Clinical Commissioning Groups in England are declaring just two-thirds of payments they have received from private companies and charities, an investigation led by The British Medical Journal has revealed.

The BMJ, alongside researchers at the University of Bath and Lund University in Sweden, analysed responses from all 207 CCGs in England to freedom of information (FOI) requests about payments accepted from private companies and charities, and then compared this with those publicly declared over the same timeframe.

This revealed that £1,283,767 worth of payments were identified in CCGs’ publicly available registers covering either the calendar years 2015 and 2016 or the tax years 2015-16 and 2016-17, but that the amount identified from the FOI requests was at least £5,027,818.

Seventy-three percent of payments received from drug companies was for sponsorship of education and training events, while around 19 percent was streamed into specific projects, the investigation found.

The BMJ says a wide variety of reasons were given by CCGs for not publishing details of all payments, including believing there is no requirement to do so and also experiencing problems in getting information about event sponsorship from third parties.

It also noted that the Association of the British Pharmaceutical Industry insists drug companies have a key role to play in supporting healthcare organisations and that both sides share an ambition for greater transparency, while some CCGs claim such sponsorship arrangements enable them to run a larger amount of educational events.

Nevertheless, it cites those on the other side of the fence who question the ethics of such practice. For one, Professor Paul Glasziou at the Centre for Research in Evidence-Based Practice at Bond University in Australia, was quoted by The BMJ as saying: “Pharmaceutical company dominance of the funding of continuing medical education can result in prescribing that harms,” and that doctors are often unaware of the influence this may have on their decisions.

“Clinicians are often naive about the persuasion tactics used by some companies. So we urgently need better ‘inoculation’ against these tactics, as well as better regulation and funding of balanced continuing education,” he argues.

However, in response to the BMJ’s report, NHS Clinical Commissioners stressed that NHS England has set out “very clear guidelines on managing conflicts of interest and as statutory bodies, CCGs have a clear responsibility to work within those guidelines”.

“This BMJ investigation seems to imply that there is some wrong doing on the part of CCGs by working with external companies and pharmaceutical organisations, which we would strongly challenge,” it said, and noted that the NHS England guidance “is clear, as are we, of the benefits to NHS staff and patients of securing the right kind of sponsorship for learning, development and networking opportunities.

“Having the ability to offset some or all of the costs of these types of activity, managed in the right way and following due process, means that CCGs can continue to make the best use of their limited budgets for frontline services for patients.”

Moreover, in an open later to the BMJ published today, ABPI chief executive Mike Thompson said he was disappointed with the article “that inaccurately depicts the work of the pharmaceutical industry in the UK”.

He argues that the press release sent out by the BMJ to publicise the article “was grossly misleading in its portrayal of the facts” and that this lead “respected national media to wrongly claim this research showed, ‘Pharmaceutical giants have bought tickets to sports matches and pop concerts’.

“Yet the BMJ must have known that these were from a catering company, a property company and a University – a point not made clear in their press release. Sadly, this is how fake news gets created.”

Thompson also stressed that the BMJ is well aware that the Association’s Code of Practice prohibits the provision of gifts by industry.

“It sets very clear guidelines on appropriate interactions and collaborations between the pharmaceutical industry and healthcare organisations and health professionals. There are also stringent rules governing the types of sponsorship for events, meetings and training, a fact that the BMJ reporting fails to acknowledge.”

The letter goes on to say that the research “should draw a clearer distinction between the pharmaceutical industry, and the actions of other private sector companies, and public sector institutions such as Universities. Currently, this reporting conflates the two, which is unhelpful.”

Also highlighted by the ABPI were the recent measures put in place to improve transparency, such as the launch of the pharmaceutical industry’s disclosure database Disclosure UK and the strengthening of NHS England guidance on conflicts of interest.