APPENDIX 20
Memorandum submitted by the Joint Task
Force on Medicines Partnership (PI 58)
1. INTRODUCTION
1.1 The Task Force on Medicines Partnership
is a Department of Health funded programme which aims to help
patients to get the most out of medicines by implementing the
principles of concordance. Concordance is a process of successful
prescribing and medicine taking where health professionals and
patients work together as partners to agree on diagnosis and treatment,
and patients are supported in medicine taking.
1.2 Medicines Partnership was set up at
the start of 2002 under Pharmacy in the Future, part of
the NHS Plan. It consists of a 30 member Task Force, supported
by the Medicines Partnership centre, hosted by the Royal Pharmaceutical
Society (RPSGP), under the Directorship of Joanne Shaw. Medicines
Partnership has a unique perspective on how to enable patients
to get the most out for their medicines, because the Task Force
represents a unique collaboration between the NHS, health professionals,
patient groups, academics and the pharmaceutical industry.
1.3 The experience of the Medicines Partnership
programme demonstrates the following:
— It is possible for the NHS to work
closely with the pharmaceutical industry for the benefit of patients
and collaborating partners. Through its programme, Medicines Partnership
has worked successfully with industry, harnessed industry resources
and influenced industry to work differently in many of its projects.
The key prerequisite for a successful joint project is transparency
of objectives at the start.
— In order to make informed choices
and get the most benefit from medicines, patients need much better
information and support at the time of the prescribing decision
and when they come to use medicines. There is currently a lack
of clear, accessible information for patients which accurately
presents the possible risks and likely benefits of different treatment
options. Pharmaceutical companies are well placed to contribute
to this information because of their unique resources and knowledge
of their own products. Regulatory constraints, and fears about
pharmaceutical company influence limit the extent to which companies
use their resources in this way. A number of Medicines Partnership
projects illustrate how this can be done effectively.
2. MEDICINES
PARTNERSHIP'S
WORKING RELATIONSHIP
WITH INDUSTRY
2.1 The Task Force has been a partnership
with industry from the outset. In 1995, Merck Sharp and Dohme
and the Royal Pharmaceutical Society of Great Britain established
a joint commission on the causes and consequences of non-compliance.
Research suggested that 50% of medicines prescribed for long-term
conditions are not taken as intended. This represents a huge cost:
to patients (in avoidable ill health and premature death), to
the NHS (in wasted medicines and avoidable hospitalisation): to
society (in avoidable sickness absence and social support)), and
to the pharmaceutical industry (in lost revenues and mistaken
perceptions about efficacy).
2.2 The programme has five objectives:
— To encourage and enable professionals
to involve patients as partners in prescribing decisions;
— To ensure that medicines concordance
is incorporated in public and private sector policies;
— To facilitate model practice projects
and demonstrate results;
— To influence patient and public expectations;
— To enlarge and disseminate the knowledge
base about concordance.
2.3 The programme breaks new ground by recognising
the mutual interest of both the public and private providers of
health services in improving medicines' use, and seeking innovative
and transparent ways to allow the two to work together within
current guidelines.
2.4 Examples of projects where Medicines
Partnership has worked jointly with industry include the following:
— We are building on the learning of
Roche, Biogen and Schering-Plough who are all providing proactive
nurse-led telephone support programmes for patients taking specific
medications. We are assisting these companies in evaluating their
services and making them more sensitive to the needs of patients.
We hope to use the results to inform a randomised controlled trial
of telephone support for people taking statins, and use this to
build a case for much greater provision of these services where
they are shown to be effective, possibly offered through NHS Direct.
— We collaborated with a range of companies
and other stakeholders to deliver Ask about Medicines Week 2003,
a campaign intended to encourage the public to be more proactive
in finding out about their medicines. Planning is now well in
hand for a second Ask about Medicines Week in November 2004.
— We are collaborating with the ABPI
and individual companies to develop a new structured source of
medicines information which will be available through NHS Direct
Online and other media. This is the subject of a separate submission
to the Committee from the Medicines Information Project itself.
— With Merck Sharp and Dohme and MORI,
in 2003 we commissioned a major survey of patient attitudes to
medicines and medicines information, to assess success to date
with the national agenda. This will form a baseline against which
repeats of the survey will be compared in this and future years.
— We have received a major unrestricted
educational grant from Pfizer to pilot a community pharmacy service
for patients with Parkinson's Disease and are working collaboratively
with them and other stakeholders on implementation.
— We have worked with Bristol Myers
Squibb to develop a guide for health professionals on setting
up medication review services for people with schizophrenia.
— We have collaborated with Sanofi
Synthelabo and a consortium of interested organisations, including
the Muslim Council of Britain and a rabbinical authority and advisor
to the Board of Deputies of British Jews, to produce a guide to
drugs of porcine origin and their clinical alternatives, with
information on culturally sensitive prescribing.
2.5 Throughout these projects, two important
principles have guided the way in which we work with industry
and made it possible for all parties to benefit.
2.6 Firstly, there has been transparency
of objectives on all sides at the outset. The recent ABPI and
NHS Alliance guidance on the NHS and Pharmaceutical Industry working
together[74]
suggests that industry and the NHS should agree joint objectives
at the outset of projects. Whilst this is important, we also believe
that in addition, there must be a recognition that the different
parties involved have different goals and reasons for participating,
and these need to be clearly understood by all to avoid misunderstanding
and mistrust.
2.7 Secondly, in all of our projects, three
parties are involved: the NHS (including prescribing professionals),
patients and patient organisations, and industry. This coalition
of interests and expertise provides an effective check on any
potential undue pharmaceutical company influence: prescribing
professionals are usually able to provide a fact-based, unbiased
perspective on the evidence for different treatment options and
patient groups provide an important user-perspective.
3. THE NEED
FOR IMPROVED
MEDICINES INFORMATION
AND SUPPORT,
AND THE
PHARMACEUTICAL INDUSTRY'S
ROLE
3.1 Concordance requires patients to have
sufficient information about treatment options, in a style and
format that meets their needs, to enable them to make informed
choices about treatment in collaboration with a health professional.
A newly published study[75]
confirms the findings of many before it: after around four weeks,
a large proportion of patients starting out on new medicine for
a chronic condition are no longer taking the medicine—most
intentionally so—and most expressed a substantial and sustained
need for more information about their medicine.
3.2 The pharmaceutical industry is well
placed to play an active role in providing enhanced information
about medicines. Companies have unrivalled access to information
about the risk and benefit profile of individual medicines through
both trial data and reported incidence of adverse reactions after
product launch. They also have access to substantial resources
to enable them to deliver information and support, and also a
significant interest in doing so. The Medicines Partnership projects
outlined above show that, with the right checks and balances in
place, industry can play a valuable role in this area to the benefit
of patients.
3.3 There are a number of regulatory and
other barriers to industry playing this role to the full. For
example:
— Regulations limit the usefulness
of the patient information leaflet which each product must carry,
and result in many patients reporting that the leaflets are too
general, too narrow, too negative and too late to meet their needs.[76]
— Direct to consumer advertising controls,
and the ABPI code of conduct, have led to confusion about whether
it is legitimate for companies to inform patients prescribed with
their products about the availability of support and information
services offered. Therefore, for example, the Motivation, Advice
and Proactive Support (MAP) telephone service offered by Roche
to patients taking Orlistat (Xenical~) for obesity, is not advertised
on the product packaging, and patients can only find out about
it from a health professional.
— In our experience, fear of pharmaceutical
company influence can prevent local health services working collaboratively
with industry at an organisational level, leaving relationships
with companies to individual health professionals, where problems
can occur.
4. CONCLUSIONS
AND RECOMMENDATIONS
There are good reasons why pharmaceutical industry
influence on the NHS needs to be considered very carefully. Industry
can play a valuable role, particularly in providing information
and support to patients taking medicines to facilitate shared
decision-making with health professionals. Medicines Partnership
has shown how industry collaboration can work well, both through
individual Medicines Partnership projects and also through the
Medicines Partnership programme as a whole, which has been an
open collaboration with industry from the start. Based on this
experience, we believe that mistrust of pharmaceutical companies
prevents industry from playing its potential role to the full,
and that patients and the NHS would benefit from more open, transparent,
multi-lateral working relationships with industry.
Joanne Shaw
Director
74 NHS and Pharmaceutical Industry Working Together
for Patients, 2004, ABPI and NHS Alliance, available from www.abpi.org.uk. Back
75
Barber et al, Quality and Safety in Healthcare 2004; 13:172-175. Back
76
Raynor, DKT, British Pharmaceutical Conference, 2003. Back
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