Clinical commissioning groups (CCGs) in England have accepted hundreds of payments from drug companies that they have not disclosed to patients and the public, reveals an investigation by The BMJ today.
Publicly declared payments include tickets to top sports matches and a Beyoncé concert. Yet only two thirds of the 4,600 payments - and a quarter of the value - that CCGs accepted from private companies and charities in 2015-16 and 2016-17 were listed in registers or declarations published by them.
The findings also show that a large number of payments go to a handful of organisations, with nine CCGs accounting for half the number of payments received.
In collaboration with researchers at the University of Bath and Lund University in Sweden, The BMJ received responses from all 207 CCGs in England after it made freedom of information requests about payments from private companies and charities.
The data were then compared with the details published by CCGs in their online public registries of declarations.
NHS England guidance requires CCGs to declare all conflicts of interest and to maintain and publish registers of their conflicts of interest and procurement decisions.
The total monetary value of payments identified in CCGs' publicly available registers that covered either the calendar years 2015 and 2016 or the tax years 2015-16 and 2016-17 was £1,283,767, whereas at least £5,027,818 has been identified in the payments listed in responses to The BMJ's request.
More than two thirds (73%) of the funding from drug companies was for sponsorship of education and training events. For example, NHS Warwickshire North CCG received 89 payments with a total value of £24,150 in 2015-16 and 2016-17 to sponsor educational events, but these are not listed in the CCG's current online register.
Other CCGs outsource the logistics of arranging event sponsorship to hospital trusts and private companies. CCGs have also sought funding from drug companies to support internal meetings.
After event sponsorship the largest proportion of funding from drug companies to CCGs is for projects, around 19% of the total funding, the results show. One such project was undertaken by NHS Southwark CCG, with £24,000 in funding provided by Bayer, Boehringer Ingelheim, and Pfizer. Information about the project's funding was not published in the CCG's registers.
The Association of the British Pharmaceutical Industry says that drug companies have an important role in supporting healthcare organisations and they "share an ambition with the NHS to see greater transparency and disclosure of information around industry support to healthcare organisations and professionals."
And several CCGs say sponsorship arrangements with drug companies allow them to host more educational events than they otherwise could.
However, many CCGs already accept no payments from charities or private companies. For example, NHS Hastings and Rother CCG told The BMJ this "helps to avoid any potential or real situations of undue bias or influence in the decision making of the membership of the CCG, governing bodies, or staff."
Piotr Ozieranski, the University of Bath lecturer who has been researching these payments with The BMJ, thinks it is inappropriate for commissioning bodies to accept funding from the private sector. "It seems rather peculiar that CCGs are permitted to accept any payments or benefits in kind from private sector companies," he says.
Professor Paul Glasziou at the Centre for Research in Evidence-Based Practice at Bond University in Australia, argues that doctors are often unaware of the effect of drug companies' activities on their own behaviour. "Pharmaceutical company dominance of the funding of continuing medical education can result in prescribing that harms," he says.
When asked why they had not published details of drug company payments, CCGs gave a variety of responses, such as believing there is no requirement to do so and citing problems sourcing information about event sponsorship from organisations to which the work had been outsourced
After being alerted to the omission of information about industry funding on their websites, some CCGs have either published this information or committed themselves to doing so.