Pharmaceutical giants are pouring tens of millions of pounds into struggling NHS services – including paying the salaries of medical staff and funding the redesign of patient treatment – as they seek to boost drug sales in the UK, the Observer can reveal. Drug firms are simultaneously funding groups that lobby for greater investment in their disease areas, and in some cases are paying generous consultancy fees to influential ­healthcare professionals, including GPs who have worked as clinical leads for NHS England and have received as much as £480,000 each from industry since 2019. The spending is revealed in an investigation that lays bare the growing role of Big Pharma in the UK’s health sector, with analysis of more than 300,000 drug company transactions since 2015 showing a surge in spending on activities other than research and development (R&D). Payments to UK health professionals and organisations, including donations, sponsorship, consultancy fees and expenses, reached a record £200m in 2022, excluding R&D with companies seeking to promote lucrative drugs for obesity, diabetes and heart conditions among the biggest spenders. The total spending was almost double the £108m paid by the drugs industry in 2015, while payments to healthcare organisations in the same period nearly tripled to £156.5m. The payments include more than £29m in funding to NHS trusts, as well as millions more to GP practices and companies that support NHS care. A further £43.7m was paid to doctors, nurses, pharmacists and admin staff. The rise in spending raises concerns about the growing influence of pharmaceutical companies in the NHS as it reaches its 75th anniversary milestone. Amid record pressure on services, drug giants say closer collaboration can help deliver major benefits to patients. But project documents reveal many of the partnerships are expected to lead to a boost in sales for the companies, fuelling questions about conflicts of interest. David Rowland, director of the Centre for Health and the Public Interest thinktank, warned that “cash-strapped” NHS trusts could not afford “to be naïve about these deals with Big Pharma”. “They are certainly not providing this funding as an act of charity,” he said. In some cases drugs firms have been granted a direct role in shaping patient care in NHS services that prescribe their products, including through projects that let them oversee the redesign of treatment pathways for diseases including obesity, diabetes, multiple sclerosis, cancer, asthma and rare disorders. Other companies are paying the salaries of pharmacists, nurses and other healthcare staff to work in NHS teams. In one case, the drugmaker Eli Lilly has partnered with a major London NHS trust to help “optimise” the multidisciplinary service that provides care for patients with diabetes, obesity and heart conditions. Corporate documents show the project with the Royal Free in London aimed to “implement a new model of care” and to “optimise treatment and/or triage patients” to the newly designed secondary care team, with outcomes including a reduction in waiting times. “Lilly may benefit from an increase in patients prescribed Lilly medications,” the documents add. Eli Lilly makes drugs for diabetes and is seeking approval for its obesity drug Mounjaro, a rival to the recently approved Wegovy injections. Records show it spent £3.5m on payments to NHS organisations in 2022, up from £147,000 in 2018. The company said all payments were publicly declared in line with industry codes of practice, adding that it believed in “working closely” with UK partners to “ensure people can access the most effective new medicines”, and that its NHS work had helped cut waiting times and support post-pandemic recovery. Another major maker of diabetes drugs, Sanofi, has partnered with NHS organisations to review and improve treatment services. A potential benefit for Sanofi is an increase in sales. “As a result of pathway changes some appropriate patients may be prescribed Sanofi products in line with local or national guidance,” one project document says. Sanofi said all its projects were transparent and ethical, and that it shared a “common goal” with the NHS of improving outcomes for patients. In some cases, the decision to partner with the NHS when it is under great pressure appears to be part of a strategy. One pharma industry consultancy firm tells clients on its website that there has never been a better time to do so, adding that setting up “capacity busting” programmes could be the “single biggest opportunity for companies to increase sales quickly”. It cites an example where it helped launch a network of “discrete, dedicated” injection clinics in conjunction with NHS ophthalmology services where the intention was to “prescribe the client’s product” at trusts that were battling “significant delays”. The clinics were delivered out of hours on NHS premises and resourced by “NHS staff in their time off”, and they boosted the drug company’s sales by enabling “a significant increase in patient access to the therapy”. As well as drug companies partnering with NHS trusts, the Observer has found that some are making payments to influential doctors as they seek to expand the rollout of their blockbuster drugs. One prominent doctor, Dr Yassir Javaid, a Northampton GP and a former NHS England regional clinical lead, was the largest individual beneficiary of money from pharmaceutical firms in 2022, receiving £132,390 in fees and expenses. Disclosure UK records show he has been paid £483,561 since 2019. Javaid has appeared in sponsored presentations for medical colleagues to promote the benefits of certain diabetes drugs, including those made by firms from which he has received payments. Javaid said he had voluntarily opted to appear on the Disclosure UK database; he always correctly disclosed his interests; and his sponsored educational sessions “promoted evidence-based and guideline-recommended use of treatments”. Drugs giants AstraZeneca, Eli Lilly and Boehringer Ingelheim are among the firms making payments to GPs. The overall biggest spenders on non-R&D payments to the UK health sector included Sanofi, which spent £16m in 2022, GlaxoSmithKline, which spent £14.7m, and Novartis, whose 2022 payments totalled £14.3m. The Association of the British Pharmaceutical Industry, a trade body which publishes the Disclosure UK database of drugs industry spending, said companies were required to be transparent about payments and were banned from making payments that constituted an inducement to prescribe or promote a medicine. Dr Amit Aggarwal, the ABPI’s director of medical affairs, said there was greater openness than ever about such arrangements, adding that partnerships between drug firms and the health sector could deliver huge benefits for patients: “Collaborative projects benefit patients and the healthcare system and they are governed by the industry’s strict code of practice, which goes above and beyond the law.” NHS England said collaborations with industry helped patients “benefit from faster access to innovative treatments” and that it was “not unusual for industry to provide funding to support service delivery in areas such as improving cardiovascular health, tackling infectious disease or rolling out innovative cancer therapies”. It added that “strict safeguards” were in place for managing conflicts of interest.