Pharmaceutical company promotional payments to English general practices: a longitudinal study

General practices have been a long-standing focus of pharmaceutical promotion, but their financial relationships with pharmaceutical companies remain understudied.

To examine pharmaceutical company payments to general practices in England from 2015-2022, focusing on changing patterns of payments and what this reveals about companies' marketing.

Descriptive analysis of pharmaceutical company payments made to practices using data from industry's Disclosure UK database, covering 4430 recipient practices and 54 companies over an 8-year period.

Annual Disclosure UK data from 2015-2022 were merged, identifying practices using a novel algorithm-based methodology, and categorising payments by type (for example, donations and grants, event sponsorship). Trends were analysed by company and payment type. The Gini coefficient measured payment concentration, and the persistence of relationships was assessed over time.

Pharmaceutical payments to general practices rose from £2.5 million in 2015 to £7.5 million in 2022. While 54 companies made payments, just one company, Chiesi - marketing commonly prescribed respiratory inhalers - accounted for more than 50% of the payment value from 2017 onwards. More than 40% of practices received payments from only one company, and 74% of company-practice relationships lasted just 1 study year. A few companies dominated, with a Gini coefficient of 0.86, driven by Chiesi's payments.

The growing scale and concentration of payments and the dominance of one company raises concerns about bias in general practice. Future research should investigate the impact of payments on clinical decision making, but to do so, payment disclosures need enhanced transparency, particularly through including product-specific payment details.