Innovation with integrity: Why NHS-industry partnerships matter, and how conflicts of interest are managed
Dr Amit Aggarwal, Executive Director, Medical Affairs and Strategic Partnerships at the ABPI discusses the importance of NHS-industry relationships, and the safeguards in place to ensure they always put patients and the NHS first.
Trust matters in healthcare, and transparency is essential. It is quite right that relationships between the pharmaceutical industry, clinicians and the NHS attract public and academic scrutiny. Yet it is equally important to remember that these relationships are not optional extras in modern healthcare; they are fundamental to how new treatments are developed, tested, implemented, and improved. Behind every widely adopted medicine lies a long chain of collaboration between researchers, clinicians, regulators, and manufacturers. Advances that improve healthcare for patients may begin in laboratories, but it never occurs in isolation.
Why partnerships are essential
Partnership and collaboration between clinicians and companies is as essential as the transparency which underpins these arrangements. Companies develop knowledge accumulated over years of clinical research on safety profiles, interactions, and outcomes. At the same time, clinicians provide the practical insight needed to understand how medicines work outside controlled trials, across diverse patient populations and real-world settings.
Without this exchange, companies and the NHS would rely on partial information, slowing the adoption of effective treatments and limiting improvements in care for patients. Companies would lack the essential real-world grounding needed to develop and refine products and understand how they affect patients in practice. All of this would limit advancements in patient care and outcomes.
Recent history illustrates the point. The Covid‑19 vaccine rollout depended on unprecedented coordination between the public and private sectors. Gains in childhood cancer survival, now above 90 per cent for acute lymphoblastic leukaemia [1], reflect decades of iterative learning between industry and clinicians. HIV outcomes improved only once combination therapy emerged, driven by ongoing feedback between laboratory research and clinical practice [2]. Similar patterns appear in cystic fibrosis, where specialist centres and registries have shaped treatment [3] and in antimicrobial stewardship, which relies on joint efforts to research and develop essential new antibiotics. [4].
The value industry brings – and the value it gains
Partnerships become especially valuable when they extend beyond medicines into service redesign and system improvement. In Lincolnshire, a collaboration to address the underdiagnosis of diabetes among cardiac patients introduced universal testing and joint follow-up clinics. Testing rates rose sharply, hundreds of patients received more systematic care, and early signs pointed to fewer complications. The model proved effective enough for the trust to adopt permanently.
A similar dynamic emerged in hepatitis C programmes within drug and alcohol services. Expanded testing, improved data systems and better referral pathways led to more than 46,000 tests, rising treatment rates and elimination in nearly half of participating services - strong enough results for NHS England to continue the work nationally.
These initiatives succeed in part because companies provide analytical capacity, project management, and specialist expertise, particularly at the start of a project, which overstretched NHS teams often struggle to supply. Crucially, clinical decisions remain governed by national guidelines, and funding provided by the company must carry no expectation of prescribing that company’s products, or product preference.
However, it is also important to acknowledge that the industry benefits from these partnerships too. Guidance produced by the NHS Confederation and the ABPI describes a “triple win,” in which patients, the NHS and industry all gain from well-structured collaboration. For industry, involvement can bring deeper experience of working with NHS organisations, better alignment of services, patient identification and prescribing in accordance with clinical guidelines, and insights into emerging needs at the system level, informing future research, development, and responsible innovation.
Any company benefits, however, are always subordinate to the overriding requirement that partnerships must either enhance patient care, be for the benefit of patients or benefit the NHS alongside maintaining patient care. [5]
Recognising and managing conflicts of interest
Concerns about conflicts of interest are legitimate. The question is not whether risks exist but how they are identified, mitigated, and governed within a robust system of safeguards.
It is important to put the scale into context. Around 18,400 healthcare professionals are listed on Disclosure UK, the pharmaceutical industry's public database that records payments or benefits made to healthcare professionals and organisations. By comparison, the NHS employs about 1.4 million people, roughly half of whom are qualified clinical staff. Around 92 percent of healthcare professionals in Disclosure UK are named, while about 8 percent are not, predominantly due to UK data protection laws. Overall, this suggests that pharmaceutical companies have relationships with fewer than 3% of healthcare professionals.
Disclosure UK data also shows that industry funding is relatively modest compared with wider NHS spending. For example, in 2024, companies disclosed £813.3 million, at a time when total NHS spending in England was around £187 billion – less than 1 percent. [6]
We are proud of the contribution of Disclosure UK to transparency, but transparency reporting is only one part of the system of safeguards in place to ensure patients are always put first. NHS-industry partnerships operate within multiple, overlapping layers of regulation designed to ensure patient benefit remains central.
For industry, the foundations for managing conflicts of interest are firmly set within the ABPI Code of Practice, which governs how companies engage with healthcare professionals and organisations, setting clear rules on promotion, funding, collaboration, and disclosure. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines to ensure they meet rigorous standards of safety, quality, and efficacy. The National Institute for Health and Care Excellence (NICE) independently assesses clinical and cost-effectiveness before recommending medicines and technologies for NHS use. National and local formularies, alongside clinical guidance, and guidelines from bodies such as NICE, further shape prescribing decisions, ensuring they are evidence-based and aligned with population need rather than commercial influence. Finally, individual clinicians, also governed by strict professional codes of practice, discuss these regulated and recommended treatment options with their patients.
Formal governance arrangements also matter. Joint or collaborative working agreements clarify shared objectives, roles and responsibilities, and ensure projects are designed around NHS priorities. While developing these agreements can require time and effort, they provide essential accountability.
Together, these safeguards create a system in which relationships between the NHS and industry are transparent, regulated, scrutinised, and bounded by clear expectations. Evidence is emerging that well-structured partnerships can support improvements in prescribing quality and disease management in line with national guidance [7,8].
A system that works and must be protected
When the NHS and the pharmaceutical industry work together, it is not a remedy for every challenge facing the health service. But these relationships have played an important role in many of the most meaningful advances in recent decades. The UK has developed a strong, carefully regulated system that allows the NHS and industry to work together, recognises and manages conflicts of interest, and keeps patient and NHS benefits at the forefront.
Properly governed, transparent and centred on patient need, NHS-industry relationships remain one of the most powerful tools available to help industry develop the medicines and vaccines people need, and to help the NHS adopt innovation, respond to rising demand and constrained resources, and deliver better care for patients.
[1] Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®) - NCI
[3] Life sciences partnerships with the UK CF Registry
[4] GARDP | Global Antibiotic Research and Development Partnership
[5] See Clause 20 supplementary information of the ABPI Code of Practice.
[6] ABPI, Disclosure UK 2024: new record for transparency, with nine in ten healthcare professionals named in database, June 2025
[7] NHS And Life Sciences Industry Partnerships: Collaborating To Improve Care | The King's Fund
[8] Partnering for progress: a data-driven analysis of NHS-industry partnerships
- ABPI Code
Last modified: 06 March 2026
Last reviewed: 06 March 2026