The resourcing requirements of pharmaceutical/ healthcare companies have greatly changed over the last 2-3 years.

This, in the main is due to:

1. New employment legislation allowing employ ers greater flexibility regarding such aspects as maternity leave, paternity leave etc.
2. Increased periods of absenteeism from work due to long term sickness by employees
3. Increased demand by companies to keep 100% coverage of positions at all times so as to achieve their annual objectives
4. A greater desire by the workforce for flexibility in their roles
5. Other industry sectors offering more competitive packages and favourable opportunities, luring candidates away from the pharma/ healthcare industry

• In an average year 5% of pharmaceutical employees will suffer from long-term sickness
• 6-8% will go on maternity leave
• 27% will change companies

Total cost of absenteeism to British industry has reached 10.7 million - 80% of this figure due to short-term absenteeism

Figures provided by Activity Benchmarking Ltd

In a competitive sales environment, where every second counts, pharmaceutical / healthcare companies can ill afford to allow the “gaps” to remain even for a relatively short period of time.

Maintaining a full effective team during initial periods of a products promotional life is key to the success of the sales and marketing effort. Often when particular areas fall behind due to lack of cover they never have an opportunity to recover their full potential. Consequently as companies strive to maintain full productivity, to meet their business objectives interim/flexible resourcing is emerging as a matter of great strategic importance. Many of the leading pharmaceutical healthcare companies will agree flexible resource management is becoming increasingly important, far more important than it was a decade ago.

The availability of the all encompassing interim package to the pharmaceutical/healthcare industry in the last 2-3 years has allowed the industry the flexibility to ensure it is well positioned to cope with the increased degree of absenteeism in its workplace.

Interim cover can now solve the problem for such a diverse range of eventualities, whether they be expected or unexpected.

- Maternity cover
- Long Term sickness
- Secondment Cover
- Merger transitional periods
- Headcount Freezes
- When difficult to fill positions are taking a much longer period of time to recruit for

Also in times when it is proving more and more difficult to find that perfect candidate to fit into your existing team, the option of interim transfer is becoming a more desired approach.

This allows companies to employ someone on an interim project, monitor their progress and success over a given period of time, with the opportunity to then transfer them onto permanent headcount. This degree of flexibility can also apply when companies are looking to launch or test market a new product, for a controlled period of time. In this scenario interim resourcing is the ideal solution.

So what has changed over the last few years to enable a niche resource provider like The Vacancy Management Company to offer this all encompassing interim/flexible solution to the pharmaceutical /healthcare industry?

“A change in mind-set of the workforce”

The onset of a candidate driven market is such that for many, interim work is steadily emerging as the preferred option and can now be a career choice. Candidates are now not always attracted to the ideals of permanency, but instead are seeking employment that suits the overall needs of their lifestyle.

A high percentage of the workforce, both male and female now want to spend more time with their families and do not want the demands that permanent roles often impact upon them.

Other individuals want to pursue further education, travel, pursue other hobbies and therefore look to build part-time work around that desire.

An ever increasing pool of people are seeking part-time term time opportunities so as to spend more time with their children.

In all cases, high calibre candidates are looking for varying degrees of flexibility in their working lives to support their lifestyle choices. This has produced a pool of highly experienced professionals with a diverse range of skills.

• Primary care and Secondary care sales people
• 1st and 2nd line management
• Senior and junior marketers
• Nurse Advisors

Thus allowing specialist interim resource providers to offer a database of highly skilled candidates, to the pharmaceutical/healthcare industry for interim type positions.

So what makes a successful interim employee?
Irrespective of the level and type of interim cover it is imperative that the employee has:

1. Current and relative experience in the position that they will be working
2. A commitment to complete the contract
3. If a sales role- good territory knowledge of their preferred location, a range of therapeutic knowledge
4. Good relationship with their customers

Many resource providers offer interim/flexible cover as an additional service to their portfolio. However only a few companies offer interim provision as an exclusive service. So, how does the all encompassing interim package differ from just supplying a CV.

It starts with the time and dedication the resourcing company spends working with its customers so as, right from the outset, developing a clear understanding of their individual business and cultural needs.

It is then applying the different set of skills, recruitment and administration wise to ensure the right candidate and their individual requirements are matched with the appropriate client.

Another key factor is the training and development. To make this service as effective and impactful as quickly as possible for the customer, the interim employees need to be trained in the relevant therapeutic areas, which can all be part of the package on offer.

It’s not only the initial training that is important though, ongoing development is just as crucial for interim employees as this is sometimes their chosen career path. Consequently in a sales role, it may involve putting the employee through the ABPI examination.

From when the interim employee commences on a project they can now feel just as much an integral part of the team as a permanent person.

• Good remuneration and benefits package
• Receive initial training and induction and ongoing development
• Have regular contact with the interim resourcing company
• Work towards agreed objectives set down by themselves and their manager and
• Receive recognition on completion of these targets

How does this benefit the customer? It means they have a highly motivated individual, to cover a gap which they can ill afford to have. There is no need for them to get involved in the recruitment process- this can all be done for them by the specialist resourcing company.

Also once the project has commenced- it is completely hassle free for them. The all encompassing package ensures all administration, project management i.e expenses provision, maintenance of car etc is completely taken care of.

So whether you are the pharmaceutical/healthcare company or the employee, the name of the game is securing a return on investment.

With the all encompassing interim package the pharmaceutical/healthcare company can be assured their business objectives can at all times be kept on track.

On the other hand the employee can keep the flexibility they desire to suit their lifestyle choices, but also have a career where they receive a good remuneration package and are continually developed in their role.

This must be a win:win solution for both the company and the employee.

Introduction
Currently, all doctors registered with the GMC can practise medicine in the UK. A new system is being introduced to strengthen the register through the issuing of a ‘licence to practise’ and periodic (5-yearly) revalidation to continue to be licenced. The timetable is as follows

• April 2003 – GMC publication issued to all registered doctors re: revalidation and licence to practise
• End 2004 – all registered doctors will be issued a ‘Licence to Practise’
• 1st January 2005 – any doctor wishing to practise must hold a licence
• April 2005 – first doctors will be invited to be revalidated
• 2010 – second round of revalidations will start (5 year rolling programme)

Why? Well, you can’t fail to have missed Harold Shipman, the Bristol Heart Surgeon, and the Alder Hey scandals. Each of these cases of misconduct has undermined the public’s confidence in the medical profession, and in response to the public enquiries following these cases, the GMC had to act to restore faith in the medical profession.

The GMC published ‘Good Medical Practice’ in May 2001, a document outlining what is and is not acceptable from doctors. Revalidation and the licensing process have been introduced to help benchmark doctors against these standards, thereby increasing confidence that care provided by your doctor is in accordance with the high standards expected of the medical profession, and that doctors are up-to-date and fit to practise medicine throughout their career.

What is Revalidation?
To keep their licence to practise, once every five years the GMC will ask doctors to show that they have been practising medicine in accordance with ‘Good Medical Practice’. Revalidation is the combination of doctors confirming this, and of the GMC confirming that their licence to practise is renewed.

How will Revalidation occur?
It is an individual doctor’s responsibility to provide evidence of their continuing ‘Good Medical Practice’. The GMC is expecting evidence under the seven heading of ‘Good Medical Practice’, which are:

• Good clinical care
• Maintaining Good Medical Practice
• Teaching and Training
• Relationships with Patients
• Working with Colleagues
• Probity
• Their health

There are two routes doctors can take to provide evidence of practising in accordance with ‘Good Medical Practice’ –

- Appraisal route
- Independent route

For most doctors working within a ‘managed environment’ (including GPs and hospital doctors), the Appraisal route will be the most straightforward route.

Appraisal as a route to Revalidation
It is expected that most doctors working mostly in the NHS will choose this route to Revalidation. Doctors using this route will not have to collect any additional data over and above that required for appraisal and other local systems.

To use this route, doctors should have worked in a managed environment, participated in an annual appraisal system and completed supporting documentation based on the principles of ‘Good Medical Practice’. The appraisal system should be operating within a quality assurance system (such as GP appraisal through the PCT framework). The GMC believes that full participation in annual appraisal, with completed supporting documentation during the revalidation cycle, is a powerful indicator of a doctor’s current fitness to practise.

There will be schemes of appraisal to cover all groups of doctors with NHS contracts before revalidation commences in 2005 (including academics and managers). GPs working to a GMS contract, a PMS contract and supplementary lists held by PCOs (e.g. locums) can consider themselves to be working in a managed environment. A joint DoH/GMC website has been set up to explain the link between appraisals and revalidation for every group of registered NHS doctors – www.appraisaluk.info.

Some GPs will be concerned that appraisals have not yet started in their locality, and indeed their local medical committee may be advising them against participation until the PCT provides adequate funding to allow protected time to prepare and attend an appraisal meeting. However, the GMC advises that doctors will only need to have evidence of having had one appraisal before their first revalidation (2005 at the earliest), so GPs should not be concerned as PCTs are now speeding up the appraisals process. If they are concerned that an appraisal may not have occurred before 2005, doctors are advised to prepare via the independent route instead. Doctors cannot blame the PCT if they are inadequately prepared for revalidation, and should now consider contacting the PCT to ask to be appraised even if their LMC is lukewarm!

You can support your GPs by hosting ‘Preparing for Appraisal’ meetings.

The Independent Route
To use this route, doctors will need to show they are adopting the principles of ‘Good Medical Practice’ and undertaking appropriate continuing medical education and professional development. Evidence will be required of what has been done over the revalidation period, such as quality indicators, where necessary supported by other data and information.

‘Portfolio Doctors’
Doctors who divide their time between several roles may still be able to use appraisals to assist their revalidation, provided all or most of their roles are within managed environments, and their combined roles can be subject to appraisal covering the range of roles. This will include the large number of consultants working both in the NHS and private sector, or GPs who also work for a locum agency outside their practice commitments. Doctors who are not confident that they can be properly appraised on their range of roles should prepare for revalidation via the Independent route at least for their first revalidation.

Doctors in Training
Most doctors in training will be in a scheme which requires a ‘RITA’ (a Record of In-Training Assessment’). Full participation in RITA plus retention of the documentation will be considered equivalent to appraisal for the purposes of revalidation.

Help with Revalidation
Each of the medical Royal Colleges have already produced speciality-specific versions of ‘Good Medical Practice’ for the relevant doctors, e.g. ‘Good Medical Practice for General Practitioners’ by the RCGP in March 2002, explaining what constitutes ‘excellent performance’ and ‘unacceptable performance’. Doctors engaging in appraisals have/will receive guidance from their ‘management organisation’ – for GPs in England, PCTs are providing all the necessary backup, training and (in most cases) financial assistance to provide locum cover to free up protected time to reflect on practice, complete the paperwork, and attend an appraisal interview. The DoH/GMC’s revalidation website will provide access to these tools once available: www.revalidationuk.info.

Supporting Documentation
When it comes to revalidation, the GMC will not normally want to see all the supporting documentation used at annual appraisals (or indeed by those using the independent route). For GPs in England using the appraisal route, a collection of ‘form 4’s from each appraisal will suffice – i.e. the summary document signed off by both the appraiser and appraisee, to confirm what was discussed and agreed at the appraisal. However, the GMC advises doctors to retain the backup information (Forms 1-3) and PDPs for the duration of the period running up to the revalidation, because they will do random spot-checks when additional information will be useful. The backup information will also be required if the doctor wishes to question the revalidation decision.

How will doctors be revalidated?
‘Reasonable notice’ will be given to doctors invited to participate in revalidation. The GMC expects (hopes?) most communication to be conducted by email/the web. Information provided to the GMC for revalidation will be reviewed by both medical and lay people. Full details have yet to be published (on the GMC website, www.gmc-uk.org) on exactly how it will be done, but 70 doctors went through pilot revalidations in 2002 using a similar set up to that mentioned above which worked well.

Questions and Answers about Revalidation
If you want to know more about revalidation, you can contact the Healthcare Partnership for a copy of the full documentation sent to all doctors in April 2003, free of charge (see details at the end of the article).

How will this affect my job as a representative?
As someone who spends time with doctors, you need to know about topics of current interest. Revalidation for a doctor means a chance to keep their job – which is likely to be of some interest to them! Even those doctors who are confident in their ability will want to know exactly what is expected of them to prove their ability to provide ‘Good Medical Practice’, and for almost all your customers, annual appraisal will be their chosen route to revalidation. Many GPs are still waiting for their first appraisal, and clearly this now assumes a greater importance with its explicit link to revalidation.

Meetings about appraisals and revalidation are likely to continue to be good for drawing an audience, possible alongside a product-related clinical topic. Why not try this ‘joint approach’ to future meetings and reap the benefits of extra customers attending, and the satisfaction of providing customers with topics that are of real interest and relevance?

IN RECENT YEARS there have been radical changes in the prescribing landscape. Nowadays, customer contacts are frequently made in group situations and pharmaceutical sales representatives can find themselves in many different selling environments in the course of a single day, speaking to a wide range of buyers and influencers all with their own agenda and priorities. Consequently, representatives need to have greater flexibility and the skill to adapt their approach, often at short notice. In this article I will offer some techniques to help you adjust to the new landscape.

Fail to prepare, prepare to fail
The better prepared you are, the more easily you can make lastminute changes. Prepare to speak to a group the way you would plan a one-to-one discussion – sell to the customers’ needs. Spend time thinking about your audience – their expectations and needs, their likely attitude, the ‘hot buttons’ they can relate to. For example, consultants in coronary care might be led by clinical detail and papers, so make sure you know your stuff. Rehabilitation specialists have a longer-term relationship with their patients, so with them you may want to focus more on improved quality of life.

It can be useful to think beyond the people you are talking to directly to their eventual audiences. Prescribing advisors, who have to make and enforce prescribing decisions, can be a tough audience to win over. They have to get buy-in for their decisions from the clinicians, so it might help your case if you include some examples and benefits that are directly relevant to that secondary audience.

The biggest difficulty I have when I’m running courses in the pharmaceutical industry is persuading speakers to limit the detail and focus on a few key points. I encourage them to imagine that they have to summarise their entire presentation in one minute for the chief executive – this ensures that they identify and emphasise the important messages they want the listeners to take away. Once you’ve identified your key messages, prioritise them for your audience For example, with a new inhaler, the key question in the minds of nurses in the asthma clinic might well be ‘Is it easy to use?’, so your first point would be ease of use. Practice managers might be more concerned about cost, so you would bring price higher up the agenda for them.

Bare facts don’t win hearts and minds; you must bring your talk to life with examples that the audience can relate to. Turn your monologue into dialogue by involving the listeners’ minds with rhetorical questions or phrases such as ‘Picture this’ or ‘Remember the last time a patient presented with …’ Match the examples to the audience. Get the GPs visualising patients walking in through the surgery door; remind the nurses of the benefits of a drug that doesn’t cause constipation in children; quote respected regional or national experts to the consultant. References to topical issues or recent media coverage show your knowledge of the industry and create a link with your listeners.

Finally think about your visual aids. Laptops might sometimes be too formal, but are very useful for larger audiences. But limit the number of slides and make them as visual as possible. They are not there to remind you of what you want to say, but to help the audience – perhaps by showing the results of clinical trials in graph form. Always print out hard copies of your slides and number them. This way, if your time is reduced at the last minute, you can display only the key slides by typing in the slide number and pressing enter. Whatever equipment you use, always have a backup plan in case of failure.

Question time
Try to anticipate the likely questions – the easy and the hard ones. It’s particularly important to be aware of any myths the competitors might be putting around about your product, so that you respond confidently to such comments as ‘your drug is too expensive to be mainstream’. Ask questions to establish what they’re comparing it with, and then give them the facts and figures. Knowledge of your audience is especially valuable during the discussion phase so that you can redirect questions – a clinician who doubts the efficacy of your drug may be convinced by hearing of a colleague’s experience of using it. In my next article I shall be giving more tips on handling group discussions.

On the day
However thoroughly you plan, you can’t anticipate everything. Lastminute changes can really throw you off balance, but if you’ve done your preparation, you should be able to cope. Below I have identified some of the common problems which you might encounter and suggested some solutions.

Reduction in time
Your ten-minute slot has been cut down to five. You can’t get through all the information and slides you’d originally planned just by talking more quickly! Remind yourself of the key points; cut out the detail; keep in the examples. Arrange follow-up sessions for anyone who needs more in-depth information.

Change in audience
You are expecting to speak at a prescribing meeting; when you arrive you learn that the objective of the meeting has changed and your audience now includes GPs, nurses, health visitors and practice managers. The chances are that the presentation you planned for the pharmacists will be much too detailed so you’ll probably have to abandon it. You can play for time by opening up the discussion right at the start and asking them which issues they’d like to discuss. Identify the key ones, and address each one in turn using relevant examples and benefits.

Faulty or missing equipment
You plan to show a patient video; the hospital has assured you that they have a video player – only it doesn’t work. Or your laptop crashes just as you display the first of your PowerPoint slides. You should already have a contingency plan. Don’t waste valuable time fiddling with the equipment; if you can’t fix it quickly, abandon it. Be matterof- fact about this – it’s not the end of the world. People don’t remember problems so much as how you cope with them. Open the session up; use vivid examples to create pictures in the audience’s minds; use handouts or a desktop presenter.

Body language and voice
However good the message, the packaging will carry its own story. In other words, you need to consider the impression you are creating with your body language and the way you sound. Standing increases authority, credibility, visibility, and helps breathing, but isn’t always appropriate. If you are sitting, be careful not to slump in your chair, and lean slightly forward in an open position. Avoid fidgeting with pens, clothes or spectacles; keep your hands away from your face. Eye contact is very powerful – try to make direct contact with as many individuals as possible for two to three seconds.

Smile at your audience to show that you are pleased to be speaking to them. Nervousness can make you speed up, but breathing lower and slower can help reduce tension and give power to your voice. Replace ers, ums, and ‘you know’ with silent pauses, which add to your credibility and allow the listeners time to absorb what you’ve said.

Above all, show your enthusiasm – it’s highly contagious and will stick in people’s minds much longer than a recitation of facts and figures.

BACK IN 1999, when it hit the global market, Viagra created ripples not just in the pharmaceutical industry, but also among the general population. Men with Erectile dysfunction (ED) or male sexual dysfunction fast came forward to seek treatment. Pfizer quickly sold billion dollars of Viagra worldwide, and in many countries Viagra was at least one of the top ten drugs in the many pharmaceutical markets globally. The other side of coin can be female sexual dysfunction (FSD). However, unlike male sexual dysfunction, FSD is still controversial. Does FSD exist or are the drug companies “inventing” a medical disorder?

At this time, there is no real evidence to prove that FSD’s existence is due to biological reasons. The American Psychological Association (APA) broadly classifies female sexual problems as a mental disorder, which includes: loss of sexual desire or arousal, discomfort during intercourse, diminished blood flow into the vagina, trauma-related aversion to sex, and the inability to achieve orgasm.

Female Sexual Disorders: Transforming Approach
Historically, female sexual problems are diagnosed and treated by psychiatrists, psychologists, or sex therapists with limited treatment options and mainly managed through education, counselling sessions, or other psychological methods. However, due to probably low success and limited psychiatric literature, the demand for more medicalbased treatment is fast becoming a trend. Today, urologists and gynaecologists are more involved in treating female sexual problems resulting from medical conditions that cause diminished pelvic and vaginal blood flow and nerve damages. Still, education and communication between partners is preferred and emphasised.

In 1999, an article was published in the Journal of the American Medical Association claiming 43 per cent of women aged 18 to 59 suffered some kind of female dysfunction. The study had involved approximately 1,500 women who were asked if they had experienced any of the seven sexual problems for two months or more. A “yes” to any of the problems was classified as sexual dysfunction. Researchers now charge “43 per cent” as over-cited and overblown and accuse drug companies of creating a new category of disease in order to push new drugs into markets. This prompts the question, how drug manufacturers can possibly suggest drugs for a disorder whose very existence is questioned.

Where is it headed?
There are already products such as Niagara, Vitara, and Viacreme, aphrodisiac herbs, and diet supplements claiming to help women achieve sexual satisfaction. The effectiveness of these products remains controversial, however this suggests that women do seek treatment for some form of sexual problems. On the western medication front, pharmaceutical companies are still in the big rush to develop a potential “Pink Viagra”, in order to provide women the same “quick fix” as their male counterpart. The question is, will “Pink Viagra” make its way to the market? As mentioned earlier, the very existence of FSD is still questionable. In addition, there are several more hurdles when it comes to market “Pink Viagra”. If the root cause of FSD is linked to biological reasons, this means that the whole treatment and management would likely shift to the women diseases specialists - the gynaecologists and perhaps the urologists. However, the available evidence suggests that FSD would remain very much categorised in the mental/psychological disorders. This is where primarily, the psychiatrists and psychologists would play an important role in treatment and management.

To summarise, there is an unmet medical need in the management of FSD, which the pharmaceutical companies are seeking to fill. However a lot of effort needs to be employed in understanding female sexual behaviour, treatment and disease management. A much more scientific approach will be required to create the necessary awareness among the patients and the physicians.

Background
Frost & Sullivan is an international growth consulting company that monitors a comprehensive spectrum of markets for trends, market measurements and strategies. This on-going research is utilised to complement a series of research publications to support industry participants with customised consulting needs.

PHARMACEUTICAL COMPANIES operating within the UK are now faced with the need to work within the four different healthcare systems operating within England, Scotland, Wales and Northern Ireland. In order to ensure that the activities of the sales team on the ground are aligned to the NHS there is a need to fully understand their environment and tailor national strategies accordingly. This article explores the recent developments within the three devolved nations and makes some suggestions on how sales team activities may need to be adapted to make the most of any local opportunities.

Scotland
A New White Paper
‘Partnership for Care’ is the latest white paper to be published by the Scottish Executive and it outlines what the political plans are to provide Scotland with an NHS fit for the 21st century. In the summary, Malcolm Chisholm, Minister for Health and Community Care, clearly outlines the cultural change that needs to take place that will result in the patient being placed at the centre of care. This will be achieved by the devolution of power to frontline healthcare workers and the redesign of services that will improve integration and partnership and result in patients experiencing a better and quicker service.

The key points from the white paper are summarised below:

• Unified NHS Boards, abolition of NHS Trusts, and new requirements to devolve authority to frontline staff and to involve professionals.
• New Community Health Partnerships (evolving from Local Health Care Co-operatives), more accountable to local communities, better matched with social work services and better able to represent local interests within the NHS Boards.
• A new Scottish Health Council to involve the public in NHS Scotland.
• A Change and Innovation Fund to help NHS Boards improve services for patients.
• A new guarantee of treatment on time, initially for certain heart surgery but to be extended to services with national waiting time targets. New clinical and local service targets.
• A Patient Information Initiative and a new complaints procedure to give patients and carers better information and a stronger voice.
• A radical approach to improve health – a Health Improvement Challenge focused on four groups; children in early years, teenagers, people at work and communities.

Sales representatives working in primary care in Scotland will have been working closely with Local Health Care Co-operatives (LHCCs) in the past and the new white paper describes how these groups are likely to evolve into Community Health Partnerships in the future. These changes are required to ensure that the new Community Health Partnerships become fully involved in service planning and delivery and are able to undertake the following activities:

• Ensure patients and a broad range of healthcare professionals are fully involved in local decision making
• Establish substantive partnerships with Local Authorities
• Have greater responsibility and influence in the deployment of NHS resources locally
• Play a central role in service re-design locally by ensuring the appropriate integration of primary and specialist services
• Play a pivotal role in delivering health improvement for their local communities

When re-designing local services, the Health Boards and Community Health Partnerships will be required to adopt a ‘whole systems’ approach which will entail clearly identifying the patients experiences when using NHS services, identifying any duplication or gaps in the service and then defining evidence-based best practice to address these issues. Consequently, there will be a need for a close partnership between primary and secondary care providers and also increasingly, social services and local authorities. It will be those teams of sales representatives who are able to work seamlessly between primary and secondary care and who are able to discuss this process locally and offer services and solutions to help implement service re-design e.g. integrated care pathway development, that will receive a favourable response from the new Community Health Partnerships.

Measuring the quality of NHS services in Scotland
NHS Quality Improvement Scotland (NHSQIS) is a new body that was formed in January 2003 through merger of the existing clinical effectiveness organisations:

• Health Technology Board for Scotland (HTBS)
• Clinical Standards Board Scotland (CSBS)
• Scottish Health Advisory Service
• Nursing and Midwifery Practice Development Unit
• Clinical Resource and Audit Group (CRAG)

The purpose of NHS Quality Improvement Scotland is to improve the quality of healthcare in Scotland by:

• Providing advice and guidance on effective clinical practice
• Setting standards and monitoring performance
• Making recommendations for service improvements

In order to achieve these objectives, NHS Quality Improvement Scotland will perform the following functions:

• Sharing information about good practice
• Sharing lessons from adverse events
• Advising on the value for money of health interventions
• Reducing variation in clinical practice through advice from health technology assessments and commissioning guidelines
• Conducting audits and collecting and publishing clinical performance data
• Setting clinical and non-clinical standards relating to all aspects of patient experience.
• Reviewing and monitoring performance through self-assessment and external peer review, and investigating serious service failures
• Supporting implementation of clinical governance in NHS Scotland

This makes this organisation very influential – it is the equivalent of the National Institute for Clinical Excellence and the Commission for Healthcare Audit and Inspection merging in England - and it will be imperative that anyone working in Scotland is fully conversant with its working and recommendations.

The Scottish Medicines Consortium (SMC)
This is probably the biggest hurdle for the pharmaceutical industry in Scotland and therefore the industry needs to formulate a strategy for engaging with the SMC. The remit of the SMC is to provide advice to NHS Boards and their Area Drug and Therapeutics Committees across Scotland about the status of all newly licensed medicines, all new formulations of existing medicines and any major new indications for established products. A sub-working group of the SMC has been formed called the New Drugs Committee and it will advise and make recommendations on the issues surrounding newly licensed products to the SMC. Any company launching a new product must complete a New Product Submission form and the SMC aim to make a recommendation as soon after the launch of a product as possible, full guidance notes describing how manufacturers should engage with the SMC are available on their website. The SMC meets monthly and a full list of members can be found at www.htbs.co.uk/smc/member.

Two examples of recent SMC advice are given below:

Antidepressive X
Indication: Major depressive episodes.
Advice: Recommended for use in NHS Scotland.
Reasons for advice: “Antidepressive X has been shown to be as effective as citalopram in short-term use and the health economic model submitted suggests that it is also cost-effective. However, the resource usage assumptions and clinical evidence underpinning the model are not robust and no clear benefits are demonstrated over the parent product - citalopram or other effective and cheaper agents.”

Combined Oral
Contraceptive Y
Advice: Product Y is not recommended for use within NHS Scotland.
Reasons for advice: “There is no evidence that Product y, a new combined oral contraceptive (COC) pill has effects superior to other standard strength COCs on acne, pre-menstrual symptoms or well-being. A statistically significant favourable weight change of 0.3 – 0.7 kg compared to a standard strength COC (over a period of 26 cycles) comes at a substantially increased cost. There is no evidence that patients who discontinue other COCs because of weight gain tolerate Product y any better. Product y is substantially more expensive than competitor products and provides little additional benefits for this extra cost.”

The Minister for Health and Social Care has publicly stated that: “NHS Scotland should take account of the advice and evidence from the SMC and ensure that recommended medicines are made available to meet clinical need.” Therefore, knowledge of SMC recommendations is a pre-requisite for anyone working in Scotland. A full list of SMC recommendations are available on their website (www.htbs.co.uk/smc) and again it will be extremely important for all representatives working in Scotland, as well as their Marketing colleagues, to regularly review the website as it also lists the dates when future guidance will be issued as well as current guidance. On a more tactical level, local teams will need to identify who is responsible for implementing the advice within the Community Health Partnerships.

Wales
Local Health Boards
On April 1st 2003, the 22 Local Health Boards (LHBs) in Wales became statutory bodies replacing the five health authorities and 22 Local Health Groups (LHGs) that previously existed. The LHBs are coterminus with the Local Authorities which means that there is likely to be closer integration of health and social care from the start. Their key roles are defined as:

• Corporate and Clinical Governance
• Securing and Providing Primary and Community Health Care Services
• Securing Secondary Care Services
• Improving the health of communities
• Partnership working with local authorities and Trusts to ensure effective commissioning of services
• Public engagement to ensure that the public voice is considered in all local service developments
• The provision of primary care services

LHBs will have a chair who is appointed by Jane Hutt, Minister for Health and Social Services, four officer members (Chief Executive, Finance Director, Medical Director and Nurse Director) and up to 17 non-officer members who will include the following:

• Up to three GPs
• 1 pharmacist
• 1 dentist
• 1 optometrist
• 1 nurse
• 1 allied health professional
• 1 specialist in public health
• Up to 4 local government nominees including an elected member and a senior social services officer
• 2 nominees of local voluntary organisations
• 2 lay/community members, one of whom must be a carer

It will be important for pharmaceutical companies to identify who the members of LHBs are so that they can discuss effectively local priorities with them. At the time of writing however, the LHBs appear to be formulating their own guidance on working with the pharmaceutical industry and are currently not entering into any joint working relationships. This means that whilst future guidance is being developed any joint working with the NHS in Wales is likely to be more successful when it can be developed at a GP practice or individual Trust level.

The All Wales Medicines Strategy Group (AWMSG)
The All Wales Medicines Strategy Group held its inaugural meeting in October 2002 and the remit of this group is, “to provide advice to the Minister for Health and Social Services in an effective, efficient and transparent manner on strategic medicines management and prescribing.” It aims to reach a consensus view on medicines and management issues, particularly those affecting both primary and secondary care and its main functions are to:

• Advise the Welsh Assembly on the development of a prescribing strategy for Wales
• Advise the Welsh Assembly of future developments in healthcare to assist its strategic planning
• Develop timely, independent and authoritative advice on new drugs and on the cost implications of making these drugs routinely available on the NHS
• Advise the Welsh Assembly on the implementation of a range of strategic recommendations from the Prescribing Task and Finish Group

This last point is very important because the Task and Finish Group report included the following recommendations for discussion:

• Sponsorship or direct employment by the industry of service-based posts should cease
• Pharmaceutical sponsorship for staff training should be indirect through a generic fund rather than, as at present, through direct provision and funding
• Where there is justification for the deployment of specialist nurses then they should be funded by the NHS. Existing sponsored nursing post which will be funded by a transfer from primary care drugs budget within the unified Health Authority allocations

The minutes of the AWMSG meetings are available on their website and it would appear that so far no further consideration has been given to these recommendations but it will be vital for anyone working in Wales to regularly review the minutes of the AWMSG for any further developments. The group meets quarterly and any pharmaceutical company launching a new product must complete a Therapeutic Development Assessment form ahead of the product being launched which is then considered by the AWMSG and a recommendation made soon after the launch of the product. AWMSG membership includes representatives from the industry and a full list of the members of the group can be found at www.wales.nhs.uk/awmsg.

Northern Ireland
The current uncertainty over the future of the Northern Ireland Assembly has inevitably had an impact on the speed at which the NHS has developed compared to Scotland and Wales and therefore very few changes have been made recently. The NHS locally is managed by 4 Health and Social Services Boards (HSSBs) who commission and purchase health and social care services for their local population on behalf of the Department of Health, Social Services and Public Safety.

Local Health and Social Care Groups
15 Local Health and Social Care Groups (LHSCGs) have been formed to take over from the previous GP fund holding arrangements and each group covers a population of between 60,000 – 200,000. LHSCGs are responsible for the planning and delivery of primary and community care and also contribute towards commissioning decisions made by their local HSSB. In the longer term, LHSCGs will take on greater responsibility for commissioning and will also receive delegated budgets.

The management board of each LHSCG consists of the following members:

• 5 representatives from local Community Trusts and HSS boards (including at least 1 nurse, 1 social worker and 1 allied health professional)
• 1 local acute Trust representative
• 5 GPs
• 1 nurse
• 2 community/service users
• 1 social worker
• 1 community pharmacist
• 1 Allied Health Professional
• 1 LHSCG Manager

Therefore, it is important for representatives working within Northern Ireland to access these key people as in the future they will be involved in making more decisions around the commissioning of local NHS services.

Conclusion
This brief overview of recent developments within the NHS in the devolved nations demonstrates that the pharmaceutical industry really is operating within four separate health systems and these are summarised in Table 1. It is important to ensure that marketing strategies are designed to reflect the difference and support local sales teams in responding to local developments and adapting their tactical plans accordingly. Only by regularly tracking the developments and modifying strategic and tactical response will success follow.

REPRESENTATIVE DEVELOPMENT in most companies is pretty well thought out and documented. Whole departments are structured around bringing new representatives into the business and up to speed as fast as possible, with all key skill areas of the role being covered by predominantly in house training teams. After initial training, first line managers, often supported by additional trainers and coaches, focus much of their efforts on continually developing representative skills in order to make them as good a sales person as possible.

It is commonly agreed that the first line manager’s role is critical to a pharmaceutical company. Logic would therefore suggest that the efforts put in to developing first line managers both towards the job and whilst in it would also be high; however this was not always the case.

Historically, pre the emergence of the huge UK pharmaceutical organisations, (the product of the merger and acquisition activity in the industry) the development of potential sales managers was traditionally quite ad hoc. New manager development was likely to be the responsibility of the current first line manager who was developing a likely successor, ongoing development was left to the national sales manager. The increasing sophistication of the pharmaceutical industry, the sheer scale of companies and thus the need for large teams of first line managers as well as the challenges of the NHS environment has undoubtedly led to an increased focus on management development. Today, compared with even ten years ago, many companies, especially the larger organisations, have more people involved in the processes of developing potential managers and current managers, than ever before. Many of the large companies have gone down the route of having dedicated management trainers and coaches devoted to developing the skill sets of this group. Others, without dedicated in house resource, will often use external training companies to develop the necessary skills. Across the board companies will admit to spending considerably more time, money and effort on developing line management than a decade ago.

So, as an aspiring line manager how can you maximise your chances of getting your first management role?

In the first instance take control of your own development, it’s your career, therefore your development should be seen as your responsibility, not just that of your employers. Development is not just about going on training courses, as there is a wealth of other sources that can assist with personal development. Consider if a professional qualification would help your development. Take a look at other internal or external resources that may be available – for example there are many books and magazine features aimed at managers and management development. The Internet too has opened up a wealth of information with many sites featuring sections on management skills in the pharmaceutical industry. Review any career pathways your company has laid out. It may be that the typical route to being appointed a line manager is clearly signposted. Many managers will first work in training or coaching role before they take up the reigns of line management. In the last Pf survey, 27% of all representatives who wanted to progress their career, felt that training would be their next role, another 25% felt marketing would be a good step, and only 3% felt that a move to regional management would be the next job they did. Look at what the options open to you are and if you have a clear career goal, get the right jobs and experiences under your belt to give you the maximum chance of getting your chosen role.

Susan Glenn, Director of Training at The Arlington Academy, who has many years of management training experience in the pharmaceutical industry, shared her views with us. “ In many ways development to any role in the industry is much more transparent then ever before. Most companies will have competency frameworks, which vary slightly from company to company They will give however, good guidelines to the key areas of skills and competencies that a job requires. Anyone aspiring to a new role as a manager should carefully study the job description and competencies associated with the role and with the help of their line manager be able to draw up a developmental plan which will give then the experiences and training they need to be able to do the job successfully.”

From Susan’s perspective representatives aspiring to a manager’s role face one major challenge that is critical to their success. “ New managers have to learn to work and achieve their results through others. This is a tough lesson to learn. My advice to anyone who wants to move into a line management role is to get experience of this as part of your development plan before taking up a post. Look for ways you can work through others, for example being a coach or trainer and note how your communication style affects other people’s performance. Each one of us likes to be managed differently so make sure that when you work with people, you remember the old saying, “one size does not fit all.”

Steve Brown, the Lilly UK Sales Manager trainer, was appointed one year ago in order to accelerate the development of new and experienced sales managers in Lilly and to help identify and develop potential new managers “Historically,” said Steve, “Sales Managers identified talented representatives in the sales force and worked with them to help them develop towards their chosen career. My role was introduced in order that Lilly could help accelerate and develop potential new managers and indeed further the development of existing line managers.” There is a clear belief at Lilly that having the best possible team at line management level and by giving them the skills and competencies they need, will really drive the business forward. “I work with the sales management team to help ensure future managers are developed in the most effective way possible. Our objective is to have tight development plans which are regularly monitored and assessed and help individuals achieve their management aspirations as soon as possible.”

Lilly, as do many companies, helps people achieve their development ambitions through a variety of methods. There are formal training courses; assessment and development centres, home learning techniques, secondments and support for professional qualifications available. The emphasis is on continual personal development where the competencies and skills necessary to grow are identified and then the manager and employees looks at ways to fill gaps through the appropriate projects or secondments. A “ robust and well developed career framework forms the basis for all development plans right through from representative level through to senior sales management positions” says Steve, “ but we are always reviewing and refining our processes to ensure we get it right for our employees. Whatever level an employee is at, we are committed to helping them achieve what they want to achieve.”

Selection of first line managers has also become increasingly sophisticated in the pharmaceutical industry in the last 10 years. Simon Coates Walker Commercial Director of Futures Resourcing, a leading supplier of manpower to the pharmaceutical industry, shares his experience of industry recruitment methodologies for first line managers. “The process of recruitment of first line managers has become more stringent as companies have recognised how critical getting the right person for this role is. Typically recruitment of a first line manager will be a two-stage process with a screening interview with either HR or the second line manager and then an assessment centre. Assessment centres will usually be built around a competency based recruitment model and include a number of exercises such as a competency based interview, a presentation, a team exercise, an in tray exercise and business exercise.” Additionally many companies will also use psychometric testing, including personality profiling and verbal and numerical reasoning to give a further insight in to a candidate. Jan Cox, the Operations Director at Futures offers potential candidates advice on performing well at assessment centres. “Candidates who have prepared well for an assessment centre will always do better on the day. If you cannot get hold of the exact competencies a potential employer will be judging you against, use your judgement to gauge what you think will be important and prepare for the interview and presentation with these competencies in mind. If there are going to be verbal or numerical reasoning exercises do some practice before the event just to get the hang of how the types of questions work. Good preparation pays big dividends.”

Whichever way you look at it, getting a manager’s position in today’s pharmaceutical industry will be no easy ride. Successful candidates will have put in plenty of preparation in terms of a robust and structured personal development programme; they will also for the most part have been tested in a rigorous selection process. Getting to management, for most, is not a cheap fares route, be prepared to pay up in terms of commitment to getting the job, then hold on tight when you board that plane, as no matter how much you paid for the seat, there will still be turbulence ahead. So Buckle up, settle down and try to enjoy your flight.