A Nursing Times investigation has revealed that thousands of nurses accept payments and benefits from the UK pharmaceutical industry each year, sparking warnings that they should “keep their eyes wide open” in dealings with drugs companies.
UK pharmaceutical companies published information on payments to healthcare professionals for the first time last summer, as part of efforts to boost transparency.
“We don’t yet know what the impact of industry payments on nursing practice will be”
Nursing Times has analysed the Disclosure UK database, which is hosted by the Association of the British Pharmaceutical Industry (ABPI) and at present only covers information for 2015.
It shows there were more than 6,100 payments to individual nurses in 2015 totalling more than £2.5m. However, it may represent just a fraction of payments to nurses, because many are listed on the database under their speciality or trust and not specifically identified as nurses.
Meanwhile, other nurses may have chosen not have their details disclosed and, as a result, are included in aggregate figures reported by drugs firms, rather than listed individually.
“There is no way to provide an exact number of nurses that received a transfer of value during 2015,” an ABPI spokeswoman confirmed.
The database also shows payments to organisations including the Royal College of Nursing, which received more than £75,000 in 2015 from pharmaceutical companies for the sponsorship of conferences and events, consultancy fees and in the form of grants or donations.
“Nurses need to be aware of this and make sure they are prescribing medicines with an evidence base”
While the disclosure of such information has been welcomed, it has inevitably raised questions about the extent of pharmaceutical firms’ influence in areas like prescribing.
Last year, NHS England held a six-week consultation on plans to strengthen the management of conflicts of interest in the NHS. Under the new guidance, published in February and due to come into force in June, nurses will be required to declare outside employment and the details of where and when this takes place, although not earnings at this stage. This will include any additional advisory work that nurses may undertake for the pharmaceutical industry.
Data published as part of the disclosure scheme shows the UK pharmaceutical industry spent a total of £340.3m on working with health professionals and organisations in 2015.
While most was for activities relating to drug research and development, the database shows about a third – £111m – was paid to individual professionals and organisations for activities such as speaking at meetings, sponsorship for attending events in the UK and abroad, including registration fees, accommodation and travel expenses, training services and donations or grants.
Identifiable payments to individual nurses in 2015 ranged from £4 to £16,750 with pharmaceutical firms sometimes funding or part-funding specialist nursing posts.
Australian nurse academic Quinn Grundy, postdoctoral research associate at the University of Sydney’s Charles Perkins Centre, has explored payments to nurses as part of her research into industry partnerships in healthcare.
She said nurses and nursing organisations must take issues around conflict of interest and independence “very seriously” in order to preserve the public’s trust in the profession.
“We know doctors who receive payments for consultancy, or who attend sponsored events, tend to prescribe more of the promoted drug,” she told Nursing Times. “This tends to be a more expensive option than what is available and has less of a safety track record than older, established medicines.
Concerns flagged over pharma payments to nurses
“We don’t yet know what the impact of industry payments on nursing practice will be, but it merits investigation,” she said.
Disclosing payments was a good first step, said Ms Grundy, but argued that it was “not enough on its own”.
“We need to take the next step to eliminate relationships that are harmful to patients, healthcare budgets or threaten the public’s trust and to create a system where collaborative relationships can occur ethically and health professionals can remain independent,” she said.
“Are the pharmaceutical industry trying to influence nurses? Yes, of course they are,” said independent consultant nurse and advanced nurse practitioner Professor Matt Griffiths.
“Nurses need to be aware of this and make sure they are prescribing medicines with an evidence base and in the best interests of patients,” he told Nursing Times.
Nurse prescriber Steve Hemingway, senior lecturer in mental health at the University of Huddersfield, has been paid by firms to deliver presentations and for an educational trip abroad.
“Pharma industry reps will always be nice and try to ingratiate themselves with you”
He said a “pragmatic” approach was needed given the current financial constraints in the NHS, because pharma-sponsored events and activities were a vital source of continuing professional development (CPD).
But he urged nurses to keep “their eyes wide open”. One thing made clear to students on prescribing courses at his and other institutions was that they would “become a saleable commodity”, he said.
“Nurses need to know when they are adopting more autonomous roles – advanced practice, medicines management and prescribing roles – the industry will want to talk to them,” he noted.
While there was more transparency around payments now, he said “the tension between using the industry and actually being exploited by them or becoming an agent of them” remained.
“Nurses need to be realistic and have their eyes wide open,” said Mr Hemingway. “Pharma industry reps will always be nice and try to ingratiate themselves with you. Every pharma company has a wonderful mission statement, but ultimately it’s about private supply and demand and whether they can get their product sold. For the nurse it should be about whether or not that product is worthwhile.”
Professor Griffiths, who has also been paid by the pharmaceutical industry in the past and more recently last year, stressed that “transparency is everything” and also highlighted CPD opportunities.
“Having a transparent relationship where you can see that finances have changed hands is vitally important,” he told Nursing Times.
“But we also need to acknowledge that if we didn’t have the pharma industry helping financially to support nurses on courses, or get them involved in other pieces of work, then it would be quite a sad world because there is very little money for education in the NHS,” said Professor Griffiths.
With government moves to encourage partnership work between the public and private sector, pharmaceutical firms were likely to become more involved in the health service, he said.
“We need to listen to them, find out about new drugs, find out what the latest research says about particular conditions and use the education from them in a professional manner,” he said. “But we also need to keep our guard up and use our critical skills, so we’re not just being fed a certain amount of information the drugs company wants us to have.”
There are already standards and guidance for nurses on working with the pharmaceutical industry, explained Steph Aiken, deputy director of nursing for the Royal College of Nursing.
“NHS trusts will often have local guidance so nurses should always start with that,” she said.
“NHS trusts will often have local guidance so nurses should always start with that”
The Royal Pharmaceutical Society’s prescribing competency framework – endorsed by the RCN and supported by the Nursing and Midwifery Council – states that nurses must make decisions based patients’ needs and not “personal considerations”, and work within local formularies.
Nurse prescribers must also work “within the NHS/organisational or other ethical code of conduct when dealing with the pharmaceutical industry”, according to the framework.
While the NMC code does not specifically mention involvement with drugs firms, it requires nurses to promote professionalism and trust and ensure any treatment they prescribe is appropriate for an individual patient. Section 21 of the code requires nurses to “act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with”.
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The NMC said it was not possible to say how often allegations of misconduct linked to nurses accepting payments from drugs companies came up in fitness to practise cases – if at all – as its data was not broken down in that way.
However, the regulator’s fitness to practise team said they could not recall any recent cases involving this type of allegation.
Julie Ballard, corporate relations manager for the RCN, pointed out the pharmaceutical industry was “heavily regulated”. “Funding typically comes via educational grants, and companies have a ‘hands off’ relationship throughout projects,” she said.
Pharmaceutical company disclaimers make it clear they have had “no editorial input or influence” on specific initiatives and the relationship between sponsors and project teams is carefully managed, she noted.
When it came to the RCN’s own dealings with firms, Ms Ballard said the body worked with a wide range of different partners and – as of September 2016 – just 8% of the college’s collaborations were with the pharmaceutical industry.
“By collaborating with others, the RCN can utilise industry intelligence and expertise which enhances the RCN’s work,” she said. “Securing external funding facilitates broader dissemination of messages and resources, expanding the reach and influence of what the RCN can achieve on its own for the nursing profession and patient care.”
She stressed that the college did not enter into joint work “that could be perceived as endorsing a particular product or service”.
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“The RCN works to ensure that joint ventures are ethical, mutually beneficial and underpinned by formal written agreements to enable an open and transparent way of working,” said Ms Ballard.
Meanwhile, the ABPI also said it was committed to transparency. “We believe it is right that the public get to see how we work with doctors, nurses and pharmacists and organisations to ensure life-saving medicines are developed for the patients who need them,” said a spokeswoman.
“We can’t develop new medicines on our own – we’re proud of the vital working relationships we have with doctors, nurses and health professionals,” she said. “We follow strict rules about how we work together – these relationships matter – they allow us to make medicines work as effectively as possible, while the whole of the NHS benefits from up to date information about the latest treatments for patients.”
She highlighted that pharmaceutical firms’ work with professionals like nurses included developing resources to help patients understand their conditions and treatment.
Companies also funded meetings to bring nurses and other clinicians together to discuss how knowledge of certain diseases was changing, worked with doctors, nurses and pharmacists on “advisory boards”, and carried out market research, she noted.
The figures for payments to health professionals in 2016 will be available on the ABPI website in June 2017.