PHARMACEUTICAL IDEAS

Published: 22/07/2004, Volume II4, No. 5915 Page 18 19

This is the first in a series of articles linked to sessions being held at this year's party political conferences.The Health Hotel is a unique forum of over 25 organisations, including HSJ , which have come together to form a concerted lobby group at each of the events.For more details visit www. healthhotel. org. uk

Partnership is an increasingly important word in healthcare circles. The 'devolved'NHS is diversifying rapidly and this is creating many opportunities for pharmaceutical companies and the NHS to look at new ways of working together.

It is also envisaged that up to 15 per cent of operations and diagnostic tests will be carried out by private hospitals and clinics by 2008.

The pharmaceutical industry is already working closely with the NHS - a new survey shows that more than half of all primary care organisations already work in partnership with it.

But is partnership between drugs companies and the NHS a good thing for patients? Can a partnership result in unfair pressure on a doctor to prescribe a particular treatment? Is it right that a commercial company can be involved in supporting an organisation that may later buy its products?

These are all questions that can and should be posed. Probity, equity and transparency must be the watchwords of relationships between pharmaceutical companies and the NHS. These aspects are addressed in a new guide to joint working launched by the Association of the British Pharmaceutical Industry in association with the NHS Alliance.

Founded in the well-established Association of the British Pharmaceutical Association code of practice, the new guide aims to overcome potential difficulties in setting up collaborations. It also demonstrates how properly managed joint projects, from the nutritional screening of older patients to optimising management in palliative care of cancer pain, work in practice.

The framework for joint working between the industry and the NHS promotes close and effective working to benefit patients. The industry acts as a partner, stakeholder and as a supplier to the NHS, and each of these roles requires different approaches. Although the overall aim of improving health for patients is shared, the organisational objectives of pharmaceutical companies and the NHS are different. The framework builds on the lessons learnt from successful past collaborations to ensure those of the future produce results.

As a guide for future cooperation, the framework stresses that all joint activities should be for the benefit of both individual patients and for wider populations and that any agreements between the industry and NHS partners are conducted openly and transparently. Other key provisions are:

nthe interests of individual patients must be protected;

n clinical aspects of care should be under NHS control, although industry input is legitimate and offers benefits to patients and NHS organisations.

n joint working should not be seen as an endorsement or promotion of a specific medicine or technology.

n clinicians have a duty to provide whatever treatment they consider clinically appropriate.

n pharmaceutical companies must comply with the ABPI code at all times and NHS staff must comply with NHS - and relevant professional organisations' - codes of conduct.

This framework is a practical and flexible guide that will help increase trust, honesty and respect in joint projects between the industry and the NHS.When partnerships are well handled they create significant benefits for patients because health services and pharmaceutical companies are better placed to develop therapies around their needs.

This document was made possible with the support and advice of the NHS Alliance, which will be promoting use of the protocol across the country.

Alliance chief executive Michael Sobanja agrees that partnership working is important: 'Resources and time are always a major issue for trusts, but there are many ways in which joint working could actually share the workload and improve results. Patients benefit by close and effective working between the pharmaceutical industry and the NHS. This document sets out a framework for such partnerships and gives excellent examples of how this works in practice.'

As well as laying out clear guidelines for co-operation, the report also highlights some case studies of how pharmaceutical companies have been working with the health service. Some examples include:

In 2003, Pfizer set up a medical review team to support primary care organisations in improving the quality of prescribing for patients over the age of 65. The work highlighted how complex prescriptions can be for this group and the need for effective medication review. The review led to a reduction in the number of medicines taken and helped patients get more from their medicines.

nSince 1995, Merck Sharp & Dohme has been collaborating with the NHS to examine what is known about the barriers to patients taking medicines that they are prescribed. The investigation is continuing, but has already resulted in clearer patient information about what their medicines are for and how to take them.

n Gloucestershire primary care trusts have approached Abbott Laboratories for nutritional expertise and support to investigate the problem of undernourished elderly hospital patients. The steering group set up as a result initiated a new nutritional screening programme that successfully identified those at risk of malnutrition and improved health outcomes.

These case studies demonstrate just how much added value can be brought to the NHS by collaboration with the pharmaceutical industry and we hope to see more projects of this kind flourish in the coming months.

Further evidence of the benefits comes from a recent survey of PCOs by Medical Management Services and supported by the ABPI. This showed that joint projects now cover a wide range of subjects including medication reviews, education updates for staff and sponsorship of meetings, as well as development of specialist primary care clinics and specialist nurses.

Medicines management projects were rated as the key issues. Other top-rated areas included team building and communication skills, implementing National Institute for Clinical Excellence guidelines and national service frameworks and nurse training.

It is areas like these in which joint working will grow, although innovation, service redesign and customer/patient involvement will also be supported in order to make the NHS more patient friendly.

The NHS plan and other recent publications from the Department of Health all point to the benefits that can come from a constructive engagement with the private sector.

The ABPI is strongly in favour of increased early engagement with the NHS and using the expertise of pharmaceutical companies not as simply as suppliers but as supporters of clinicians and managers.

If this is carried out in a spirit of mutual openness and transparency, then all will benefit - companies, trusts and, most importantly, patients.

Kevin James is chair of the ABPI's NHS taskforce and managing director of Wyeth (UK and Republic of Ireland).