A pre-requisite for entry into pharmaceuti-cal sales is for prospective candidates to ‘shadow’ a representative - a practise which I am sure most of you have been involved in both before and after you got into the industry. But have you ever stopped to question this practice? Is it because shad-owing is accepted policy or do we continue the practise because we did ourselves so therefore everybody else should? Is it to ensure that a candidate understands what the job is about, therefore allowing us the benefit of not having to sell it to them? Or are we merely trying to maintain the ongoing practise of exclusivity in the phar-maceutical sales industry? It appears that there are many questions to be answered with regards to the practise of shadowing. In this article we shall explore the rationale behind the practise, highlight its pros and cons, evaluate how it compares with recruitment practise in other industries and then make some suggestions for the future.

The Rationale There are several rationales for shadowing, some of which are:

• To enable the candidate to gain an insight into the role of a representative within the industry. Therefore, if and when they enter the business they are well prepared for the role ahead.
• In organising a day’s shadowing, the candidate may demonstrate the initia-tive, determination and tenacity to over- come many objections and barriers which is a feature of a representative’s daily work.
• All companies want to minimise the risk of making a bad hire. To recruit a new person can cost up to £60,000 in the first year - including salary, benefits, training, and time invested - so it is essential that the firm hires the correct people in order to get a return on their investment. Shadowing helps in this direction.

These all seem to be very plausible reasons for continuing the policy of shadowing. However, there are both pros and cons asso-ciated with this practise and we would do well to familiarise ourselves with them.

The Pros A prospective representative who goes forward for interview after a day’s shadowing will have a snap shot appreciation of the potential career and industry. A hiring manager can feel more confident if the individual has demonstrated the tenacity, determination and levels of initiative which will be needed to gain access to GP’s and to be successful in their role. This information should maximise the success of appointments and minimise the risk of early failures. Only people who are really determined to get into the industry will be motivated to par-ticipate in shadowing. The hiring managers can focus their ener-gies on competency-based interviews and do not have to ‘sell’ the opportunity to candi-dates who, without shadowing experience, would know little of what the job entails.

The Cons Have you ever wondered why many com-panies have a policy that bans their own rep-resentative be shadowed whilst demanding that in order to get an interview, the candi-date must have shadowed? Why is this? Quality control - If a candidate spends a day with an unknown representative, how can it be ensured that the ‘quality’ of the day is such that it allows the candidate to get a true insight into the role? Has the candidate spent time with a ‘good rep’ or a ‘bad rep’? Have they been taken to all the easy-access surgeries? Who ensures that the representa-tive has not got some bad habits or low-levels of motivation that will be passed onto the prospective employee? If a candidate has been told that they must shadow before they will be even be consid-ered for an interview then, if they meet a representative from one of your competitors who are also recruiting in the same area, there is a risk that that company will inter-view and employ them before they even come back to your business. In a competitive recruitment market, does shadowing place an additional barrier to entry for experienced sales people from other industries? Will prospective employees be put off by the pharmaceutical industry if they can get a good job elsewhere without the additional effort. These factors are worth considering and could mean that although the people that do shadow are motivated and determined, they may not actually be the best people available. Personal safety - Does the company repre-sentative know who their shadower is? Are they really a recent graduate? Or are they actually from a rival firm or even an under-cover journalist? Or worse still, could they be a complete raving lunatic! In an industry which values its high ethics and safety, it seems strange that some companies would encourage a practice which potentially puts its employees at risk. Company liability - If a non-company person spends time with a representative in their car and they are injured in an accident, are they insured? A point worth checking before you next take somebody out with you. It is clear that there are both pros and cons with regards the practise of shadowing.

Best Practise As mentioned earlier, pharmaceutical sales exists in a very competitive recruitment mar-ket where all companies try to attract the best quality people from recent graduates to expe-rienced sales professionals. However, in Michael Page’s experience, recruiting for other sectors such as FMCG, Business services, IT/Telecomms, travel/leisure etc is a different challenge because none of them encourages or stipulates shadowing prior to interview. They will expect an interviewee to have researched their company, industry, job role and market place prior to interview - a task which is relatively easy given the infor-mation readily available. They will also expect that the recruitment company will have given the candidate all the relevant information about the role and even told them about the frustrations of the job such as horrible recep-tionists, over-worked clients, traffic jams and of course, the endless administration (sound familiar?) Some would argue that medical sales is a unique industry. But is it really that different to selling a business service or manufactured good such as photocopiers or stationary? Surely the answer is no. All sales people face the same problems such as gaining access to clients and dealing with objections and rejec-tions. This is what makes being a salesperson fun and challenging.

Suggestion on the future role of shadowing There is a growing realisation that the role of the medical representative is no longer about simply having a cosy chat with the local GP. The industry has moved on from taking on raw science graduates and is now looking to recruit experienced sales profes-sionals who will achieve results in what is an increasingly competitive market. If this is the case then surely we should be looking at ways to encourage these types of people and perhaps amending practises like shadowing, which may put them off? There is no doubt that shadowing can be a useful tool as a part of the recruitment pro-cess but as we have discussed above, there are some inherent problems. If shadowing is to remain part of the overall recruitment process however, it could be better used, perhaps after the first interview stage once it has been decided that a candidate has all the competencies, personality and skills to do the job. In making this slight amendment to shadowing it would still be possible to:

• Ensure the quality of time and type of activities that the candidate will experience
• Minimise the risk of losing them to another firm and create a greater sense of affinity with your company
• Make it easier to attract experienced sales professional from other industries
• Get to know who the shadower is thus ensuring the safety of the company representative
• Ensure that your company has the relevant insurance to cover this activity So, to shadow or not to shadow, that is the question.

Darren Spevick is the Managing Consultant at Michael Page, responsi-ble for sales recruitment in the phar-maceutical and healthcare industries. Telephone: 01727 730 128 email: darrenspevick@michaelpage.com www.michaelpage.co.uk

Corporate Structure usually represents the line management of organisations Note that the Executive Team (four groups) have considerable concern as to the percep-tion of the organisation to the outside world, including local press, patient groups and issues surrounding complaints. The press advisor and legal affairs are key voices with regards the Chief Executive. Since April 1999, the CE was not only responsible for finance, but is now responsible for the quality of both patient care and the staff who are delivering it. Given that most CEs are not trained practitioners of any sort, the responsibility and accountability can only be delivered through clinical gover-nance. Of all the Executive Directors, the Medical Director and the Director of Operations are the two who have a significant impact on the role and performance of clinical staff and sup-port services. The Director of Nursing is one of the most far-reaching and diverse roles and will be a key target for stages of nurse prescribing, nurse consultants and nurse education. However, as is often the case, these individu-als are almost exclusively out of reach to most representatives from the Pharma industry.

The Director of Finance (DOF) has become one of the most commanding and dictating positions within the Trust. Directives on cost containment or budget reduction will have compulsory attainment. No argument. No dis-cussion. Directors of HR are interesting targets for the industry as most NHS Trusts & PCTs have staffing difficulties and Pharma companies, whilst realising this, have not yet been able to crack this problem. There are some fantastic examples, however, of collaborative working within pockets of the Trust. General Managers for the various Directorates (Medicine, Surgery, Woman and Children’s Services) have become very impor-tant with regard to interface logistics between the Executive Directors, their Trust Performance Targets and the patients on the wards who require care within the budget available from the DOF. Indeed, recently, one or two drugs and ther-apeutics decisions have been blocked or deferred by General Managers who hold sig-nificant budgetary power and can, to a certain extent, dictate commissioning resources for problematic drug use/costs. Director of Pharmacy holds many keys though these individuals have varying accessi-bility to the Pharma Industry. More important-ly, pharmacy staff working under this remit (formulary pharmacists, directorate pharma-cists and medical / drug information pharma-cists) have significant influence over medicines use within the hospital and subse-quent primary care interface. Pharmacists will be covered in further issues of the Matrix. Other Support Services such as Dieticians, Physiotherapists, Microbiologists will be tar-gets for those therapeutic areas in which they are directly or indirectly involved. Note some support services are now under PCT auspice for example, diabetes nurses and dieticians.

NHS Trusts have many Boards & Committees. Philosophically, they allow staff and man-agers who often do not have any line respon-sibility to each other to come together in some forum as dictated by the title of that Board. Operationally, they allow decisions to be made which often cross departments and multi-disciplinary staffing grades. These Boards and committees will either be advisory or policy making. It is not always clear which type a given group is! The CMB is a very important Board and acts as a filter to major decisions that may affect the Trust. Some therapeutic decisions may need to go, ‘through’ CMB although even this is varied and may not be clear to what extent the CMB, ‘need to know’. Modernisation Review Group do have all the NSF groups reporting progress along with Cancer Unit Steering Group. As the Government becomes more focused on per-formance than just audit, this will be a very important group. Remember that CHI (Commission of Health Improvement) are changing their role over this next year from an, ‘audit’ role to an, ‘inspection’ role. Their teeth have become larger and sharper and issues around cost, quality and performance will become more focussed than they have ever been before. This is both good and bad news for Pharma Companies. Whilst Drugs and Therapeutics Committees will become, ‘even more focused’ on evaluating new drugs, more and more groups will have an impact that will need con-sideration.

Case Study

A Trust comprising of three hospitals where a mixed variety of products were used for thrombo-embolic disease (DVT, PE, unstable angina) should see a concerted effort made to standardise practice across the hospitals. For historical reasons different heparins were being used for similar conditions. During this process a variety of Pharma Companies made contact with various individuals – but who were the key players? The review was Pharmacy led – but the lead consultants across three Directorates were crucial. Orthopaedics, General Surgery, Medicine and Obstetrics and Gynaecology and Cardiology. In each case, various companies targeted certain individuals but it became apparent that not one single representative had been able to see all the relevant clinical staff. Orthopaedic surgeons are never keen to use heparins – in fact to pursue the process Clinical Risk Management and Clinical Audit were both called upon to increase pressure and move issues in the right direction. Non of the Pharma companies had thought about this. Where does clinical evaluation for risk assessment in surgery occur? The answer lies very much in whether patients are blue-lighted in or whether they are elective. Patient access and consideration of where patients are eval-uated (as much as how they are evaluated) was key to producing well placed guidance on completion. Again, staff involved with clerking or ward staff involved in assessing risk were targeted by one company only and it helped them significantly. Post Grad Med Centre was key to meetings being held by individual directorates. Only one company was able to influence support at Directorate meetings so as to be at the right place at the right time. The Finance Director watched this process very closely. Significant financial data was provided throughout the process. As Haematology is key to the whole process, and there were significant issues addressing three sites and cross-political borders, only one company was able to bring some of these influences together in a short but very effective forum Medical education for nurses was addressed by all companies but most only one or two deliv-ered on promise. Some nursing staff reported favourable discussions regarding this to pharmacy. The creation of ward charts, protocols and lamin-ations was crucial in supporting the process. Clinical project sub-committee was key to aiding the audit process which actually helped the Trust achieve some of its audit targets – something which inevitably helps the CE of the Trust look favourably on those involved.

Pharma companies should bear issues like this in mind. We all have targets to reach. In the context of the Matrix, do any of your targets match ours? If you don’t know – find out!

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.

SO WHAT IS IT that will be keeping PCTs, their Chief Executive’s and other members of the team awake at nights? This table gives some idea of the breadth of the agenda faced by PCTs and is by no means exhaustive nor is it in any particular order. Let’s have a look at some of the issues in greater detail:

1. Financial Management This might sound odd at a time of record investment in the NHS, but for many the name of the game will be to balance the books. Whilst the new money is welcome, it comes with strings – national priorities and developments, of which there are many – see section 9 below. For others, the task will be to spend the money wisely and in ways that really make a difference to patients by both improving outcomes and improving patient experience of the NHS. The NHS, and particularly the acute sector has a seemingly insatiable appetite for soaking up money without demonstrable benefits – perhaps just catching up on the decades of under-investment means this is inevitable. One of the real problems faced here is that for some the big resource limiter will be the absence of people, and not money. We are entering a phase of development where thinking imaginatively around the use of the work-force will be far more important that funding difficulties. The new allocations have also been followed by advice as to where PCTs sit with regard to target allocations – some with a distance from target of 30% – a huge variation to plan for.

2. Performance indicators The big issue here is that this year PCTs will be star-rated for the first time – often on issues outside of their immediate control. Being star rated on issues like suicide and infant mortality can be tough, and many of the other indicators mean PCTs taking responsibility for what appears at first glance to be the responsibility of others – discharge arrangements from hospitals are a good example. But if PCTs are to be the central linchpin of the NHS then they must face up to this key role of pulling it all together and delivering to populations and patients. Make no mistake, the ability of some chief executives to achieve star ratings will mean the difference between keeping their job or not, and may mean the difference between the organisation being swallowed up by some of the higher performing organisations in the area.

3. Engaging professionals Remember the political rhetoric of 1998-9? Primary care organisa-tions were to be run by the front line with “Doctors and nurses in the driving seat”. A few years on and many PCTs are witnessing profes-sionals walking away in droves. There are many reasons for this but perhaps a dawning realisation that Primary Care Trusts are the new bureaucracies is at the centre. Bigger, more managed organisations with statutory responsibilities have a hard time being inclusive friendly bodies and it is showing. The cynics say that the metamorphosis from PCT to HA and Strategic HA to old region is pretty quick, but whatever the reality this is coming at a time when PCTs are going to have to tackle one of the biggest NHS jobs of all time – implementing the new GP contract, on top of everything else and trying to engage all clinicians – dentists, optometrists and community pharmacists to name but a few.

4. Engaging the public The difference between PCTs and yesterdays Health Authorities can probably be measured in two key ways – how effective they are in engaging professionals (see above) and how effective they are in engaging the pubic – patients and populations alike. A whole plethora of new bodies is starting to emerge, Patient Advocacy and Liaison Groups. Public Forum, and the Commission for Public and Patient Involvement in Health but the real test will be whether the woman in the street is heard and listened to. Will these new mechanisms make a difference? Is the new NHS prepared to share decision making with the public? Or will it be another round of tokenism and disillusionment – I think not – but it will be down to PCTs to make the difference.

5. Developing commissioning Let’s face it – commissioning has gone backwards not forwards. Intended to be the basis for a new partnership between primary and secondary care, it has all too often become the squabbling ground or the one where the PCT became preoccupied with its own organisational change and took its foot off the commissioning accelerator. Ministers expect some pretty big changes here and see commissioning as being a key delivery mechanism. Of course, life wouldn’t be the same with-out some substantial change to cope with so the new financial changes, with the introduction of national tariff pricing and patient choice will test many to the limit. We had just got used to commis-sioning again when the politicians became impatient and decided to re-introduce purchasing and a competitive edge to the game. Finally, we are just coming to terms with the realisation that commissioning in the future will mean the commissioning of primary care as well as sec-ondary care services.

6. Working together I’ve already touched on this – working together with acute trusts is one thing, but have a look at the partnership list of potential bodies NHS must work with effectively to achieve success. One PCT Chief Executive I know has his list up to forty three – and only manages to keep it that low by counting the voluntary sector as one. So there is a very real challenge to create partnerships that involve all stakeholders and deliver the goods in terms of health improvement.

7. Overview and Scrutiny Committees Of course, a key partner in the health community is the local author-ity, but they are about to become a key assessor as well. Potentially the most demanding of the new accountability mechanisms (don’t forget CHI – whoops sorry CHAI from 1 April) Local Authority Overview and Scrutiny Committees will start to get their teeth into the NHS – and some old scores will be settled as well.

8. National Service Frameworks Delivering National Standards was one of the big ideas for New Labour and we are now on the never ending National Service Framework merry-go-round. Personally, I’m a fan – about time too that we had some national standards in place – but don’t underestimate their impact and the difficulty in sustaining improvement. The easy stuff has been addressed – now we are down to the hard slog of main-taining initial momentum – and addressing the new ones – like the Diabetes NSF – even if it was watered down – that will mean a huge new challenge for PCTs. And the world will not stand still over the next three years. There will for example be the new National Service Frameworks for Children and Renal Services and the delivery of that for Diabetes.

9. Delivery the national agenda One of the big plusses for 2002 was the switch to three year plans, financial allocations and planning guidance. This was remarkably suc-cinct and tells PCTs in clear terms what they have to do up to 2006.

The priorities are clear:

• improving access to all services through:
• better emergency care
• reduced waiting, increased booking for appointments and admission and more choice for patients
• focusing on improving services and outcomes in:
  • cancer
  • coronary heart disease
  • mental health
  • older people
• improving life chances for children
• improving the overall experience of patients
• reducing health inequalities
• contributing to the cross-government drive to reduce drug misuse

In addition each NHS organisation, working with its local councils and other local partners, will need to develop underpinning plans which show the total increases in capacity in the three key areas of:

• physical facilities
• workforce
• information management and technology

The challenge of creating a three year delivery plan will be only out-stripped by the ability of PCTs to deliver… Finding space for the local agenda This might be seen as an offshoot of national priorities. The PPF guidance is quite clear. “ Other than the targets in this document, arrangements for delivery will be a matter for local determination. Local organisations and com-munities will set their own timescales and milestones. They will be responsible for reporting to and accounting to their local communities for improving these services where necessary” All very well, but when do PCTs find the time? My concern is that there will be little space for local organisations to address local needs.

Conclusion I was tempted to use the phrase “If you are not confused…you don’t know what’s going on…” but in reality, it is a question of knowing what’s going on at a local and national level. This is a big challenge but one which field staff can get to grips with – start by applying the ten challenges above to the local scene and does some environmental mapping. NHS knowledge was at one time the preserve of the spe-cialist NHS liaison manager – these days it is a vital tool for all sales professionals to use in a changing customer environment. Michael Sobanja Director of NHS Alignment – HealthGain Solutions Chief Executive – NHS Alliance Michael Sobanja writes personally, he takes personal responsibility for the views in this article that may not represent the views of either organisation mentioned above

The top ten key issues for PCTs in 2003

• Financial Management
• Performance indicators
• Engaging professionals
• Engaging the public
• Developing commissioning
• Working together
• Overview and Scrutiny Committees
• National Service Frameworks
• Delivering the national agenda
• Finding space for the local agenda

Twenty years ago few people perceived pharmaceutical sales as a career choice - it was something they fell into usually through the recommendation of a family member or a friend. It was reckoned to be a safe and secure job. However, things are very different today. The competition is fiercer, the NHS has become a less friendly customer and new organisations such as NICE have proved to be damaging for certain products. But a career in pharmaceutical sales is still a highly attractive prospect and the numbers trying to get into the industry continue to grow. Entry-level salaries of £18-£22,000 are considerably higher than average in the sales environment and generous bonus schemes coupled with excellent training are further reasons why the number of prospective repre-sentatives remain consistently high. Consequently, the entry criteria has become more stringent and normal testing and inter-view methods alone are not sufficient to secure a position. So who is ideal pharmaceu-tical representative material and what experi-ence and skills should they have?

Education

• Degree educated
• Qualified nurse or equivalent health professional
• Two A levels – one preferably in a science subject
• A valid driving licence with no more than six penalty points

Experience

• Previous selling experience
• Worked in an autonomous business role
• Experience of working in a customer service environment

Skills

• Good written and verbal communication
• Ability to build and maintain relationships
• The ability to work on your own with minimum supervision or as part of a team
• Sound analytical skills
• Determination
• Honesty

Questions to ask yourself

• Am I comfortable spending a lot of time on the road?
• Would I be happy working ostensibly on my own?
• Can I deal with the rejection from receptionists and customers?
• In terms of family commitments would early morning starts pose problems?
• Can I spend 4-6 weeks on the initial training course?
• I am prepared to attend overseas conferences?

Doing your research At a first interview you will be expected to have:

• a good rudimentary knowledge of the role of the pharmaceutical representative
• a basic understanding of the function and the structure of the NHS
• ideally to have shadowed at least one representative and to have researched the company to whom you are applying for a position

So where do you find the relevant informa-tion before applying for an interview? To find out what a pharmaceutical representative does, you can do one of the following:

• Make contact and shadow a representa-tive for the day.
• You may be prepared to pay for an Intro-duction to Pharmaceutical Sales course which is run by many recruitment agencies. The fee for a one-day course can range from nothing to £200, but by doing it this way you can save yourself a lot of time and energy.

Where do I find pharmaceutical sales vacancies? You can apply online for most positions now so it is imperative that your curriculum vitae is of a high standard as it will provide you with your first window of opportunity. Remember to identify which companies are prepared to accept rookie representatives: a good starting place is often the contract sales forces who are happy to interview graduates or applicants with no previous pharmaceutical sales experience. (The recruit-ment agencies will be able to guide you in the right direction).

Putting your CV together Think of this process backwards: what does the potential employer want to see rather than what do you want to tell them? If you are a graduate then obviously your academic qualifications are paramount. The pharma companies are ideally looking for sci-ence graduates, but non-science graduates can still apply - what you have to do is con-vince your prospective employer that you can take in quite complex scientific disease and product information. Extra information on any work experience you may have, or hobbies and clubs of which you are a mem-ber, helps to demonstrate your communica-tion skills and ability to work with other people. If you are not a graduate then you need to demonstrate that you have relevant sales experience, again coupled with an ability to retain large amounts of scientific information. The last thing a company wants is to take someone on who can’t graduate from the Initial Training Course, as that would mean an enormous waste of money. Make sure that the personal statement at the beginning of your CV includes the infor-mation that is vital for you to relay to the prospective employer. The rest of your CV has to indicate that you have the right education, work experience and personal skill set that will ensure your success in the field. Ensure that you include two good work and personal references, but do ask their permis-sion first before stating them.

Telephone Screening You have seen the advertisement, now what? You may be asked to ring in to a call centre to apply for an interview. The call centre will be given a list of relevant ques-tions to gauge your suitability for the position advertised. DO NOT assume that you are ringing for a casual chat. It may be an official telephone interview so refrain from making the call until you are in the right environment and in the correct frame of mind to answer serious questions about yourself. (Note - remember to identify which companies are prepared to accept rookie representatives. A good starting place is often the contract sales forces who are happy to interview graduates or appli-cants with no previous pharmaceutical sales experience. The recruitment agencies will be able to guide you in the right direction).

The Interview As in all things PREPARATION is the key to a successful interview. First do the background research on the company inter-viewing you. A potential employer cannot fail to be impressed by someone who has done their homework. It proves determina-tion and professionalism

• Make sure you know where the venue is and if possible visit it the day before, allowing time for traffic problems. There is nothing that creates a bad first impression more than being late
• Always arrive early, you will not be seen early but the interviewer will have been informed that you have arrived
• Always look smart, dark suits in general look more professional and create a good first impression
• Take your qualifications, driving licence, passport and brag file (portfolio of positive feedback on your work) along with you

So you have been successful at your initial interview but what next? A second interview with the pharmaceuti-cal company itself, a second interview with the second line manager or, more commonly these days, an assessment centre. Assessment Centres can vary widely in their content but generally contain the same key elements.

• An interview
• A presentation
• Aptitude/psychometric tests

The interview will not be a completely new concept for you, but you may never have had to do a presentation before.

• The presentation title will either be given to you beforehand or on the day you attend the assessment centre.
• You will usually be given some acetates and acetate pens and time to prepare.

A few tips for you

• Title on the first page
• Outline what you will cover in the presentation on page 2
• Use stab points and then talk round them rather than writing everything on the acetate
• Cover the topics – ensuring a maximum of five key points per acetate
• Summarise what you have said
• Keep to the time limit – try and time yourself beforehand
• Always be enthusiastic, positive and maintain good eye contact

Aptitude/psychometric tests These are tests to gauge your written and numerical skills as well as personality type. If you fancy a practice beforehand then click on to the Saville and Holdsworth website www.shlgroup.com. This website has online tests, allowing you to complete a timed test which is then immediately marked, giving an indication of how you would fare on the day. So you have got through the telephone interview, the face-to-face interview and now the assessment centre. You should be informed during the next few days whether you have been successful or not. If you have been unsuccessful do ask for some feedback so that you can work on any areas of weak-ness.

The job offer Before accepting the position you must read your contract carefully. Areas to be checked:

• Is there a probationary period and if so how long?
• For a part-time position, how many full days am I expected to work each year?
• Pension provisions.
• Daily allowance.
• Private Health Insurance.
• Sickness.
• Daily Allowance.
• Bonus Schemes/Share Options.

All present and correct, then GOOD LUCK IN YOUR NEW CAREER