Due to their extensive contact with patients suffering from diverse medical problems, GPs acquire knowledge about a variety of conditions and the available treatments for them.
This information is of particular interest to the pharmaceutical industry. Companies that value this first-hand experience are prepared to reimburse doctors for time spent feeding back to them.
Code of practice
Pharmaceutical manufacturers are keen to work with doctors, and the Association of the British Pharmaceutical Industry (ABPI) tightly controls their actions. While the industry works through self-regulation under the ABPI's code of practice, complaints against individual companies have been upheld and competitor companies can generate complaints.
The ABPI has issued guidance for drug companies in their dealings with the medical profession. This takes into account the GMC's advice to doctors.
Any financial arrangements should not compromise a doctor's professional judgment in prescribing matters and should be declared for tax purposes.
Pharmaceutical companies value the opinions of practising doctors on the benefits and problems of medicines. Market research regarding these products can be undertaken and doctors involved can be paid for their time and effort.
Such contacts with GPs for market research purposes differ from the routine visits to surgeries made by drug company representatives for which no payment should be made. Market research involves more targeted questioning which may be about a single product, a range of treatments for a specific disease or general prescribing behaviour.
The market research contact may be a one-off or involve the collection of data over a longer period to compare past and current prescribing habits.
All patient data supplied by a GP must be anonymous and should not influence your usual prescribing. There are strict national Caldicott guidelines relating to electronic gathering of patient data - see 'The Caldicott Guardian Manual 2006' on the DoH website.
Increasingly drug companies expect their market research questionnaires to be completed online, but postal and telephone questionnaires, along with one-to-one interviews are also used.
Several market research companies recruit GPs to help them to provide useful feedback about their pharmaceutical company clients' products. If you do take on work via a market research company, you are likely to be approached again in the future. However, such information gathering should not be product promotion in disguise.
Some market research companies such as Lead Medical Panel or Exafield advertise for doctors for new studies. However, you are more likely to receive a letter or email inviting you to participate.
It should come as no surprise to GPs that drug companies make a significant financial investment in bringing a new medicine to market. This investment can include building up databases of groups of doctors whose opinions they value and who they can target for post-production marketing surveillance.
Fees for such services are agreed in advance, usually with some idea of the time commitment involved. The BMA agrees fees annually with the ABPI which expects payments to doctors to be in line with the agreed amounts (see box).
Many companies wish to be associated with medical education and on-going professional development in particular. Doctors providing the education, for example, by speaking at a meeting, can be paid reasonable amounts for their time, particularly preparation time.
Fees may be for the main speaker or to doctors supporting a meeting, for example a GP chairing it. Drug companies cannot however pay a practice to rent at the surgery. Some very experienced GPs seem to shy away from speaking at meetings, perhaps feeling they have less to offer than hospital colleagues. Personally, I am interested in listening to someone with experience of similar clinical situations to those I have found myself in.
As with all clinical trials, it is essential that all clinicians involved check that appropriate ethical committee agreement is in place.
This includes ensuring that any clinician caring for a patient is made aware of the presence of any extra clinical information recorded about their patient as part of a research project.
All work carried out by a doctor as part of a project for a pharmaceutical company should be paid at a realistic rate. Again, the level of payment is agreed between the BMA and ABPI.
Post-market surveillance forms
Fees agreed by the BMA and APBI. No fee can be paid for reporting adverse drug reactions.
GPs' expertise may be useful to drugs companies in other ways. A primary care perspective is often integral to producing treatment guidelines.
Companies may sponsor meetings to discuss proposed guidelines and reimburse participants' time and travel expenses.
I have also previously been reimbursed for time spent helping to train pharmaceutical representatives.
Listening to a dozen presentations on the same new asthma product and commenting was surprisingly interesting.
As in many areas, GPs are in a unique position to help a pharmaceutical company.
Contact with the pharmaceutical industry may be mutually beneficial, allowing companies access to GPs' knowledge and experience. It is only fair that, in return, GPs should be reimbursed for the time spent on this work.
- Dr Phipps is a GP in Lincolnshire
- The Code of Practice for the Pharmaceutical Industry 2008; Quick Guide to the Code for Health Professionals
- Good Medical Practice (2006)