AUTH/2352/8/10: GlaxoSmithKline v Chiesi — Clinical Support Service treated as an unacceptable switch programme

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Key facts

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Case	AUTH/2352/8/10
Parties	GlaxoSmithKline v Chiesi
Issue	Clinical Support Service alleged to facilitate a switch service rather than a genuine therapeutic review
Applicable Code year	2008
Complaint received	20 August 2010
Case completed	28 February 2011
Key evidence cited	GP letter to patient about Seretide 125 to Fostair 100/6 change; local NHS email encouraging practices to use CSS for three prescribing tasks with limited named options
Breach clauses	2, 9.1 and 18.4
Appeal	Appeal by Respondent; unsuccessful
Sanctions	Undertaking received; Advertisement (additional sanction)
Source	https://www.pmcpa.org.uk/cases/completed-cases/auth2352810-glaxosmithkline-v-chiesi

Reviewed by Dr Anzal Qurbain (FFPM) — ABPI Final Signatory

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GlaxoSmithKline (GSK) complained that Chiesi’s Clinical Support Service (CSS) in one NHS area facilitated a switch service rather than a genuine therapeutic review.
GSK relied on: (1) a GP letter to a patient stating practice policy had changed and the patient would be prescribed Fostair 100/6 instead of Seretide 125, and (2) a local NHS email encouraging practices to use Chiesi’s CSS for three prescribing tasks with limited, named product options.
The patient letter suggested the change was driven by “practice policy” and that there had been no prior discussion with the patient; the footer referenced a “therapeutic review service provided… by Chiesi Limited”.
The local NHS email encouraged practices to take up CSS assistance for: switching CFC beclometasone inhalers to CFC-free options (listing Clenil Modulite/Qvar with Clenil Modulite for children), switching Seretide 125 MDI patients with a possibility of transfer to Fostair MDI, and optimising tramadol MR to Maxitram SR.
Chiesi argued CSS was non-promotional, GP-led, and involved pharmacist clinical assessment with GP sign-off; it said it had no prior input to the NHS email but received a copy and responded that it would start contacting practices to arrange appointments.
The Panel/Appeal Board focused on the way the service was being offered/implemented in light of the NHS email and Chiesi’s proactive response, concluding it amounted to unacceptable assistance with a switch programme.

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Breach found (upheld on appeal): the arrangements did not meet the requirements for a bona fide therapeutic review and were treated as facilitating a switch service.
The Appeal Board was “extremely concerned” that Chiesi’s response to the NHS email showed an intention to act proactively to assist implementation of the prescribing plans outlined.
The Appeal Board considered such switching advice would be influential and that company assistance in implementing the switch services was unacceptable.

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