The Matrix - DECODING THE NHS

by Admin 1. July 2003 05:00

Communicating with the prescribing advisers in Primary Care represents one of the industry’s biggest challenges. Pharmaceutical companies have learned how to handle and influence consultants, and have also had significant experience with handling GPs, despite changing structures within the NHS. However, the prescribing adviser is a pharmacist, and the industry historically has encountered difficulties with this new and evolving customer. This issue looks at some of the reasons behind this.

STRATEGIC HEALTH AUTHORITY
(Pharmaceutical Adviser)
There is only 1 pharmacist in this role per Strategic Health Authority Pharmaceutical Adviser, and their role is similar to that of the Pharmaceutical Advisers within the Older Health Authorities.

Their roles and duties include:
• Public Health Issues
• Prescribing Strategy
• Healthcare Population Needs
• National & Local Initiatives
• National & Local Standards
• Audit & Performance Management.

They DO NOT have any line management to any of the PCT CHIEF PHARMACISTS though they are more senior in rank. They can dictate how care is prioritised, because the newer strategic health authorities are advisory and supportive to the PCTs under it. They will offer guidance and will certainly monitor activities. In fact, they are carrying out much in the way of the performance management, such as creation of league tables, NSF targets etc. The Strategic Health Authority has no money. The budget is all with the PCTs now, though pharmaceutical advisers for the strategic health authority may be involved in high- cost, low- use drugs after a committee has approved clinical use.

PCT CHIEF PHARMACIST
There is 1 pharmacist in this role per PCT. They have the Global PCT picture – but often don’t know the GPs or practice trends or pockets of decisions. They are answerable to the whole strategic health authority for budgets/targets, local priorities and local initiatives.

A large part of their role is organising community - based activities:
• Pharmacy Services for Nursing Homes
• Controlled Drugs in the Community
• Oxygen Delivery (though this has just changed)
• Community Pharmacy Services – negotiation,LPC, contracts
• Public Health – smoking, Cancer services, Weight management?
• Nurse Prescribing / Patient Group Directions
• Immunisations / Vaccinations / Women’s Health/ Contraceptives / Sexual Services
• Prescribing – very important part of the role – see later in the article.
• GP Services – this relates to above but will now be closely linked to GP contract.

PRESCRIBING ADVISERS
There are usually between 1 and 4 of these per PCT, and occasionally more. They are answerable to the PCT CHIEF PHARMACIST, and many of their activities are devolved from those of the Chief Pharmacist as listed above:
• Prescribing – On a day to day basis they hold the daily activities with info on who’s prescribing what, and what needs to be changed / controlled / supported
• Influencing prescribing – With the expenditures known from every practice and every GP in every practice, PACT Data is used to show/share information with practices. They will also ask for explanations about variations in prescribing.

They will also sit on interface d&t committees (to be explored in further issues) to aid in deciding which drugs go onto formulary.

They will be involved in policing of ‘guidelines and formularies’ and will ‘tell GPs what to prescribe and what not to prescribe’ (PS – the GPs don’t always listen!)

PRACTICE BASED PHARMACISTS
Practice based pharmacists work under the PRESCRIBING ADVISERS – usually on specific. They often are sent into practices to achieve one or two particular aims, such as:
• Sometimes they trouble shoot – other times they support GPs with one project in exchange for compliance in reducing prescribing in another.
• Involvement with SWAPS eg PPI or Calcium Channel Blockers.
• Aiding practice with prescribing incentives

They will often finish a ‘project’ then move to another practice to repeat / work on another project. Sometimes they are allocated 1 project across a few practices (ie) high users of COX-2, or may be allocated to 1 practice to organise/influence prescribing across a range of areas (ie) early adopters (term given to GP practices that tend to use ‘newly launched drugs’). Often, practice based pharmacists are sent into the same practices that are targeted by the pharmaceutical industry, to counter the influence of the representatives – this activity is an anti–marketing one.

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Features

A Breath of Fresh Air for Asthma Sufferers?

by Admin 1. July 2003 05:00

Asthma is a chronic disease of the respiratory tract, which is currently showing a significant increase in prevalence. Asthma is caused by hypersensitivity to an allergen - in other words, a sufferers immune system overreacts to an allergy, typically causing inflammation of the airways and an increased mucus production in the lungs. The lungs and air passages may become blocked, resulting in the wheezing and coughing characteristic of many asthmatics. Asthma currently affects an estimated 100 million people worldwide, and is more common in children than in adults. For example, in the UK alone one in eight children and one in 13 adults, has been diagnosed asthmatic. There is little doubt that the condition is becoming increasingly common. Many healthcare professionals and research organisations have suggested that this is due to increased pollution and greater exposure to potential allergens, such as dust, mould, chemicals and cigarette smoke. Certainly, asthma is more of a problem in developed nations than in poorer developing countries. The tremendous cost of treating and alleviating the symptoms can only be guessed at. In the UK, there are around 74,000 hospital admissions as a result of asthma each year, 1,500 fatalities, and it is estimated to cost the National Health Service (NHS) well in excess of £850 million (1,3 billion Euros). Treatment for asthmatics is generally through the use of “bronchodilators” - pharmaceuticals that help to relax the muscles in the airways - together with steroids to help reduce inflammation. Natural treatments that ease the symptoms of asthma have been slow in coming, but the extraordinary prevalence of the condition and concerns about the side effects of steroids, particularly in children, make this an interesting market for investigation. Natural products with potential asthma-relieving properties include:

Caffeine
Several recent studies have looked at the effect of caffeine consumption on asthmatic symptoms. One project, which looked at 72,000 subjects, found that asthmatics consuming two cups of coffee per day had a 23 per cent lower chance of having an asthma attack. This effect is likely to be due to a product of caffeine breakdown, theophylline, which is a bronchodilator sometimes prescribed for asthmatics. It is thought that the effects can last for up to six hours. These findings are thought by some to give at least part of the reason for the greater prevalence of asthma amongst children, as they are far less likely to be consuming coffee.

Magnesium
Magnesium is sometimes given intravenously to hospital patients undergoing an asthma attack. It is well known to relax muscles, including those in the air passages. Indeed, low levels of magnesium are linked to severe muscle cramps. Many studies have demonstrated a link between magnesium intake and asthma symptoms and suggest that supplementing the diet with magnesium could reduce those symptoms. Magnesium intake is generally thought to be below the recommended daily limits in most sectors of the population.

Ginkgo Biloba
The herb ginkgo biloba has been used for many years in Chinese medicine. It is something of a cure-all, with suggestions that it may have benefits for allergies, eye health, dementia and migraine amongst others. Many of these effects result from its allergy reducing properties, and this is why it has been recommended for asthma sufferers. Ginkgo biloba does not act as a bronchodilator, but appears to behave as an inhibitor, preventing a key mediating factor from producing the allergic, inflammatory response.

Chile Peppers
Due to the combination of vitamin C, flavonoids and capsaicin found in chile peppers, they are thought to be a good food for relieving symptoms of asthma. Vitamin C is a natural antihistamine, flavonoids also inhibit histamine release and capsaicin reduces mucus build up, preventing blocking in the lungs.

Other Nutrients
Many other nutrients have been suggested as having a role in asthma prevention - or at least, it appears that a deficiency can result in increasing asthma symptoms. These nutrients include vitamin C, essential fatty acids (EFA), selenium and vitamin B. Food intolerances are regularly cited as a factor in asthma attacks. It remains to be seen whether functional food and supplement manufacturers, can gain any opportunities from the growing need for asthma - relieving treatments.

Background
Frost & Sullivan is an international marketing 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. Interviews and free executive summaries are available to the press.

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Features

Tell me why I don’t like Mondays

by Admin 1. July 2003 05:00

TO GET TO THE TRUE FACTS of the matter I went to talk to the industrys largest suppliers of representative activity data, Synavant. Synavant, once Walsh and also part of IMS Health, compiles its data from over 250 sales forces, which is approximately 7500 representatives across the UK, so they have a pretty clear view on what is happening in the UK today.

Is it a myth or is it fact that getting to see our customers is easier some days than others? Are Mondays as bad as they are made out to be? If you were going to plan days off the road either for, training, meetings, appraisals or annual leave purposes which days would you choose?

Before the data is reviewed in more detail it is worth looking at the definitions of the data groups provided:
• The data provided is for 2002.
• Contacts data represents all contacts by GP representatives in this period calling on all types of customers that are recorded on the returns for Synavant including GPs, Nurses, retail pharmacists, hospital doctors etc.
• Contacts mean customers seen either at a meeting or a face-toface detail
• Calls are representative’s contacts on GPs, and meetings are representative contacts in a meeting situation on GPs

So are less customer contacts made on a Monday that any other day of the week?

Chart 1 shows the break down of contacts, calls and meetings by days of the week including the weekend, this data shows the total number of interactions made each day in 2002.

Monday is in fact the day of the week (excluding Saturdays and Sundays) when less contacts, calls and meeting contacts are made. Interestingly there are contacts, calls and meetings contacts recorded for the weekend, although these represent a very small proportion of the total contacts delivered. When Saturday and Sunday are compared there is more activity recorded for Saturdays than Sundays, with 1% of all meeting contacts taking place on a Saturday. For the most part, one would expect these contacts on healthcare professionals to be at meetings; surprisingly the data does show some face-to-face calls on GPs on both days. So either this is a very enthusiastic representative off seeing customers over their weekends or contacts at meetings and symposiums, which due to the ways different companies record these interactions, have been classed as face-to-face calls.

Back to Mondays, how bad are these compared to the other days of the week?

Well relatively speaking they are worse for all of the three groups of interactions we are looking at, total contacts, calls and meeting contacts.

Chart 2 shows the percentage of calls made on each day of the week. Monday is the weekday when the least number of interactions happen in any of our categories. Wednesday is the day when most calls are made in the week. Thursday comes a close second followed by Tuesday and then Friday.

This data does not however reflect the actual number of days worked per representative, so there may be some data skewing if representatives work less Fridays and Mondays, either because of annual leave, sick leave or meetings.

However working with the evidence we do have if you were making choices about which days you would take annual leave or go to a training course, taking into consideration which days were usually most productive in terms of customer interactions, there is some logic here on which to base decisions.

It is also interesting to look at which combinations of days of the week seem to be most productive for customer interactions. If you are looking at part time working options or again planning for time off the road it may be useful data to consider. Chart 3 looks at combinations of various days of the week. The interaction average column, averages the percentage of interactions on GPs either at meetings or face-to-face interactions. The last column shows the actual proportion of time these number of days represent in the week, as it simply calculates what percentage of the week is taken up by the number of days worked. E.g. 2 days of the week represents 40% of 5 days.

As Mondays have a lower number of customer interactions than any other day, if you are choosing to work a reduced days week then clearly by not working Mondays and choosing only to work other days you essentially get a bigger bang for your buck. The biggest gain is seen for working a combination of 3 days Tuesday to Thursday when essentially you gain 7% interactions more than would be expected using the 20% for every working day calculation- i.e. you gain more than half a day!

Interesting Stuff? Does it bear out your views of accessibility in your geography? Maybe not, but it may answer the question in the main to “tell me why I don’t like Mondays?”

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Features

GPs vote overwhelmingly for a radical new contract - good news for patients, doctors and representatives

by Admin 1. July 2003 05:00

Paul Midgley of Healthcare Partnership reviews the effects on representatives of the YES vote on the GP General Medical Services (GMS) contract announced 20th June.

Background
IN RECENT YEARS the morale of GPs has plummeted as workload reached unsustainable levels. As a result, GPs retired early, left general practice, or chose another career path. Numbers of new GPs entering the training schemes also plummeted, leading to a GP workforce crisis and many unfilled GP vacancies in less desirable areas. This was exemplified in the British Medical Association (BMA) publication in 2001 ‘Reality behind the rhetoric’ following a national survey of GP opinion. Since then, the BMA (General Practitioners Committee, GPC) have been in negotiations with the Department of Health (NHS Confederation) to radically reshape the national GP contract arrangements (GMS Contract) to address the concerns raised within this report. GMS is the national contract under which the majority (~70%) of family doctors work. (Approximately 30% of GPs now work under ‘Personal Medical Services’ (PMS) contracts, locally agreed with their PCO.)

This is the first constructive change to the national GP contract since 1966. The current Red Book arrangements were imposed by government in 1990 and have failed to improve general practice. It is hoped that this new GMS contract will be a turning point. It allows GPs to control their workload, receive better and fairer pay, and enhances their pensions. It brings record investment to general practice. It allows GPs greater choice as to how they deliver services to patients. Most importantly, its system of rewarding practices for delivering high quality care will be better for patients and will produce improved health outcomes. So, how has it been received?

Overwhelming ‘YES’ vote
Family doctors have voted overwhelmingly to accept the new national GP contract. In a ballot of all general practitioners throughout the UK (over 43,000, including GP trainees), 79.4% (70% turnout) voted “yes” to the question: Do you wish to see the proposed new GMS (General Medical Services) contract implemented?

Dr John Chisholm, chairman of the BMA’s General Practitioners Committee, announcing the ballot results, said: “This signals a new era for general practice. The profession has given a clear mandate for change….I believe this is the turning point for general practice and that family doctors have chosen the road which will lead them to a better working life and provide their patients with even higher quality care.”

What’s different about this new contract?
- Unlike the current Red Book contract with its open-ended terms, this is a real contract that spells out what GPs are expected to do and pays them for that work. New work means new money.
- It is a practice-based contract – the contract will be between the practice and the Primary Care Organisation, using nationally agreed terms.
- Individual GP lists will cease but patients can ask to see a named doctor.
- Funding is based on the needs of patients, not the number of doctors.
- It is a UK-wide contract with the protection of UK negotiation.
- There is a Gross Investment Guarantee backing the promise of unprecedented investment in general practice (33% rise over 3 years).
- For the first time, practices are paid extra for delivering quality patient care.
- Clinical work is put into one of three service categories: essential, additional or enhanced. Essential services have to be provided by all practices.
- The current GP 24 hour responsibility for patient care will end.
- GPs will have the freedom to staff and structure their practices as they want to.
- A Minimum Practice Income Guarantee (MPIG) backs up the contract and ensures no practice will lose financially. Instead all will gain.

Still to be sorted
One of the contentious areas in the new contract for GPs has been the allocation formula for distributing resources. An early review of the formula is in hand and preparation for this review will now begin. The formula distributes money to practices on the basis of factors including the weighted needs of patients and relative workload and costs. GPs want to see these factors include additional issues such as the extra costs of running small or split-site surgeries, and the workload involved in seeing patients who do not speak English.

What are the immediate effects?
Now that the profession has accepted the contract, those parts of it that do not require primary legislation will come into force almost immediately. These include a pay uplift backdated to April 2003 for GMS doctors averaging 11% in the current financial year and amounting to an average of 26% by year three.

Which aspects will take longer to implement?
Those aspects requiring primary legislation include enabling Primary Care Organisations (PCOs) to provide GMS services directly. This will allow PCOs to make sure patients have access to services in the evenings and at weekends when GP practices exercise their new right to opt out of responsibility for out-of-hours cover. The switch to PCOresponsibility for providing out-of-hours cover takes place by 31 December 2004 at the latest.

Your opportunity – facilitate change, build strong partnerships
Look out for major re-organisation of your target (GMS) practices as a result of the new contract. Talk to target GPs and Practice Managers about their plans. Likely effects include:

1. Increased audit to assess/improve their current clinical performance vs Quality Standards targets, in the following areas/patient groups, which you may be able to help with:
- CHD
- Angina
- Smokers
- Diabetes
- Stroke
- COPD
- Epilepsy
- Cancer
- Mental Health
- Asthma
- Hypertension
- Hypothyroidism
- Post-MI patients
- Px flu vaccine
- Hypercholesterolaemia
- Left Ventricular Disease

2. Increased audit of other services to assess their performance vs Quality Standards, such as:
- Patient records
- Patient communication
- Education and training
- Practice management
- Medicines management
- Patient experience – surveys
- Cervical screening
- Child Health Surveillance
- Maternity services
- Contraceptive services

3. Practices will also need to ensure they have basic services in place to comply with the new contract. You may be able to help them in areas such as providing:
- Practice leaflet
- Complaints procedure
- Non-discrimination policy for patients
- Store medicines in accordance with medicines act
- Record batch numbers of vaccines, stored as per instructed in temperatureregulated fridge
- Staff administering vaccines trained in anaphylaxis treatment
- Consent policy
- Premises and equipment meet Infection Control standards
- Healthcare professionals covered by indemnity insurance
- GPs annually appraised
- Computerised data conforms to Data Protection act
- Compliance with current employment rights & discrimination laws
- Staff terms and conditions of employment
- Compliance with Health & Safety at work regulations
- Healthcare professionals comply with child protection guidance
- Clinical governance system and nominated practice lead
- Consent forms for minor surgery, immunisations in notes

4. Other areas to be aware of with the new GMS contract:
Increased diversity of prescribers. To overcome the shortfall in GP numbers, and with improved funding, practices will increase the diversity of prescribers to share the clinical workload, e.g. nurse and pharmacists used to manage patients with chronic diseases – they may undertake the majority of patient reviews, altering medication doses, adding in additional medications according to protocols, and implementing medicines management for patients on multiple concurrent treatments.

Nurse-led minor illness clinics will also increase. Make sure your contact data-base has all these new prescribers included so you get credit for your calls!

More GPs with a Special Interest (GPSIs)
delivering ‘enhanced services’ within their own practice to prevent patients having to be referred to hospital. You may be able to help set up these services. GPSIs may also become sought-after speakers at your meetings (and charge less than Consultants!) – you can help them advertise their service.

Radical change in education for GPs and staff. PGEA ends in April 2004.
What will motivate GPs to attend your meetings after that? All GPs will have identified their educational needs in a ‘Personal Development Plan’ (PDP) following appraisal. You will need to know the common themes in GPs’ PDPs so you can continue to organise relevant educational events to ensure a decent audience. Ask Practice Managers who will know what their GPs need to learn about. PCO educational tutors will also be useful contacts as they will work closely with GP appraisers to address learning needs from PDPs and appraisal. Less clinical lectures, more skills-based workshops are likely. Less evening meetings, more practice- or smallgroup based afternoon events during Protected Learning Time (not just mass events!). Think carefully about the best way to utilise your promotional budget to gain maximum impact. What about supporting Practice Professional Development Planning meetings to help practices reorganise their service in light of the new contract?

In summary, this is an exciting time to be a GP representative, and those of you who understand the best way to help your customers manage change will be in a great position to build strong and enduring relationships and partnerships to deliver excellent patient care – and increase your sales! You will get job satisfaction from being more involved – those representatives who aim to be more than a provider of ‘four key messages’ will thrive in this new world of primary care – are you up to the challenge?

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Features

The joys of independence

by Admin 1. July 2003 05:00

IT IS NOT ALWAYS REALISED that some of the big-name pharmaceutical companies such as Boehringer Ingelheim, Napp Pharmaceuticals and Servier are still privately-owned. This gives them a certain amount of freedom that companies driven by institutional shareholders do not have. Externally, this often translates into greater commercial flexibility whilst internally, it fosters a strong family culture in which personal development and career progression are supported and encouraged. In this article Chris Chugg, Human Resources Director for Boehringer Ingelheim UK offers his views on the differences between the private and public pharmaceutical companies from an employee perspective.

Several of the big names in the pharma industry are still in private ownership. At first glance these companies resemble the other big players in the field but, unlike the others, they have only a small number of private shareholders. They are committed to providing value for their stakeholders – the private shareholders and the employees. Moreover, as a result of private ownership, I believe that there are three critical factors that typically differentiate these companies from public, shareholder-driven companies. They are:

  • Freedom to take decisions quickly
  • Ability to plan long-term
  • Family environment and culture

Each of these factors has important implications for employees of these companies.

The freedom to take decisions quickly can be a decisive factor in any business. While no one would advocate hasty, ill-considered decision-making, there are sometimes situations in business where the ability to make a decision quickly enables an opportunity to be seized. A good example of this type of situation was when Genentech, the manufacturer of alteplase (Actilyse®) was looking for a European partner. This was not just a question of marketing but involved making a commitment to build a specialist biotechnology manufacturing plant in Europe for the production of alteplase. The owners of Boehringer Ingelheim were able to analyse the situation and make the commitment promptly. This astute decision gave Boehringer Ingelheim a valuable foothold in the (then) emerging marketplace for clot-busting drugs and the company is now recognised by world medical opinion as being a leader in this field. This is not to imply that all decision-making is centralised, for the same flexibility extends to managers throughout the company – everyone can make plans without the additional constraint of having to consider short-term “shareholder value”.

The second critical factor is the ability to plan long-term. A privately-owned company is not obliged to satisfy the short term needs of the equity markets and can make long-term investment plans with more certainty without compromising the need for success. There is a willingness to experiment and a premium on innovation over short-term commercial return. Moreover, they can afford to take a longer perspective on the investment in good ideas. Long-term planning makes good commercial sense and it gives these companies a greater feeling of stability. In most successful, privately-owned companies this is also linked with a strong ethos of independence and resistance to the idea of takeovers or mergers. These two things together have important implications for employees – a company that plans to survive and prosper, under the same ownership, over the long term, can offer attractive employment and development opportunities. The pharma industry has seen many mergers in recent years and the threat of redundancy or redeployment casts a long shadow over many careers.

The third critical factor is the family environment and culture. Family ownership stretching back over decades inevitably influences the way in which a company functions and the successful private companies have learned how to make this work in a very positive way. Typical features of a family culture are long-term employment – it is not unusual to find employees who have been with a company for 15-20 years or longer - and investment in individuals. This is usually underpinned by a real understanding of the fact that people work best in a stimulating environment that is psychologically healthy. In practical terms this boils down to a number of factors - the provision of a pleasant working environment, for example, Boehringer Ingelheim’s in-house coffeeshop has made a spectacular change to communication within the company - stimulating work challenges - and support and encouragement for self-improvement.

When it comes to field based sales staff, we work on the basis that they need to be able to bring an individual approach to their jobs, but also to know that they can rely on the company to provide all the support they need so that they do not work alone. The family approach often involves active mentoring of individuals to ensure that their skills are most effectively used. One long-standing employee recalls. “At one stage I was given a position in which I made a complete idiot of myself; I was hopeless at the job. The company took the view that I was a round peg in a square hole rather than a hopeless case. I was moved to another post – something we agreed I was good at – and I have never looked back. I was lucky that the atmosphere here allowed me to admit that I was no good in this particular role without talking myself out of a job altogether.”

Another aspect of the family approach is public recognition and rewards for innovation. It is often the people who are doing a job who can see how it could be done better and it is important to have an atmosphere in which people can suggest improvements and try them out. Recently a team at Boehringer Ingelheim came up with an innovative method for packaging. Another team devised a new approach to recruitment and resourcing that shortened the overall process considerably. Both teams were given awards in the annual “Value through innovation” day.

Privately-owned pharma companies can offer long-term job stability and a commitment to individual development coupled with nimble commercial tactics unconstrained by institutional shareholder demands. These are the very qualities that have put them where they are today.

Boehringer Ingelheim: More than100 years of private ownership.

The foundations for the present day pharmaceutical company were laid in 1885 when Albert Boehringer set up a chemical factory in Ingelheim. Albert Boehringer was the grandson of Christian Friedrich Boehringer who had started the family’s chemical business in Stuttgart in 1817. Initially, the main products were tartaric acid and lactic acid. In the early years of the 20th century, the company started to produce pharmaceuticals, first with pain relief, then cardiovascular products, bile products, a narcotic analgesic and respiratory sympathomimetics. Albert was a caring employer. He introduced a staff insurance scheme as early as 1902, and a few years later a foundation for old and infirm workers was established. In 1910 he took the then magnanimous step of granting a fortnights annual leave to all employees. A pension scheme available for employees with 20 years service was introduced in 1912. Later a staff canteen was provided where Boehringer Ingelheim employees enjoyed a free meal each day – a particularly valuable benefit when food became scarce in 1917.

When Albert died in 1939 the company employed 1,500 people. Over the next 20 years, under the stewardship of his two sons, Albert and Ernst, together with his son-in-law Julius Liebrecht, Boehringer Ingelheim grew into a modern, researchbased pharmaceutical company. In the late fifties new and highly effective drugs were introduced and these formed the basis of the established pillars of the company’s research programmes: agents for the treatment of respiratory, cardiovascular and gastrointestinal diseases.

In 1962 the UK company, Boehringer Ingelheim Limited, was set up in Isleworth. The product range and turnover continued to grow and in 1972 the company moved to its long-term home in Bracknell, Berkshire.

Today Boehringer Ingelheim is at the forefront of the pharmaceuticals business and produces a range of market leading products. It now has seven research and development centres worldwide and has moved beyond its traditional areas of specialisation - respiratory, cardiovascular and gastrointestinal disease - with a new focus on diseases of the immune and central nervous systems, cancer and viral diseases. The company also has businesses dedicated to consumer health care and veterinary medicine.

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First Line Management Development

by Admin 1. July 2003 05:00

 

Getting your first line management role can be quite a challenge. Most first line managers will have spent several years being developed for the role through a variety of methods including inhouse training courses, external courses or qualifications, projects, interim career steps or secondments - all of which will have increased their experience enough to allow them to take up the controls of a region. This article will look at how companies go about training their managers and ensuring they continue to develop throughout the rest of their careers.

First Line Manager Training for new managers
In most modern firms, first line manager training is, for the most part, a very organised affair. Companies recognise the importance of the manager’s role and are therefore committed to putting them through comprehensive training programmes. John Metcalf, HR director from Solvay, said: ”My perception of the training of line managers these days is that it tends to be more structured and taken more seriously. Historically, companies often went through the motions of training but now we recognise the benefits effective line managers bring and therefore we really do invest in helping managers to become as able and as competent as possible.”

Larger firms who have big first line management teams will usually have dedicated personnel who will support development. These coaching managers are sometimes field-based and they work with existing managers on specific areas. Alternatively, the ‘coaches’ are head office based trainers who may deliver formal training courses and design or commission appropriate training packages. However, smaller companies may not have dedicated personnel and the training of managers in the organisation will fall under the remit of HR, training and also second line managers.

New managers will often find a comprehensive induction programme set up for them and this can take the form of internally delivered training plus meetings with key personnel and departments. Alternatively, the formal management training may be contracted out to training companies who provide a specific management induction programme. For some companies, particularly those with smaller management teams and less in-house resources, these training companies provide new managers with a good base of learning upon which to build their subsequent management experiences.

Phil Yates of Customised Training Solutions, a training company that runs management courses, feels that external tuition offers delegates some great benefits. He said: ”Similar challenges are faced by all new managers but differing company cultures allow fascinating and valuable discussion on the varied approaches. Many delegates find this such a valuable experience that they remain in contact to take advantage of the informal mentoring opportunities presented by the extensive skills and experience base of the facilitators.”

Many companies, however, prefer to use in-house training. Lilly, for example, have a comprehensive induction programme in place for their new managers. Steve Brown, the UK Sales Manager Trainer at Lilly, explains how they treat new personnel. He said: “When new managers join an organisation, it can be quite hard for them because their previous networks may have been taken away. We aim, through our new manager induction systems, to put this network back for managers and get them as productive as possible as soon as possible.”

From 2003 onwards, a new Lilly sales manager will have a three month induction programme which will introduce them to all necessary personnel and processes, like the HR department and IT systems. They will also spend time with Steve and their NSMs reviewing coaching skills and consolidating and aligning business analysis techniques. Moreover, there is an initial five days capability training which encompasses some of the core management skills such as leadership, developing and managing people through a career framework and managing for high performance. Remote learning, followed up by time spent with a personal product trainer, covers off much of the product training issue.

Dedicated time is also set aside for field observation where new managers go out to observe their team but do not actively get involved in giving feedback or comment. Steve added: “These observation days are purely for the new manager to observe, both from a product and people perspective, whilst removing the temptation to charge in and then perhaps later regret their words or actions. We give the new manager a chance to see what is going on in their new region and then step back and consider and plan before any changes are implemented.”

Solvay has a slightly different induction process. As a smaller company with just 12 managers, the training of new managers from external organisations tends to be an individually tailored package put together in collaboration with the new manager, sales management and Phil Banks, Solvay’s training manager.

Phil said: “Much of the training we do for new managers is on a one-to-one basis. However, about half our managers come from internal candidates who have gone through our Key Replacement Programme. This is a two-year development exercise for potential RBMs and it gives them a good grounding in the skills they will need in management. We also have a manager’s handbook which the regional management team put together and this gives invaluable instructions on all our processes and administration.”

On-going training, as you would expect, varies from organisation to organisation but increasingly it seems that, as the job grows bigger by the day, line managers are being helped to cope with the increased demands.

Management coach Allan Mackintosh said: “Line managers need to be able to multi-task in an increasingly complex environment therefore companies need to look for effective ways to increase and sustain the skills of this group of key individuals. In order to do this, companies must find ways to support and enable managers to run the internal drivers that can sometimes detract them from their core job. First line managers are so often squeezed from all directions that they can lose their focus and end up spinning in ever-decreasing circles. Thus, senior managers must take time to coach and mentor their first line managers in order that this does not occur.” Activity Benchmarking Ltd reported that on average, line managers spend 0.8 days a month being trained (although this does include product training). This year Solvay will spend 9 days on management development training alone, believing that this is the best way to add value to their business. The training will form part of an annual structured programme for their managers aimed at the development gaps identified by sales management, training and HR.

Lilly take a slightly longer term approach and have introduced an on-going management development programme which takes managers from their induction period right through to three years into the role. After that, training becomes more specific to the needs of the individual and their career aspirations. Again, line management development is the responsibility of a team with the Sales Management Trainer working closely with the NSM team. The Lilly scheme, called the Sales Manager Development Programme, takes line managers through a modular training programme that covers all the key areas of the job such as situational leadership, business planning, tactical business management, interviewing and selection. Together with a progressive career pathway, managers are taken through a structured development programme which after three years, could lead to a senior sales managers role. After that, the next step is into a leadership programme aimed at developing the next Principal Sales Managers and NSMs for Lilly.

Clearly, the training of managers is firmly on the agenda. Line managers perform a critical role and therefore investment in their skills is a fundamental necessity. And there is no doubt the environmental challenges the NHS is delivering will add to the necessity for managers to be even more skilled. However, companies need to recognise the burden their line managers carry and help them cope with it. As an industry, we do not want to have the ‘busy manager’ described by Heike Bruch & Sumantra Ghosal in the Harvard Business Review (Feb 2002), where managers studied were found to have spent 90% of their time on ineffective activities, with a mere 10% of time being spent in a committed, purposeful and reflective manner.

Therefore, line management needs to be supported not just by extra training but the new people also need to be given the authority to manage the business, their team and their own lives. Arguably, time management is the course all managers should start with as there is no doubt that they need to be organised and extremely clear on their priorities. Managers also need to embrace their own continual professional development to ensure they keep pace with the skills this complex and multi-functional role demands.

Keith Jordon, NSM for UCB Pharma, offers a succinct closing point. He said: ”Development of first line managers is extremely important. They need to be able to use a very wide range of skills, from field coaching to influencing corporate strategy and only by effective development and training can they fulfil this mandate. Their role is critical in the success of any sales team and that will continue to be the case long into the future of the pharmaceutical industry.”

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Cultural Intelligence

by Admin 1. July 2003 05:00

HAVE YOU EVER WONDERED why we select candidates for Medical Representative positions largely on their personality and potential ability to develop relationships with customers - and yet after the candidate is appointed there is little or no training provided on how to build and develop customer relations? Managers often assume that the 1 or 2 choice examples given to our cleverly-worded questions on customer relationship building are sufficient evidence that candidates are experts on the subject! Let’s focus on this key skill area further and see how Cultural Intelligence & Diversity training can help us be more focused on our key customers and provide that competitive edge we are always searching for.

Customer relationship building
We know that the essential role of a Medical Representative is to use his/her communications skills and knowledge to persuade the customer to prescribe our product rather then the competitors - that’s provided we have managed to overcome the many obstacles to seeing the doctor in the first place! But these communication skills are considered to be generic ones which apply to every type of customer, no matter what personality or background. In this modern, commercial and highly competitive world that utilises niche-marketing strategies, customer profiling and other market intelligence tools, can we really use the outdated ‘one size fits all’ approach?

Customer Relationship Management Systems (CRMS) are widely used in our industry but in essence they are only electronic versions of good contact notes. And these systems don’t prepare or coach reps on how to deal with the diversity of customers. Customers don’t behave in a predictable manner and are not convenient social stereotypes to which labels can be attached. If you have attended Social Styles training courses like I have, then you’ll know they provide convenient generic templates or neatly defined categories to fit people into. That’s a bit like carpet-bombing to hit a lone soldier! These courses never take into consideration the high number of ethnic or culturally diverse customers in the NHS. Why not? Perhaps they should when you consider 34%1 of the NHS staff are from a non-white background (South Asian - 27%1 origin) and if you look at a typical Medical Representative’s GP Target List, 50-60% are from a culturally diverse background.

Are people the same?
Are people all the same? Do we have the same values, cultures, languages, identity markers, lifestyle considerations, belief systems and expectations? I doubt it. Whilst we may have the similar economic needs and wants (remember good old Maslow’s pyramid?) at the emotional and cultural level I suggest we have different influencers on our lives. Within each region of England we have distinct dialects, historical and cultural variations that separate and identify people as different. So, again, why do we cling to the ‘one size fits all approach’ to people in organisations and their potential customers?

Diversity and cross cultural working - ‘Think the same but differently’
Globalisation and changing demographics in the UK means that most organisations have staff that need to be able to work crossculturally. In addition, the growing competition for talented people means businesses need to recruit from every possible pool to increase their chances of recruiting the best candidates possible. Many public sector organisations (e.g. Asda, HSBC bank, Sainsbury’s, BT, Marks & Spencer) have already implemented policies which encourage diversity and cultural awareness and have benefited in terms of improvements in recruitment and retention. But is the Pharma industry doing the same? Do Pharma companies train their staff - especially their managers - on cultural diversity and how to manage people from diverse backgrounds? If the answer is no, then we must ask why not? Think of the benefits such as skill and developmental improvements, recruitment from a wider pool of talent and the empowerment of people. Not forgetting to mention the tangible benefits of a happy, committed workforce with better staff retention rates.

‘To Change the world we first need to change ourselves’
That’s where the new approach of Emotional Intelligence (EI) helps by filling in the gaps in our understanding of people. EI provides valuable insights into human behaviour, or, with a more commercial viewpoint, important information on buyer behaviour. Cultural Intelligence recognises the differences we all have in terms of our lifestyles, languages, cultures, religious influences and practices and general ethnic backgrounds. In short, it helps us to understand our customer a little deeper so that our approach in communicating and selling is better focused, intelligent and culturally more sensitive. The end result will hopefully be a better appreciation from the customer and consequently a more lasting and fruitful relationship. Cultural sensitivity is also important for any caring employer in terms of the crucial issue of human resource utilisation. Retention of their most valuable resource (people of course!) is dependent on an organisation’s ability to recognise different cultural backgrounds as well encouraging individuality. A study from The Industrial Society (Jan 2001)2 found that 67% of UK managers regard diversity and equality as matters of high priority over the next two years. But significantly, only 45% of organisations responding to the survey have strategies in place to achieve this aim!

How is this relevant to me in medical sales?
As mentioned earlier, nearly a quarter of NHS staff are from a nonwhite background and these figures clearly suggest this group needs special attention in order to achieve the maximum penetration and results.

How do we do this? Well, there are several approaches to achieving this objective. As a Business Manager from an Asian background, I have always used my cultural knowledge to gain access (sometimes preferential access) and develop excellent bonds with doctors. Ask any Asian Medical Representative you know how they use their own knowledge to their significant advantage. So knowledge and training on this knowledge is the first step. In addition, we need to go beyond typical customer profile notes of prescribing habits, usage commitments, and the occasional interests/hobbies questions to more in-depth awareness of ethnicity, traditions, festivals, language, customs and key/relevant religious practices.

For example: do we know which of our doctors will be celebrating Eid, Diwali or Holi? Which of our doctors attending meetings will be requiring halal food and which will not eat beef? How can we tell from just the name of a doctor which ethnic background he/she belongs to and hence the pre-call objectives you should include in your visit? How do we avoid the potential religious/political pitfalls that lie in waiting when dealing with customers from a South Asian background? What do you think the response will be from a Muslim doctor if you send them the customary Christmas card? All food for thought. Such practical knowledge will enable us to be more professional, show to the customers that we have taken the trouble to understand them better, recognise and respect their values and religious/traditional practices. This will separate us from the other standard, often careless approaches made by other sales people. One of the key outcomes we are trying to achieve in sales is being remembered and what better way is there than showing that you are knowledgeable? This extra knowledge – and I have seen it first hand from my own teams - will make that extra impact you desire and get you remembered…and invited back!

Conclusion
Cultural Intelligence and Diversity training provides tangible advantages to all company employees, especially front line sales people. This knowledge will result in a more confident, focused and professional approach to customers from different cultures and consequently, more productive outcomes. Moreover, recognising cultural diversity at every level of employee development has real benefits to the organisation in terms of motivation, retention and utilising talent resources.

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Group Therapy for the Uninitiated

by Admin 1. July 2003 05:00

The selling process is changing; an increasing number of customer contacts are now being made in group situations. However, many sales people are concerned about the effect of this, as group discussions can easily slip into an unfocused free-for-all if they are not carefully managed. The more people involved, the greater the potential for disaster. In this article I will identify some of the problems that can arise in group discussions, and suggest how you can either prevent them from happening in the first place, or handle them if they do occur.

Do your homework
As usual, it all starts with careful preparation. Find out as much as possible about people’s likely attitude to your product so that you can identify the potential influencers, supporters and blockers. Are there any difficult relationships within the group? Who has the most influence [not necessarily the most senior person]. Will others have their own agenda which might sabotage your meeting? The more prior knowledge you have, the better.

Anticipate and plan for the most likely questions. Identify the one question you really don’t want to be asked – and work out how to handle it. Remember that as far as the group is concerned, you represent your company, so be alert to any recent media coverage – make sure that you are briefed on the official company line.

Potential problems: the negative voice One negative voice can affect the whole discussion; sweeping state ments such as ‘You won’t find anyone here prescribing that’ delivered in a confident voice by someone senior can silence the whole group. There are a number of ways of handling this.

• Ask questions to separate out fact from opinion, and correct the facts if appropriate.
• Open the discussion, and ask others if they have had any experience with the drug.
• Refer to other local respected doctors who have prescribed the product.
• Brief a supporter before the meeting and ask them to ask probing questions to get at the underlying issue.
• You might be able to bring a champion with you – for example, a respected GP who has done a patient review and had good results – who will give their own positive experience.

Paradoxically, if another member of the group is too enthusiastic on your behalf, it could come across to some as a set up, and therefore be counterproductive. So brief your supporters carefully in advance and try to make sure that they present a balanced picture.

The reluctant contributor
Some people are reluctant to speak out in front of colleagues for fear of seeming ignorant. Open up the discussion by addressing the problems – for example, ‘What barriers do you see to prescribing this product?’ Ask open questions such as ‘How have you managed this in the past?’ Be prepared to contribute relevant examples to the discussion. It’s crucial not to make anyone feel stupid, so beware of jargon and of taking people out of their depth. Remember that doctors don’t have an in-depth knowledge of pharmacology, so try to avoid detailed discussions with the pharmacist in the meeting.

The persistent expert
There may be one person in the group who has a particular knowledge of or interest in one aspect of your product, and who keeps asking detailed questions. Valuable time is passing, and you can recognise that other members of the group are getting bored. You need to move the discussion on. Obviously you must be polite, but don’t be too deferential, and remember the power of eye contact. Say something like ‘John, you obviously have a lot of experience in this area, and what I’d like to do is schedule a further meeting with you. However’ [at this point shift eye contact and look elsewhere in the group] ‘I’d like to come back to Dr X’s question about the safety profile.’ By looking away from the first speaker, you discourage them from continuing.

The unanswerable question
However thoroughly you prepare, you can still be caught unawares by a question you can’t answer – perhaps something someone has just read on the internet. Admit calmly that you don’t know, promise to find out and get back with an answer, and make sure that you – or someone from your company – gets back to them that day.

Runaway time: runaway discussion
It can be very difficult to control time if everyone is keen to have a say. You will almost certainly have been given a specific time slot, and it’s important that you get across your key points in that time. So keep an eye on your watch, and as you get near to the end of your allotted time, check with the group whether they’re happy to continue. If they can’t carry on, summarise the discussion so far and make your final points.

It’s hard to keep an animated discussion on track – but sometimes the change in direction can be very useful to you. If, for example, you are meeting with the whole practice, many more issues are likely to come up than if you were talking to an individual GP. Group members will learn from others’ questions and experience, and the whole discussion can take on another dimension. Listen carefully and assess whether the discussion is helping you achieve your objective. If it is, and there’s time, let it continue. If not – summarise and move on.

Skills needed to facilitate group discussions
The most important skills you can develop for group meetings are listening, asking effective questions and summarising. Most people think they are good listeners. However, on our training courses we find that when participants are put to the test, they are often allowing their minds to wander and preparing the response while the speaker is still talking. In a group you will need to concentrate so that not only do you hear the words, but also the direction of the discussion. You might well want to take notes, but don’t let this get in the way of listening. If necessary, ask people to pause for a second while you make a note of their point.

The ability to summarise is very powerful – a concise summary can get the discussion back on track and can move things forward while emphasising any action points.

Asking effective questions is an essential skill for anyone in a selling role. Make sure that you ask open questions, for example, ‘How did the patient respond to the change in medication?’ and follow it up with probing questions – e.g. ‘What exactly do you mean by x?’ – to get more information. Questions also enable you to disagree with someone without causing offence. Instead of saying ‘You can’t prescribe that for patients with high blood pressure’, ask ‘Isn’t that contraindicated for high blood pressure?’

Learn the skills to break into the discussion and redirect if you feel it is going down a negative path or leading nowhere. Use a slightly stronger voice and positive body language, leaning forward in an open position and making eye contact. If possible build on the previous comment, ask a question or invite a contribution from a supporter or someone you’ve observed to be concise and on track.

It’s crucial to end the meeting on a positive note. Summarise the key messages and emphasise any agreed action points. If you can, get commitment for some future action to keep people involved – for example, you can ask for a projection of the number of patients they might have next year. Finally, make sure they have all necessary contact details and that you have arranged any follow-up meetings.

Group discussions are an essential part of the sales process and are here to stay. If you develop the skills I have described you will find that they can be both successful and enjoyable.

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