Customer Insights
Customer Insights
Industry intelligence in association with STAR August 2008
This month, Customer Insights profiles a GP with a Special Interest. It examines how the concept of service redesign is providing greater opportunity for pharma and, in the process, re-engineering interactions between GPs and representatives.
What is your title?
Dr Andrew Noble, GP with a Special Interest in the elderly, and Director of Clinical Studies at Hull York Medical School
Describe your role and its main objectives.
I am a GP with a Special Interest in medicine for the elderly. I am also employed to look at Practice Development, which involves some work with practice-based commissioning. My special interest commitments mean that I do a lot of work with the two residential homes that the practice looks after, while the practice development aspect is much broader. The whole landscape of General Practice is changing and so, as a practice, we have to be more flexible and move with it. The market is being opened up to other providers, which means we have to look at how our practice functions and identify ways that help us respond to the needs of patients and to work more efficiently. We also need to look at how we can use PBC to help us achieve these aims. So my objectives within practice development are:
1. To develop the practice team.
2. To look at practice based commissioning and how we could take that forward as a practice.
Who are the key players that influence you in your role?
Patients are the main influence. We are in essence providing a service for them and so it’s a matter of being flexible and trying to work towards their needs. Internally, I work very closely with everyone in the practice – the secretarial team, the practice nursing team and the receptionists – to understand how we operate and look for ways that we can innovate to take the practice forward. Again, we look at patient surveys to see what patients require from us – the patient is always central to our thinking. Beyond that, the PCT is very influential. Its various policies and procedures impact enormously on us. And then you have the other influencers who are looking at developments in the healthcare community, such as the pharmaceutical industry. The industry has actually been quite a major influence on our direction. Not from the point of view from prescribing but from the point of view of the services we have been able to provide for our patients.
How has interaction with the pharmaceutical industry influenced your direction?
There has been a huge shift in how we have interacted with the pharmaceutical industry in recent years. For me, this was driven by previous experiences around four years ago when working as a GP elsewhere. One pharma company in particular took a decision to change how they approached GPs – they stopped coming in simply to talk about their products, and instead started to talk about disease areas. This took the focus off prescribing and, following years of being put off by simple product detailing, it really held GPs’ attentions. Suddenly, by talking about disease areas, we quickly started to move into areas such as service delivery and exploring new ways to improve it. This was the start of a shift in the right direction, and now, some years later, we are really benefitting from that approach in this practice.
How, in principle, has this worked?
We have good examples of how this approach has worked. Some time ago, we looked at the health needs of our patients and those in an adjacent practice and identified respiratory, heart disease and diabetes as areas where we could make improvements in how we delivered care. In respiratory, for example, our challenge was to make sure that patients remained stable for longer, and we needed to reduce, and indeed prevent, readmission into hospital. This required a much more intense follow-up programme than we had been able to offer.
Faced with this challenge, a pharmaceutical company approached us and offered to help with redesigning our respiratory service. We worked with them, developed the service in partnership and then proposed the project to the PCT. We now employ a respiratory nurse, funded initially by the pharmaceutical company, in the knowledge that the service will, over time, become self-funded through the savings made through PBC. In the process, we now have the beginnings of a programme that can respond to the acute exacerbations in the community, that reduces hospital readmissions and that is more accessible because it is delivered nearer to patients’ homes.
We are developing similar services, partnering with other companies, in the areas of heart disease and diabetes.
So do you believe there is greater willingness to partner with the industry?
In the area of service redesign, yes. The company we partnered with was very heavily involved in the redesign of the respiratory service, and although there will always be questions around the ethics of that partnership and its impact on prescribing behaviour, if the product is on formulary and GPs’ prescribing patterns remain consistent, it works. If you are identifying more disease and treating it appropriately, everybody wins. Most of all the patients.
Do you see medical representatives?
Five years ago, I didn’t. Now, however, I do. Why? Because, with the good ones, the focus has changed – it’s moving away from the drug. The reps I generally come into contact with are much more focused on the disease area. From an educational point of view, that’s good for me, and also from the point of view of service provision, it helps that they are getting involved in the financial aspect.
What advice would you give reps in how they should approach you?
• Focus on the disease area, not the drug.
• Look at the local area and the development needed in that health community. Know what its health priorities are. If your product, or therapy area, doesn’t align with those priorities, you’ll most likely be wasting your time.
• Embrace new ways of working. Look at partnership working and what work it involves. This doesn’t just have to be for general practices but could also involve PCTs, reach-out centres and hospitals.
• Build a network. Traditionally drug reps used to work in either primary or secondary care. For some reason there was always a barrier between primary and secondary care, and reps didn’t seem to talk to each other. Now that these barriers are being broken down, the best representatives will network across the whole health economy. The reps that have been very effective here have developed the art of networking across those boundaries.
• Education, education, education. Whenever you are talking to healthcare professionals, it is always beneficial to provide something educational. For example, if you are talking about a particular disease area, information about that area that is not necessarily linked to a specific drug will always be well received. Try to speak about the disease itself, its etiology and epidemiology, rather than simply detailing your product.