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Seqirus Template ABPI UK Template COMPANY NAME: YEAR: COUNTRY: DATE OF SUBMISSION TO CENTRAL PLATFORM: [insert date] METHODOLOGICAL NOTE (H) (Clause 24.10): [insert link here] DISCLOSURE OF PAYMENTS TO HEALTHCARE PROFESSIONALS (HCPs), OTHER RELEVANT DECISION MAKERS (ORDMs) AND HEALTHCARE ORGANISATIONS (HCOs) Article 2 - Section 2.03 & Schedule 2 & Clause 24 Date of publication: ………………………………………………….. HCPs/ORDMs: City of Unique country Country of Principal Donations and Fee for service and consultancy (Art. 3.01.1.c & 3.01.2.c & Full Name Principal Practice HCOs: Principal Practice Address local identifier Contribution to costs of Events (Art. 3.01.1.b & 3.01.2.a & Clause 24) Blank Column (Clause X) Practice Grants to HCOs Clause 24) city where registered OPTIONAL (Art. 3.01.1.a & Joint Working (Clause 20) TOTAL Clause 24) and Sponsorship agreements Benefits in Kind to Related expenses agreed with HCOs / third parties Blank Column Blank Column (Art. 1.01 & Clause 24) (Art. 3 & Clause 24) (Schedule 1 & Clause 24) (Art. 3 & Clause 24) (Art. 3 & Clause 24) HCOs (Clause 24) Registration Fees Travel & Accommodation Fees in the fee for service or appointed by HCOs to (Clause X) (Clause X) manage an Event consultancy contract HCPs/ORDMs: City of Local Register ID or Country of Principal Title First Name Initial Last Name Speciality Role Principal Practice HCOs: city Institution Name Location Address Line 1 Address Line 2 Post Code Email Third Party Database Practice where registered ID INDIVIDUAL NAMED DISCLOSURE - one line per HCP/ORDM (i.e. all transfers of value during a year for an individual HCP will be summed up: itemization should be available for the individual Recipient or public authorities' consultation only, as appropriate) Ms Kirsty Armstrong Screening and ANP Petersfield United Kingdom KAT Training Petersfield 79 Tilmore Petersfield GU32 2JA 58.10 58.10 Mrs Andrea Arnott Screening and SW Flu lead St Austell United Kingdom Public Health St Austell Sedgemoor Priory Road PL25 5AS 215.00 215.00 Ms Anamika Bansal CCG Communications Windsor United Kingdom East Berkshire CCG Windsor King Edward VII St Leonard’s SL4 3DP 23.00 23.00 Mrs Lucy Blatch Screening and Nurse Cambridge United Kingdom Public Health Cambridge Victoria House Capital Park, CB21 5XA 52.10 52.10 Miss Charlotte Cadwallader Screening and Screening and Bristol United Kingdom Public Health Bristol PHE Screening & South Plaza, BS1 3NX 224.70 224.70 Mrs Charlotte L Davies Occupational Health Llanelli United Kingdom Hywel Dda UHB Llanelli Flat1B, Prince Llanelli, SA14 8QF 304.40 304.40 Mrs Helen Donovan Public Health Professional London United Kingdom RCN London 92 New River Palmers Green N13 5RJ 2,250.00 27.36 2,277.36 Professor Harsh Duggal Communicable Professor Stafford United Kingdom Staffordshire Stafford 5 Epsom Close Wildwood ST17 4TY 306.80 306.80 Professor Sarah Gilbert Influenza vaccine Principal Oxford United Kingdom University of Oxford Oxford 7 Manor Farm Horspath OX33 1SD 1,600.00 240.20 1,840.20 Dr Catherine Heffernan Immunisations Principal Advisor London United Kingdom PHE/NHSE London NHSE (London), 133-155 SE1 8UG 2,250.00 2,250.00 Dr Roger Henderson Public Health MD Sorbie United Kingdom Liva Healthcare Wigtownshire Reiffer Park Sorbie DG8 8HD 3,060.00 838.90 3,898.90 Dr George Kassianos Influenza National Reading United Kingdom RCGP Reading 61 Plough Lane Wokingham RG40 1RQ 7,920.00 1,223.27 9,143.27 Professor Teresa Lambe Immunology Senior Scientist Oxford United Kingdom University of Oxford Oxford The Jenner Roosevelt Drive OX3 7DQ 1,600.00 247.00 1,847.00 Mrs Pauline MacDonald Immunisation Nurse London United Kingdom Infection Matters London Infection Covent Garden WC2H 9JQ 336.50 3,420.00 1,964.67 5,721.17 HCPs and ORDMs Mrs Nuala Mahon Child health Immunisation Co- Cardiff United Kingdom Cardiff & Vale Cardiff 2nd Floor, Maes-y-Coed CF14 4HH 89.20 89.20 Dr Catherine Moore Virology Consultant Cardiff United Kingdom Public Health Wales Cardiff 1st floor C Block, Heath Park CF14 4XW 5,415.00 3,209.15 8,624.15 Mrs Fiona Ridpath Immunisations Immunisation Co- Horley United Kingdom Public Health Horley 2nd Floor, York Horley, Surrey RH6 7DE 46.50 46.50 Mr Marc Rolph Public Health Health Ipswich United Kingdom Public Health Ipswich Endeavour Ipswich, Suffolk IP1 2BX 97.38 97.38 INDIVIDUAL Professor David Salisbury Immunology Consultant Wallingford United Kingdom David Salisbury Wallingford Dobsons Sotwell Street OX10 0RH 3,200.00 597.31 3,797.31 Mrs Julie Tippett Immunisations Immunisation Co- Folkestone United Kingdom Public Health Folkestone Folkestone Folkestone, Kent CT20 1JY 58.44 58.44 OTHER, NOT INCLUDED ABOVE - where information cannot be disclosed on an individual basis for legal reasons Aggregate amount attributable to transfers of value to such Recipients - Art. 3.2, EFPIA Template & Clause 24 N/A N/A N/A N/A 3,355.88 3,355.88 Number of Recipients in aggregate disclosure - Art. 3.2, EFPIA Template & Clause 24 N/A N/A N/A N/A 8 8 Number of Recipients disclosed in aggregate as a % of all Recipients (individual & aggregate disclosures) - Art. 3.2 & Clause 24 N/A N/A N/A N/A 29% 0 Public Health Civic Centre, Kaye.Holt@phe. Ashford Tannery Lane TN23 1PL 1,280.00 66.60 1,346.60 England South East Level 2 gov.uk (Clause 24) Oxford University Oxford Buxton Court, 3 Botley OX2 0JB kerry.antcliffe@i 309.00 309.00 HCOs Oxford University Oxford Buxton Court, 3 Botley OX2 0JB kerry.antcliffe@i 1,600.00 1,600.00 OTHER, NOT INCLUDED ABOVE - where information cannot be disclosed on an individual basis for legal reasons Clause 1.9 supplementary information Aggregate amount attributable to transfers of value to such Recipients - Art. 3.2, EFPIA Template & Clause 24.9 N/A N/A N/A N/A N/A N/A N/A N/A N/A Number of Recipients in aggregate disclosure - Art. 3.2, EFPIA Template & Clause 24.9 N/A N/A N/A N/A N/A N/A N/A N/A N/A Number of Recipients disclosed in aggregate as a % of all Recipients (individual & aggregate disclosures) - Art. 3.2 & Clause 24.9 N/A N/A N/A N/A N/A N/A N/A N/A N/A AGGREGATE DISCLOSURE (Clause X) Transfers of Value re: Research & Development as defined (Art 3.04 & Clause 23.2) 38,439.00 N/A AGGREGATE Development Development Research and and Research NOTE 1: 'Art.' refers to the relevant Article of the 2014 EFPIA Code on Disclosure of Transfers of Value from Pharmaceutical Companies to Healthcare Professionals and Healthcare Organisations NOTE 2: 'Clause' refers to the relevant Clause of the 2019 ABPI Code of Practice for the Pharmaceutical Industry. NOTE 3: Unique ID would be a database identifier either Binleys or OneKey. This can be left blank. NOTE 4: Payments to health professionals (HCPs) as defined in Clause 1.4, healthcare organisations (HCOs) as defined in Clause 1.9 and the relevant decision makers (ORDMs) as defined in Clause 1.5, has to be disclosed. NOTE A: Data relates to the column heading ie registration fees NOTE B: Data relates to the column heading ie travel and accommodation NOTE C: Data relates to column heading ie fees for service NOTE D: Data relates to the column heading ie related expenses agreed in the fee for service or consultancy contract NOTE E: Total £ disclosed as aggregate NOTE F: Total number of individuals disclosing in aggregate. WARNING: this is not necessarily a sum of columns V,W,X and Y as indivuduals might appear in more than one category i.e. receive fees and expenses. NOTE G: The link can be included here and/or in the methodological note NOTE H: The methodological note must make clear the number of indiviudals who have agreed to some payments being disclosed individually and some in aggregate NOTE J: Total £ for that individual NOTE K: Total £ for that HCO across all activities except R&D required optional to facilitate the process but not to be published on database.
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