The pharmaceutical industry feels most comfortable dealing with GPs, and when it became involved with disease management some years back, it found it difficult to break free of its old habit of trying to sell more drugs and the whole thing fell apart. However, in today’s NHS, the idea of selling a single type of product, even though it is a drug, is not what the planners want – and the planners are increasingly calling the tune. Judging by the endless stream of plans, letters, frameworks, and guidelines emanating from the NHS, there is considerable evidence to show how effective the management is at charting a way forward. Nevertheless, the pharmaceutical industry doesn’t seem to be taking advantage of its major customer telling it what it thinks will be happening over the next few years.

That level of available market intelligence is something that must make marketing people in other industries green with envy. To know what your main customer needs and what it plans to do should make selling in the pharmaceutical sector a doddle. What the planners need are costed, evidence-based solutions. They want to know what works, what are the outcomes and what are the costs – not of individual products, but of treatments. You’ve guessed it; they want disease management. But it is interesting that, unlike other industries, the NHS does not have a development department. There is no group of people with the specific task of designing new products – i.e. new treatments. The result is that the products generally get improved by a continuous, but very limited, process of quality control, or the “whoops – that doesn’t work – lets try something else” method. This creates an opportunity for those willing and able to understand the new NHS culture, and to work with it in partnership to provide those functions which the NHS, on it own, lacks. All of the clues leading to this conclusion, and many of the answers to the questions that arise, are to be found in the multitude of NHS publications, all of which are in the public domain.

As the PCTs increase their hold over the planning process, and they begin to be effective as gatekeepers to the healthcare system, their needs will become more obvious and they will be more proactive in looking for solutions. But, in spite of all the modernisation hype at Ministerial level, everyone knows that the process of the NHS dragging itself, or being dragged, into the modern age will be very slow. Unfortunately, at a time when the pharmaceutical industry should be gearing up to seize the major opportunities for industry, it is still wedded to using large sale forces visiting GPs. There is already much criticism of such activity from a tactical viewpoint. For example, the UK-based Doghouse Consultancy doesn’t exactly pull punches when it says that there are “no signs of innovation or risk-taking in the healthcare media, which is still as full of trains, waterfalls and all manner of irrelevant wildlife as it ever was. Every big pharma business has a big pharma sales force and/or contracted sales forces, and does things with traditional agencies in traditional ways. Far from investing in solutions-based communications planning and the human resource/service partner issues that that may arise, big pharma appears to seek comfort in convention. High-cost, low-risk strategies that squeeze margins but leave stakeholders and shareholders alike cold, are the norm.” Even this kind of harsh criticism does not begin to touch the strategic implications.

The biggest problems in the NHS are concerned with the treatment of chronic illness, since patients need to receive care across the board, in the secondary and primary sectors and in the community, and the NHS is not structured to do this. The IT companies are beginning to succeed in providing integration of data, but it seems that there is no-one able to do the same as far as care is concerned. Slowly, with the advent of Care Trusts and such innovations as the expert patient programme, there are signs of an emerging NHS focused on integrated care. However, there are significant gaps; for example, the NHS cannot yet cope well with anything resembling high technology care in the patient’s home – which will be a key strand in any solution. The new high-profile healthcare technology assessment movement is achieving results in raising quality, but mainly by weeding out the ineffective. So what is needed is a positive drive to develop integrated solutions with proven outcomes, and the pharmaceutical sector could play a really creative role in this process. In the past, the industry’s own need for data has focused on names and addresses, mirroring its tactic of communicating with GPs, but if it is to come to grips with the new requirements, it will need to have much improved data sources, providing up-to-date access to the full range of NHS publications, backed by intelligent interpretation.

By Gordon Blackwell, The Health Information Company

Most people have seen the film ‘The Matrix’. The film explores the concept of reality. Our perception of the world is real. Or at least it appears real. But the reality is that our perceptions are false, manipulated and created by other forces at large. One of the most memorable sequences is near the conclusion of the film, where actor Keanu Reeves decodes The Matrix and, all of a sudden, is able to fend off numerous arch-enemies with one hand without even batting an eye-lid. But what has all this got to do with medical representatives going about their everyday business? When you come down to it, maybe the film isn’t so different from your life as a medical representative after all. The NHS is a Matrix. It’s a hospital corridor, a GP’s surgery. It consists of people and boards. It has customers you don’t know and targets you need to know. There are Formularies and Applications. There are Guidelines and Budgets. And there is a Code. The NHS Code. This NHS Matrix also needs decoding. The representatives are bouncing off the walls, trying to get access, attempting to get drugs onto formularies, trying to see who is on committees.

Trying to decode the Matrix. Striding purposefully through the chaos are the few true believers, who believe in themselves and believe in their products, who take the time to decode the Matrix and successfully move through primary care, hospital, field training, product management and marketing. How do they do this when the Matrix is a world of the unknown, especially to those new to the industry? Don’t worry, help is at hand.... To help you decode the Matrix, we will be running a new series of articles covering issues in both primary care (GP) and secondary care (Hospital) settings and dealing with the new and challenging ‘Interface’ between the different environments. These articles are not intended to replace the information from your ITC or Training Course. Nor will they replace the facilities of specialist companies who research training methods and the customer environment. However, what they will do is to add depth and meaning to your journey as a representative. Just as your A–Z map is both an essential and accurate representation of your journey from customer to customer, you can also appreciate that it tells you nothing at all about the process of driving, the feelings and emotions experienced while in the traffic, and the stress and events of your journey. In the same way, these articles will add depth and flavour to your journey as a representative. They will supplement your training and allow you to develop a threedimensional model of the sales process you are formulating. It may even prevent you from having a serious accident. Always remember – the Map is most definitely not the Territory.

So who is going to help you decode the NHS? - Omar Ali Omar Ali is the Formulary Development Pharmacist for Surrey & Sussex Healthcare Trust, PCG Formulary Advisor to Primary Care, Executive Board Member of the National Obesity Forum, the Pharmacist Representative of the Diabetes Local Services Action Group and if that isn’t enough Omar is a National UK Speaker.

Omar, why do you think we need this type of article? The pressures facing representatives today are multifaceted. Some revolve around the product and competitor information, but more and more importantly, much is dependant upon the changing face of the customer. In many instances, the customer is ‘unknown’ - it is a person, a board, or a committee. Often, this unknown and variable component is proving to be the most difficult to address.

Who will they be aimed at?These articles will be aimed at those representatives who work in both hospitals and primary care. It will also be valuable to those who are involved in training. representatives attempting to place drugs on formulary, to those who are working with NHS partnerships and to those who are trying to pin down the real structure & function of the new NHS mechanisms. How do the readers translate this information into actions Each month we will provide the following:-
i) Coverage of the current topic. ii)A case study iii) The Do’s & dont’s

What topics will be covered? The new Prescribing Interface - what does it mean to you? Hospital Prescribing Powers & Influences Formularies - for & against, the 2-edged sword Hospital & Primary care - pull through & opening restrictive formularies. The rubber band club Do’s & Don’ts of a successful representative Primary Care - Incentivised Prescribing D&T Shockers! Formulary Negotiations The D&T Meeting - Fly-on-the-Wall Retail Chemists - left on the shelf?

Although Millions of people depend on injectable medications for treatment of various ailments, none of them enjoy this experience. The pain, trauma and anguish associated with the injections have been responsible for poor patient compliance to a large extent. This has primarily been responsible for driving the development of non-invasive drug delivery technologies. A number of approaches are being developed as an effective alternative to the injections. Pulmonary drug delivery technology has made the maximum progress among the other competing technologies.

Background Pulmonary drug delivery has been used for several years for symptomatic relief and the treatment of patients suffering from asthma and chronic obstructive pulmonary disease (COPD). In addition, inhaled products are also being used for delivery of antibiotics for patients suffering from cystic fibrosis. Extensive research, spanning over many years has made possible development of products that can be delivered through the pulmonary route in many more specialties. Inhaled products pipeline includes products for diabetes, migraine, osteoporosis, hormones, and cancer therapies.

Existing Technologies Aerosolisation of the compounds is the basis of the pulmonary drug delivery. Metered dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulisers are the three available technologies within the pulmonary drug delivery.

Nebulisers: Nebulisers are generally used within the hospital settings and provide continuous aerosol spray with the help of an external energy source. The patients that are unable to use a hand held inhaler also use nebulisers. Nebulisers are large and bulky in comparison to the hand held inhalers in use. They are not very efficient devices and lack dosing precision.

Metered Dose Inhalers: Metered dose inhalers (MDIs) have been the most widely used devices for the delivery of medications through the lungs. The conventional MDIs that were driven by the chloroflurocarbons (CFCs) are being phased out due to environmental concerns. MDIs lack drug delivery efficiency as they deliver only 5 to15 percent of the drug to the lungs, the balance being deposited in the mouth and throat. There has also been concern regarding dose reproducibility and the particle size control with these devices. The use of spacers has been of little help.

Dry Powder Inhalers: Although the dry powder inhalers (DPIs) were introduced in the 1970s, their use has been limited due to overwhelming dominance of the MDIs. Triggered by the 1987 Montreal Protocol, for elimination of CFC based MDIs, the use of DPIs have been increasing in the United States. The DPIs used currently are “passive DPIs” that utilise the patients’ inhalation as a source of energy for dispersing the powder into the lungs. This causes inconsistent dosing, and is generally a problem for small children and elderly patients. In addition, these devices have not overcome the problem of inefficient drug delivery associated with the MDIs to a large extent.

Emerging Pulmonary Delivery Technologies Due to concern over CFC based MDIs, companies have introduced new generation inhalers that utilise hydrofluoroalkane (HFA) as a propellant. A minimum of two products has been introduced in the U.S. market and more are expected to follow suite. The conventional single dose DPIs are also being replaced by multi-dose DPIs, which has been well accepted by the clinicians and patients alike. The Turbuhaler and Diskhaler are among the most popular DPIs that are used by the patients in the U.S. The active DPIs are also being developed, which use external energy source for dispersion of the powder into the lungs. The active DPIs are still in development and have not been approved by the U.S. Food and Drug Administration (FDA). Several other technologies are being developed for delivering medications effectively through the pulmonary route. Battelle Pharma is developing electrohydrodynamic aerosol delivery products for multiple indications. These devices are highly efficient and can deliver higher concentrations of the drugs to the lungs without the need for propellants. Inhale Therapeutics and Alkermes have developed dry powder inhalers that can deliver the drug much more effectively than the earlier available devices. Aradigm and Aerogen are developing electronic liquid aerosol inhalers that can deliver finer doses with precision. Many more technologies are being developed that are likely to overcome the shortcomings of the conventional pulmonary delivery technologies.

Conclusion The emerging pulmonary drug delivery technologies are targeting a number of chronic diseases that debilitate millions of patients. Further the market potential for non-invasive technologies have been increasing rapidly due to increasing incidence and increased life expectancy. With the development of advanced technologies, more numbers of patients with varied chronic ailments will be able to breathe in the drugs in a much more effective and safe way.

By Ajit Baid, Industry Analyst Pharmaceuticals, Frost & Sullivan

In the heady days of the 90’s, to many observers it appeared that money was no object for the pharmaceutical industry. Multi-million pound projects, rising share prices and vibrant job opportunities all added to this impression. Star Wars In the heady days of the 90’s, to many observers it appeared that money was no object for the pharmaceutical industry. Multi-million pound projects, rising share prices and vibrant job opportunities all added to this impression. Now, in the first few years of the 21st century, the picture is changing. Many new product pipelines are slowing, share prices are dropping and the impact of government legislation weighs even heavier on the opportunities for the industry. It’s by no means all doom and gloom, however few would say that it’s getting any easier. At times like this, the traditional ways of maintaining competitive advantage have to change and adapt in order to stay ahead of the game. Hence the battle for the “stars”, or the Talent Wars as it is sometimes called. When product differentiation becomes difficult, the real source of competitive advantage lies in the attraction and retention of talented people who can differentiate the services and representation of the company brand.

So what’s new I hear you cry?

Well in essence quite a lot, because knowing the importance of identifying the “stars” and being certain as to where the real talent lies within your organisation are often two different things. If you are a senior manager reading this, can you honestly say at any one moment, who are the real stars are in your company? Not just based on their sales performance but across a whole range of personal and professional competencies. If you are a field based manager reading this, can you pinpoint, quantify and justify the decisions you make regarding each of your representative’s careers, both to them and to your managers? In the “War of the Stars”, the need for consistent thorough, transparent and fair assessment of an individual’s performance is essential. Competencies have long been used as a way of achieving the measures and consistency that are now needed. Now before you throw the article aside at the sheer mention of competencies – yes I know at times competency and compatibilities frameworks are cumbersome, unreliable, over simplistic and time consuming to administer – I just want to impart to you some of the ways that companies (mainly outside of the industry but some within it also) are breathing new life and vigour into the whole subject of performance management and succession planning.

Let me ask you this question. If you could, at the touch of a button:

• Motivate people to take ownership for their own performance and development.
• Identify the best all rounder for a job vacancy.
• Pinpoint the gaps in performance in order to target limited T & D budgets
• Ensure that all re-grading and appraisal discussion is transparent and evidence based
• Demonstrate your capability and suitability for a promotion to others
• Plan your career on an ongoing basis daily or weekly if needed . . .

would that be useful to you? Because that’s what many companies have now achieved through well-designed on-line competency and performance management systems. Within the industry, where competencies have been put on-line as part of a coaching and development culture transition; many organisational, managerial and personal benefits have been achieved.

Lets consider some examples

In a couple of the on-line competency and talent management systems, each individual job profile is presented by a visual “web map”. This shows the schematic profile for the job role, the individual’s perception of their own competency rating profile, their managers view of their competency and the mutually agreed result. This mapping immediately supplies a gap analysis for any one individual in any one competency. The results however are far reaching in their value and application.

• Firstly, individuals with common gaps or needs can be instantly channelled onto the relevant training courses or directed towards the relevant learning resources. No more sheep dipping.
• Secondly, at the touch of a button, a full analysis of an organisations competency can be assessed in any one area against the business goals. At times like this, the traditional ways of maintaining competitive advantage have to change and adapt in order to stay ahead of the game
• Training and Development can be delivered well in advance of impending initiatives to address any technical or skills gaps.
• Thirdly, as gaps close, R.O.I. of training and Development spend can readily be assessed. confidential between the individual and the manager). Employees can therefore identify where they need to improve in order to fit the profile of their next career move.

Evidence-based on-line competency frameworks will inevitably become the next tools for creating the future

In another organisation, any permanent movement in the individuals profile result has to be evidence based. When you are responsible for collecting and collating evidence, testimonial, course attendance results etc. as well as sales figures in order to underpin your performance improvements, you can’t help but become engaged in and enthusiastic about your own development. This focus on “personal accountability” and ownership for success has made “development” an ongoing coaching and business tool, no longer reserved just for appraisal. Therefore evidence-based on-line competency frameworks will inevitability become the next tools for creating the future. Let’s consider the area of succession planning, with an engaging online competency tool. At any time, anyone can view the job profile of any other job or role (not the individual job holders results – they’ve confidential between the individual and the manager). Employees can therefore identify where they need to improve in order to fit the profile of their next career move. Likewise, where a job vacancy comes up, Senior Management can quickly call up a competency audit which will shortlist the “best fit” candidates within the company resulting in greater transparency, less bias and less subjectivity in internal appointments. The above examples only scratch the surface of what some of the online systems are capable of, a far cry from the rarely used, paper driven, procedural competency processes often found in the industry. With the complexity of selling to the NHS becoming even greater and the need for territory and product teams to all pull together, the ability to assess an individual’s performance and an individual’s sales is fast becoming a thing of the past. Retaining talent and identifying shortfalls in performance is key to the success of any business. On-line transparency of any one person’s competency profile is just one surefire way of making competency frameworks work for us. Today the battle for talent, the Star Wars, will be won and lost on the battlefield of the World Wide Web.

For more information on putting competencies on-line contact: Russell Curzon, IQdos Ltd, 45 West Street, Marlow, Bucks, SL7 2LS Tel: 01628 488556 www.iqdos.com For more information on competencies frameworks contact: Mandy Geal, Learning Partners, 88 Little Grove Field, Harlow, Essex CM19 4BX Tel: 07900 698098.