AUTH/2863/8/16 - Anonymous, non-contactable v Lilly

Engagement of consultant and his/her training and consultancy company

  • Received
    03 August 2016
  • Case number
    AUTH/2863/8/16
  • Applicable Code year
    2016
  • Completed
    19 December 2016
  • No breach Clause(s)
  • Additional sanctions
  • Review
    February 2017 Review

Case Summary

An anonymous, non-contactable complainant raised concerns about a therapy area specific training and consultancy company and its owner, a health professional who delivered services including practice audits, health professional mentoring, education and classroom based training workshops funded by a number of named pharmaceutical companies including Lilly. These services had been delivered in a number of named clinical commissioning groups (CCGs) in one area. In addition, the health professional was a specialist nurse employed on a contractual basis by a number of NHS organisations including a city based community healthcare organisation (CHO). In his/her role as a nurse within that organisation the health professional had prescribing responsibility and influence within one of the CCGs named by the complainant. 

The complainant alleged that the training and consultancy company had conducted industry funded clinical audits in several GP surgeries in the area in question which were identifiable as they had highly irregular use of the sponsoring company's product. The patients of several surgeries in one CCG were either initiated onto or switched to the sponsor's medicine with little consideration given to alternative therapies. The pattern of disproportionate increases in product sales could be directly linked back to the pharmaceutical company which had funded the training and consultancy company.

The complainant referred to a series of accredited training workshops delivered by the training and consultancy company in partnership with a named CCG which was completely funded by industry. The complainant was concerned about the potential substantial financial support to the training and consultancy company for these workshops due to reservations about the ethics of that organisation and because its owner was directly contracted to the local city based CHO. In the complainant's view industry's financial support for these courses was staggering and could be perceived as an attempt to 'buy the business'. 

​The complainant alleged that the training and consultancy company had told pharmaceutical companies that if they failed to provide support, their products would not be used in the CCG in which he/she had prescribing responsibility. The complainant stated that his/her company's local representative felt highly pressured to offer funding as he/she had been threatened that if he/she failed to support training events the health professional in question would simply get the money from another pharmaceutical company. The complainant stated that this highly coercive behaviour was completely unacceptable and he/she assumed that similar pressure had been exerted on other pharmaceutical companies. In addition the complainant noted that services provided by industry were in some cases very similar to the offerings developed by the training and consultancy company and alleged that the health professional in question had left individuals in no doubt that if their company attempted to partner in CCGs where he/she wanted to deliver programmes there could be consequences for their sales in the area in which he/she had prescribing responsibility. 

The detailed response from Lilly is given below. 

The Panel had no contact details for the complainant and so could not ask him/her for further details. The complainant had the burden of proving his/her complaint on the balance of probabilities; he/she had not provided any evidence in support of the allegations. 

The Panel noted that the complainant began by stating that he/she wished to complain about the conduct of the training and consultancy company and subsequently referred to its owner. In this regard the Panel noted that the Code applied solely to the conduct of pharmaceutical companies. 

The Panel considered that the scope of the complaint included the engagement of the health professional in question and/or the activities of his/ her company with health professionals, whether the company's activities were delivered by its owner or other individuals. However, when considering such matters the totality of a pharmaceutical company's interactions with the health professional in question would nonetheless be relevant. 

The Panel noted that the complainant had provided a website address for the training and consultancy company which named the health professional in question as the Director and another health professional as the nurse liaison lead. The Panel noted that the named health professional was contracted by the NHS to work at a number of GP surgeries in addition to his/her role at the city based CHO. 

The Panel noted Lilly's submission that it had sponsored 13 meetings run by the training and consultancy company. Eight of these meetings were for an exhibition stand at two day accredited training courses. The remaining five were for courses at local surgeries and hospitals. The Panel noted that for all 13 meetings the training and consultancy company and the city based CHO's therapy area team lead for specialist nurses and dieticians had full responsibility for the meetings' content and speakers, and for the accredited training courses, selection and registration of attendees from a named CCG. The Panel noted that sponsorship of the accredited training courses varied according to whether Lilly was one of two sponsors or the sole sponsor. In relation to the other 5 courses run at surgeries and hospitals, the amounts paid in sponsorship again varied according to the duration of the meeting. The Panel noted that there had been 30 contacts between the local representatives and the named health professional between February 2015 and March 2016. No details were provided about the status of the contacts, nonetheless the overall number appeared high. According to Lilly during its internal investigation there was no report or indication that its representatives felt pressurised or obliged to offer support to the training and consultancy company or the named health professional. The Panel noted that the complainant bore the burden of proof and considered that the complainant had not established, on the balance of probabilities, that either the provision of sponsorship or the level of sponsorship for any of the meetings was an inducement to prescribe or otherwise inappropriate in relation to the matters alleged. No breach of the Code was ruled. High standards had been maintained and a further ruling of no breach of the Code was ruled. Nor had the complainant established a breach of Clause 2; no breach of that clause was ruled. 

​The Panel noted that there was no evidence before the Panel that Lilly had engaged in any relevant activities alleged and the Panel ruled no breach of the Code.​