PHARMACEUTICAL SPONSORSHIP WORKING WITH INDUSTRY POLICY Document Owner Luton CCG Document Author Head of Medicines Optimisation Directorate Quality and Clinical Governance Ratifying Committee CCG Board Date of Approval October 2013 Date of Review November 2014 Document History Version Date Author Revision Description 1.0 Final 15 October Head of New stand-alone policy Draft 2013 Medicines 1.1 22 October 2013 Optimisation Head of Medicines Optimisation Amendments following LCCG Board discussion. Version Date Approved by: 1.1 22 nd October 2013 LCCG Board 1
Contents: 1. Sponsorship/Joint Working 2. NHS Luton CCG Acceptance of Hospitality and Gifts Protocol 3. NHS Luton CCG Sponsorship/Joint Working Protocol Appendices: Appendix 1: NHS Luton CCG Gift and Hospitality Record Sheet Appendix 2: Pharmaceutical Industry Sponsorship/Joint Working proposal PROCESS FLOW DIAGRAM Appendix 3: Pharmaceutical Industry Sponsorship/Joint Working Checklist 1 Appendix 4: Pharmaceutical Industry Sponsorship/Joint Working Checklist 2 Appendix 5: Pharmaceutical Industry Sponsorship/Joint Working Luton CCG Committee Recommendations & Approval Form 2
1. Sponsorship/Joint Working 1.1 There is an obligation on NHS bodies to work together, and in collaboration with other agencies, to improve the health of the population they serve and the health services provided for that population. 1.2 Collaborative partnerships with industry can have a number of benefits in the context of this obligation. It is important to have a transparent approach to any sponsorship/joint working proposed to the CCG and for the CCG to consider fully the implications of a proposed sponsorship/joint working deal before entering into any arrangement. If any such partnership is to work, there must be trust and reasonable contact between the pharmaceutical company and the NHS. Such relationships, if properly managed, are of mutual benefit to the organisations concerned. 1.3 For the purpose of this policy, commercial sponsorship is defined as including NHS funding from an external source, including funding of all, or part of, the costs of a member of staff, NHS research, staff training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs (including trips abroad), provision of free services (including guest speakers), buildings or premises. Joint Working is defined as situations where for the benefit of patients, the NHS and Industry organisations pool skills, experience and resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery. 1.4 In all these cases, the CCG and its employees must publicly declare sponsorship/joint working or any commercial relationship linked to the supply of goods or services and be held to account for it. 1.5 Where such collaborative partnerships involve a pharmaceutical company, the proposed arrangements must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 Inducements and hospitality ). 1.6 Whatever type of agreement is entered into, a clinician s judgement must always be based upon clinical evidence that the product is the best for their patients. 1.7 All staff are expected to comply with the protocol for sponsorship/joint working set out at Section 4. 3
2. Hospitality 2.1 The principle of integrity requires that staff should not place themselves under an obligation that might influence, or be perceived to influence, the conduct of their duties. This means that the receipt of hospitality (or gifts see below) must be subject to clear controls, and that any that is accepted must be declared and recorded. All staff are required to comply with the protocol for hospitality and gifts set out below. 2.2 NHS Luton CCG Acceptance of Hospitality and Gifts Protocol 2.2.1 Hospitality must not, under any circumstances, be solicited. 2.2.2 Staff should never accept lavish hospitality. 2.2.3 Whilst modest hospitality is an accepted courtesy of a business relationship, staff should not accept hospitality, of any kind, which could be interpreted as a way of exerting an improper influence over the way they carry out their duties. 2.3 Examples of hospitality which may be accepted, include: Invitation to a society or institute dinner or similar function. Attendance at an event at which there is a genuine need to impart information or represent the CCG in the community. Attendance at an event which is clearly part of the life of the community or where the CCG should be seen to be represented. The hospitality arises during attendance at a relevant conference or course, where it is clear that the hospitality is corporate rather than personal. 2.4 Even in the context of acceptable types of hospitality, their frequency and/or scale should not be significantly greater than the NHS, as an employer, would be likely to offer. 2.5 Hospitality may also be an issue in relation to sponsorship by external organisations from industry (see later section of this policy for sponsorship issues in general). 2.6 Hospitality offered and accepted must be notified in writing, by the recipient, to the Head of Strategy and Governance on documentation in Appendix 1, who will enter the notification into the CCG s Hospitality Register. Notification should be made as soon as practically possible after the receipt and, if possible, beforehand. If in doubt, staff should always err on the side of making a declaration. 4
2.7 Staff may accept modest working meals and light refreshments, such as those that would usually be self-funded or more significant hospitality which is clearly integral to a training course, without making any declaration. 2.8 The following examples are intended as a (non-exhaustive) illustration of what would be not regarded as acceptable hospitality: A holiday or weekend in any holiday centre. Offers of hotel accommodation, or tickets for the theatre, shows, concerts, sporting events etc. Corporate hospitality events or other similar types of activities. Use of an external company s flat or hotel suite. Any form of hospitality which is extended to immediate members of the family. 2.9 When a specific, external person or body has a matter currently in issue with the CCG, for example an arbitration arising from a contract, or if the CCG is making purchasing or procurement decisions, common sense dictates that an offer of hospitality be refused, even if, in normal circumstances, it would be regarded as hospitality of an acceptable nature. 2.10 When staff decline hospitality, they should do so in a polite but firm matter and draw the attention of the person making the offer to the existence of this policy. If necessary, staff should pay their share of any costs and, where eligible under CCG rules, claim these from the CCG in the usual way. 2.11 Provision of Hospitality by the CCG or Its Employees 2.12 Gifts 2.11.1 The proposed use of public funds for hospitality and/or entertainment should be considered very carefully. Inappropriate or excessive spending can cause lasting damage to the reputation of the CCG and the NHS. Hospitality is not the norm when conducting business; it should be provided only when necessary and appropriate. Advice should always be sought in cases of doubt. All expenditure on hospitality provided should be capable of justification to the CCG s internal and external auditors. Personal gifts (of any kind, whatsoever) must not, under any circumstances, be solicited. 2.12.1 Individual staff must not, under any circumstances, accept money. In addition, an offer of money from a potential or existing contractor 5
should be firmly refused and reported immediately to the Director of Finance or the Head of Governance and Risk.. 2.12.2 In the event that a member of staff is made aware that he or she has been made a beneficiary in a will of a patient or a service user, the employee should report the matter to his/her manager who must discuss it with the employee and the Chief Finance Officer or the Head of Governance and Risk. 2.12.3 Small, one off, tokens of gratitude from patients, their relatives or carers, of low intrinsic value may be accepted. If in doubt, staff should consult their line manager. However, substantial gifts should be politely declined, quoting this policy. 2.12.4 The giving of a substantial gift by a patient, relative or carer, can compromise the professional nature of the staff/patient relationship. 2.12.5 Unsolicited gifts of low intrinsic value (such as calendars, pens and diaries) which have a use in connection with the recipient s work may be accepted. Other personal gifts should be refused or if this is impossible, should be accepted and immediately handed over to the line manager and a record of the circumstances made and retained by the recipient. 2.12.6 Staff must not, under any circumstances, accept personal gifts with a significant financial value, or any benefits in kind, such as offers of holiday accommodation. 3. NHS Luton CCG Sponsorship/Joint Working Protocol 3.1 Before entering into any sponsorship agreement the CCG will: Satisfy itself, with reference to information available, that there are no potential irregularities that may affect a company s ability to meet the conditions of the agreement or impact on it in any way, for example checking financial standing by referring to company accounts; Assess the costs and benefits in relation to alternative options where applicable, and to ensure that the decision-making process is transparent and defensible; Ensure that legal and ethical restrictions on the disclosure of confidential patient information, or data derived from such information, are compiled with; Determine how clinical and financial outcomes will be monitored. Ensure that the sponsorship/joint working agreement has break clauses built in to enable the CCG to terminate the agreement if it becomes clear that it is not providing expected value for money and/or clinical outcomes. 6
3.2 The CCG will apply the following principles: 3.2.1 Purchasing decisions, including those concerning pharmaceutical and appliances, will always be taken on the basis of best clinical practice and value for money. Such decisions will take into account their impact on other parts of the health care system, for example, products dispensed in hospital which are likely to be required by patients regularly at home. 3.2.2 When making purchasing decisions on products which originate from NHS intellectual property, ethical standards will ensure that the standard is based on best clinical practice and not on whether royalties will accrue to an NHS body. 3.2.3 Deals whereby sponsorship/joint working is linked to the purchase of particular products, or to supply from particular source, will not be allowed, unless as a result of a transparent tender for a defined package of goods and services. 3.2.4 Patient information attracts a legal duty of confidence and is treated as particularly sensitive under Data Protection legislation. Professional codes of conduct also include clear confidentiality requirements. The CCG will assure itself taking advice when necessary, that sponsorship/joint working arrangements are both lawful and meet appropriate ethical standards. 3.2.5 Where a sponsorship/joint working arrangement permitting access to patient information appears to be legally and ethically sound (for example, where the pharmaceutical company is to carry out or support NHS functions, where patients have explicitly consented), a contract will be drawn up which draws attention to obligations of confidentiality, specifies security standards that should be applied, limits use of the information to purposes specified in the contract and makes it clear that the contract will be terminated if the conditions are not met; 3.2.6 Where the major incentive to entering into a sponsorship/joint working arrangement is the generation of income rather than other benefits, then the scheme should be properly governed by income generation principles rather than sponsorship arrangements. Such schemes should be managed in accordance with income generation requirements, i.e. they must not interfere with the duties or obligations of the CCG. A memorandum trading account should be kept for all income generation schemes; 3.2.7 As a general rule, sponsorship/joint working arrangements involving the CCG will be at a corporate, rather than individual level. 3.2.8 If publications are sponsored by a commercial organisation, that organisation should have no influence over the content of the publication. The company logo can be displayed on the publication, but no advertising or promotional information should be displayed. The publication should contain a disclaimer which states that sponsorship of the publication does not imply that the CCG endorses any of the company s products or services. 7
3.2.9 All CCG employees should discuss the implications, with their manager, before accepting an invitation to speak at a meeting organised by a pharmaceutical company. The company should have no influence over the content of any presentation made by the CCG employee. It should be made clear that the employee s presence does not imply that the CCG endorses any of the company s products or services. 3.2.10 The CCG will ensure that all sponsorship/joint working deals are documented through the use of a register held by the Head of Governance and Risk, which can be audited as appropriate. In order to demonstrate openness, the Register will be available on request to the public. 3.3 In order to provide a robust framework to support successful implementation of this policy any proposals for sponsorship/joint working by the Pharmaceutical Industry, whether direct or indirect through an intermediary, should be reviewed and commented on by the Luton Primary Care Prescribing Committee. The proposal and comments from the Prescribing Committee will then be considered and receive approval or non-approval from the Clinical Commissioning Committee. This process is encapsulated in the Pharmaceutical Industry Sponsorship/Joint Working Proposal Process Flow Diagram (Appendix 2). 3.4 Checklists 1&2 (Appendices 3&4) should be populated by the appropriate lead usually the strategic implementation lead or work stream lead and submitted to the Medicines Optimisation Coordinator. The proposal is then considered at the CCG Prescribing Committee. The Prescribing Committee issue a recommendation on the proposal. The recommendation and the populated checklists are then considered by the Luton CCG s Clinical Commissioning Committee (CCC) for final approval. 3.5 Point of contact for Pharmaceutical industry to Luton CCG: lutonccg.prescribing@nhs.net 8
Appendix 1 NHS Luton CCG Gift and Hospitality Record Sheet Date received Name of Recipient Post and Base Description and approximate value of gift/hospitality received Donor of gift or hospitality Please complete and forward promptly to the Head of Strategy and Governance at NHS Luton CCG, The Lodge, 4 George Street West, Luton, LU1 2BJ. 9
Appendix 2 Pharmaceutical Industry Sponsorship/Joint Working Proposal PROCESS FLOW DIAGRAM 10
Appendix 3 Pharmaceutical Industry Sponsorship/Joint Working Checklist 1 (to be completed by the CCG lead for the particular proposal + the pharmaceutical company representative) Contact Details NHS Organisation: Name (lead for proposal): Contact email: Contact Details Pharma Contact number: Organisation: Name: Contact email: Sponsorship/Joint Working Proposal Contact number: Type of Sponsorship/Event Amount of Funding No of Practices involved Benefits to NHS & Patients (include clinical & financial outcomes) Benefits to Pharmaceutical Company Duration of sponsorship/joint working (clarity on how and when sponsorship/joint working ceases) Are there any potential irregularities that might affect the Pharma company ability to meet the conditions of the agreement Summary of Sponsorship Any further Information Signatures & Designation Luton CCG Lead for Proposal signature: Designation of above: Pharma Representative signature: Designation of above: 11
Appendix 4 Pharmaceutical Industry/Joint Working Sponsorship Checklist 2 (to be completed by the CCG lead for the particular proposal) Proposal Can the aims and objectives in the proposal be realised within the CCG? If Yes to above- what are the reasons for working with the pharmaceutical industry? If No to above- what are the reasons for working with the pharmaceutical industry? Is the proposal consistent with the commissioning priorities of the CCG? Is there a similar service available from another source? Are the skills, competencies, professional status and qualifications of the named individuals who will be directly involved in the proposed sponsorship programme of a sufficient level to achieve the aims and objectives effectively, efficiently, reliably and safely? Information Governance Are IG requirements met, is the proposal lawful and does the proposal meet ethical standards? Evidence (where the sponsorship involves the use of a device, appliance or drug) Does the proposal include the use of a pharmaceutical product either directly or indirectly? If yes to above- what is the pharmaceutical product? Is the pharmaceutical product supported by evidence? If yes to above- what is the quality of the evidence? Does there need to be a tendering process? Presentations at events Will the pharmaceutical company be presenting at an event? If yes to above- is there an agreement that the CCG will see and agree the presentation before? 12
Appendix 5 Pharmaceutical Industry Sponsorship/Joint Working Luton CCG Committees Recommendations & Approval Form Luton CCG Prescribing Committee Outcome Proposal: Date of Committee: Recommendation: Luton Clinical Commissioning Committee Outcome Proposal: Date of Committee Meeting: Approved/Not approved State if any additional information required 13