Select Committee on Health Written Evidence


Memorandum submitted by the Joint Task Force on Medicines Partnership (PI 58)


  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.


  2.1  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.


  3.1  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.


  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


74   NHS and Pharmaceutical Industry Working Together for Patients, 2004, ABPI and NHS Alliance, available from Back

75   Barber et al, Quality and Safety in Healthcare 2004; 13:172-175. Back

76   Raynor, DKT, British Pharmaceutical Conference, 2003. Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2005
Prepared 26 April 2005