands of politicians on both sides of the border.

And such a move could finally allow the pharmaceutical industry to remove the blind spot that has prevented it from being able show the whole picture on payments.

 

[ii] ABPI disclosure website: www.disclosureuk.org.uk

[iii] ABPI launch release 30 June 2016 http://bit.ly/294IO5n

[iv] ABPI news release 17 May 2016  http://bit.ly/1YyCRkM

[v] Sunday Herald editorial: http://bit.ly/2cWHaIN