Case Summary
An anonymous 'concerned citizen' alleged that it was unethical for Novo Nordisk to staff its diabetes helpline with nurses who worked in diabetes clinics during the week. The out-of-hours helpline was only for those patients on a Novo Nordisk medicine. Novo Nordisk was thus pressurizing nurses to prescribe its products by paying for a service that let nurses have an extra source of income.
The Panel did not consider it was necessarily unacceptable for Novo Nordisk to employ nurses who worked in diabetic clinics to answer emergency telephone calls to the Novo Nordisk helpline as alleged. Nurses were bound by the Nursing and Midwifery Council Code of Conduct and so they should not allow such employment to influence them when working in the clinic during the day. Nor was it necessarily unacceptable for the helpline to provide emergency support only to patients using Novo Nordisk's products. The Panel ruled that there had been no breach of the Code.
An anonymous ‘concerned citizen’ alleged that it was unethical for Novo Nordisk to staff its diabetes helpline with nurses who worked in diabetes clinics during the week. The out-of-hours helpline was only for those patients on a Novo Nordisk medicine. Novo Nordisk was thus pressurizing nurses to prescribe its products by paying for a service that let nurses have an extra source of income.
The Panel did not consider it was necessarily unacceptable for Novo Nordisk to employ nurses who worked in diabetic clinics to answer emergency telephone calls to the Novo Nordisk helpline as alleged. Nurses were bound by the Nursing and Midwifery Council Code of Conduct and so they should not allow such employment to influence them when working in the clinic during the day. Nor was it necessarily unacceptable for the helpline to provide emergency support only to patients using Novo Nordisk’s products. The Panel ruled that there had been no breach of the Code.
An anonymous ‘concerned citizen’ complained about the use by Novo Nordisk Limited of diabetes nurses for its diabetes helpline.
COMPLAINT
The complainant noted that Novo Nordisk ran a diabetes helpline which patients taking Novo Nordisk insulin could call for emergency advice after surgery hours during the week and at any time during a weekend. Diabetes nurses were employed to operate the service and answer the telephones but the nurses that Novo Nordisk paid also worked in diabetes clinics during the week. Surely this was unethical and shouldn’t be allowed? Novo Nordisk was pressurising diabetes nurses to prescribe Novo Nordisk products by paying for a service that let diabetes nurses have an extra source of income.
The complainant could not believe that a pharmaceutical company was allowed to pay for something that was only for patients on that company’s medicine. This must make the nurse want to sell Novo Nordisk products even more!
The complainant requested a full investigation, it was unbelievable that a pharmaceutical company was allowed to carry on in this way.
When writing to Novo Nordisk the Authority asked it to respond in relation to Clauses 2 and 9.1 of the Code.
RESPONSE
Novo Nordisk stated that it employed, on a casual basis, diabetes specialist nurses for the out-of-hours helpline. The purpose of this service was to provide out-of-hours support for people who were currently using Novo Nordisk diabetes products. Patients were encouraged to see their usual health professional as soon as possible after the telephone call, to find a 96 Code of Practice Review February 2007
permanent solution to the reason they phoned. The helpline nurses were only to give emergency advice to carry the caller over until the next working day. Nurses with at least three years’ experience as a diabetes specialist nurse were selected. They were required to have up-to-date membership with the Nursing and Midwifery Council (NMC) and indemnity cover which was normally provided by the Royal College of Nursing. A record was held by Novo Nordisk of the policies and membership to ensure that these were maintained. The helpline was established in November 2001 after the need for such a service was highlighted by nurses working in the NHS as there was limited out-of-hours support for diabetics. The helpline nurses provided advice on the basis of their clinical knowledge and advice was given in line with generic helpline guidelines. Due to legal reasons, it was not possible to extend this service as standard to cover medicines not manufactured by Novo Nordisk. The helpline was run on the principle that:
● The patients’ relationships with their health professional would never be undermined.
● Only the advice necessary to help the patient until the next working day would be given, no changing of prescriptions or longer term interventions would be made. Appropriate information was passed to the patient’s health professional on the following working day, with the patient’s consent.
● The helpline was not advertised to patients, thereby keeping the health professional in control of the delivery of out-of-hours care.
● Calls not related to a Novo Nordisk product could be answered only with essential emergency advice.
● A nurse would never suggest that a caller changed the products he or she was using.
Advice was recorded and reviewed to ensure that it complied with the ethos of the helpline and was medically sound.
To date no complaints had been received about the service. The feedback from patients who had used this service demonstrated its value in providing reassurance and confidence in an emergency situation.
In April 2004 a registered centre scheme was created in response to requests from hospitals to be kept in the loop of patients’ care. Registered centres were sent the helpline feedback forms which were used to record the advice that was given to the patient. There were 82 registered centres which included some of the large centres across the UK all of which had decided to use the helpline to support patients and provide a much needed service.
To date, Novo Nordisk had had no complaints from registered centres regarding the advice given to callers. The fact that so many diabetes centres had signed up for the registered centre scheme proved it was well respected and valuable.
Novo Nordisk noted that most health professionals working for the NHS also did bona fide work for pharmaceutical companies such as participating in advisory boards, steering committees, speaking at events and writing articles in journals. They received sponsorship for research projects and travel to meetings and conferences and training. Most health professionals would have received bona fide compensation from several pharmaceutical companies over the past year.
While Novo Nordisk did not have any direct control over how nurses behaved within their capacity as NHS nurses, it considered it insulting to suggest that receiving compensation for a few hours’ telephone work would influence their prescribing practice.
The Novo Nordisk helpline employed highly experienced and well-respected nurses who abided by the NMC Code of Conduct. They would not compromise their reputation or professional standing by even appearing biased in their practice.
The nurses working on the helpline had very independent views from that of Novo Nordisk and were not afraid to voice their opinion. In the past, Novo Nordisk had had discussions with the nurses working on the helpline where they had not agreed with company decisions, such as the discontinuations of some products.
None of the trusts employing these helpline nurses had objected to them working shifts on the helpline or complained that it changed their usage of Novo Nordisk products. Most decisions about insulin prescribing were made by doctors and not nurses.
PANEL RULING
The Panel did not consider it was necessarily unacceptable for Novo Nordisk to employ nurses who worked in diabetic clinics to answer emergency telephone calls to the Novo Nordisk helpline as alleged. Nurses were bound by the NMC code and so they should not allow such employment to influence them when working in the clinic during the day. Nor was it necessarily unacceptable for the helpline to provide emergency support only to patients using Novo Nordisk’s products. The Panel decided that there had been no breach of Clauses 9.1 and 2 and ruled accordingly.
Complaint received 12 December 2006
Case completed 11 January 2007
