Supporting your target practices to hit their GMS quality targets

by Admin 1. February 2004 05:00

The Problem

Practices are faced with clear opportunities with the advent of the new GMS and PMS contracts from 1st April 2004. With demonstrably improved quality of services and possibly an extended range of enhanced services on offer, the opportunity to improve the overall health of both their patient population, and the practice cash flow and income, are clear. As with any period of tremendous change, 2004 also brings with it challenges, and the prospect of winners and losers. The knock-on effect to representatives calling on practices during a time of immense changes will be significant, and again there will be winners and losers here. Representatives who are attuned to the needs of their key practices will be able to work ever closer with them to help achieve mutually beneficial outcomes. Representatives who continue to offer nothing of ‘added value’ and sell only to their own agenda will find increasingly busy practices clamping down on time-wasting activities (such as seeing low-value reps) to refocus on higher value activities.

Quality Practice Development – a key concern for practices

The Quality and Outcomes framework (QOF) in the new contract will encourage all practices to strive to achieve high quality points scores to maximise additional income through this scheme. Achievement of 1000 points is possible for really good practices which will generate an additional £75,000 in 2004/5 then £120,000 in 2005/6 for an average sized practice (5900 patients) – over and above their guaranteed income (‘global sum’).

Given that all practices will strive to maximise their quality points, where do they start and how can you help?

Quality preparation – the story so far……. Quality Preparation Payments

Every practice received a lump sum payment in Q4 2003 to help them prepare for implementing the QOF of £9,000 for the average sized practice. A second payment of £3,250 will be made in April, and a ‘Quality Information Preparation Payment (QuIPP) will be made via a ‘Directed Enhanced Service’ also in April 04 (£2-5,000).

So, what is this quality preparation money intended for? DoH guidance on how to spend it is scant but here are some of the suggestions:

• Upgrading practice IT systems (e.g. with new GMS-compatible software & templates)

• Summarising and ordering notes onto the computer (QuIPP)

• Training staff and doctors on correct use of new Read Codes for the QOF

• Training on use of the computer generally

• Payment of locums to allow staff to attend awaydays on the new contract

• Funding external consultants to facilitate practice business planning around the new contract

The latter point seems logical and between now and the end of the year practices will be either updating their Practice Professional Development Plans (PPDP), or producing their very first PPDP, to ensure they stand the best chance of implementing the necessary changes smoothly. This uses a business planning approach to firstly engage the whole practice in the change implications of the new contract, then following a SWOT analysis, prioritises the issues that need tackling first and creates a SMART action plan to achieve this. This PPDP approach is being actively encouraged by PCTs and LMCs but there is a shortage of professional outside help so your input here may be very valuable. Healthcare Partnership are running a large number of these sessions now at the request of practices, PCTs, LMCs and proactive representatives.

Practice - PCT joint working

Practices are working increasingly closely with PCTs as joint planning for practice and service development is becoming a reality (e.g. the commissioning of ‘enhanced services’). What form will this increasingly close relationship take?

• In many PCTs, Practice Manager groups meet up every month with the PCT Primary Care Development manager to discuss issues and progress.

• Increasingly, these meetings involve an element of PCT-funded training for the Practice Manager group – e.g. Appraisal skills, how to do Practice Development Planning, etc. With the new contract there is a ‘Practice Management Competency Framework’ which provides a standards template for how practices can benchmark their management standards. Future development training for Practice Managers will revolve around this. Know what this entails so you can get involved in training these influential groups (contact Healthcare Partnership for a copy of this Competencies Framework)

• Encouraging production and sharing of Practice Professional Development Plans (PPDP). Good PPDPs help the PCT’s Primary Care Development team allocate ‘develop ment money’ effectively and informs both next year’s Local Delivery Planning and this year’s education and training needs (e.g. what sessions the PCT should be running during Protected Learning Time) as the PPDP identifies resources and training required to support Practice Quality Development.

• Encouraging good practice-based HR and training procedures through PDP and appraisal (see the QOF indicators in this area – contact us for details). This helps the PCT achieve DoH-set targets of NHSwide implementation of integrated planning and HR policies to ensure a skilled and responsive primary care workforce, and should help practices recruit and retain good staff. Strategic Health Authorities will be monitoring this under the ‘Agenda for change’ legislation.

Changing role of the Practice Manager In modern Primary Care, a highly skilled and well-resourced Practice Manager is a must for the efficient running of the practice. PCTs see practice managers as a key way to influence GPs and their practices most quickly. Why? Practice Managers have the ‘HR’ role in the practice, see all the issues in practices (especially around teamwork, skills, and education) and have a responsibility to maximise practice income (and now quality). Practice Managers play a pivotal role in practice communication – a key issue for PCTs as their messages may not always be welcomed by already overstretched GPs, and may not be communicated to the staff without the Practice Managers’ support.

Modern Practice managers need to be a hybrid of business manager, HR manager and IT specialist in most practices – plus negotiators between the GPs, staff and PCT! They are tasked to run increasingly complex, multi-million pound organisations with (usually) insufficient staff and inadequate training (and often with inadequate support from the GP partners), so time, money and skills are in short supply. They need help! Although PCTs are gearing up to provide more support, resources will be limited, so this is where you can come to their rescue! Even if you are not tasked with a call rate on Practice Managers, it can’t have escaped your notice how influential these people are, so time spent getting to understand their needs better, and the needs of your target practices, will be time well spent. If you already working a system of coverage and frequency on key target practices as opposed to call rate, then you will no doubt already be doing this.

Find out what the practice is focussing on for Quality development

You want to spend more time in key practices, selling your products to relevant healthcare professionals. They feel they have no time for ‘nice to do’ things – e.g. seeing reps – indeed they may see your visit as not only a drain on their time but also possibly jeopardising their drug budget. So, how do you address the needs and concerns of the practice, in order to address your needs to see the right customers and spend time selling to them?

Find out what is of concern to the practice. Then see if you can help support them in some way. You, your organisation, or people in your network of contacts may well be able to provide valuable assistance in key areas where help is needed. If so, you have found your way to become a valued resource to the practice. Provide the support (make a commitment to keep up your support, not just a one-off), build a relationship, and reap the rewards of improved access to sell more often to the key practice stakeholders.

Areas of Quality Development in Practice management and chronic disease management are clearly laid out in the QOF template (see headings below and points per area). If you are serious about understanding your key practices better, discuss the QOF with your practice managers and find out where they need help to improve their scores. It may be in relevant clinical areas, but it might just as easily be help in developing the administrative side that is their real need. Be alert to the whole range of possibilities, and first, be aware of areas where you can help them. If you don’t have a copy of the full QOF indicators, contact us for a copy which we can email you. This will allow you to make as many copies as you need to take to your target practices, to show your genuine interest, to find out what they really need, to identify what help you can provide, and to identify opportunities to get a business return.

Areas of ‘Quality & Outcomes Framework’ and potential points

Chronic Disease management
CHD & LVD - 121
Hypertension - 105
Diabetes - 99
Stroke or TIA - 31
Hypothyroidism - 8Epilepsy - 16
Asthma - 72
COPD - 45
Mental Health - 41
Cancer - 12

Practice Organisation
Records and information - 85 (also QuIPP DES)
Patient communication - 8
Education and training - 29
Practice management - 20
Medicines management - 42
Patient experience
Length of consultations – 30
Patient survey – 70

Additional services
Cervical screening – 22
Child Health Surveillance – 6
Maternity services – 6
Contraceptive services – 2
Access - 50

What should I do now?

1. Look at the areas of running a quality practice above. Obtain a copy of the detailed QOF indicators from us. In which areas do you or your company have personal competence? Could you train or mentor a member or members of staff? What about areas where your colleagues, manager, or head-office based staff are skilled in – could they help out?

2. What about bringing in external resources, e.g. clinical speakers, management training consultants, financial advisers, law experts? If you are worried about the cost of doing so, you could share it – e.g. with colleagues, non-competitor companies, the practice (who have had Quality Preparation Payments) or even PCT?

3. Consider supporting the PCT’s ‘Practice Managers Forum’ meetings – again, provide help as well as resources e.g. food/room hire if possible.

4. Use your business plan to document which practices will get your focus of time and budget, get the help you need and watch those sales grow!

Clearly, the better your network of contacts, the better able you will be able to help your key practices, and the better your customer access will be. Not only will you sell more but you’ll also be spending your resources on something that your customers really want that will gain them extra income and their patients a higher standard of quality care– a genuine win-win outcome!

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Are you suffering from CV phobia?

by Admin 1. February 2004 05:00

In over 5 years of recruiting sales professionals and having read and reviewed literally hundreds of CVs, I am constantly amazed at the poor quality of CVs that Sales people will write and submit to represent themselves. There is a wealth of information on ‘how to write the best CV’, and there are plenty of ‘CV Experts’ who will recommend a certain style or format that is supposedly in vogue.

THE AIM OF THIS ARTICLE is not to tell you how to write your CV, but how to prepare yourself and use your sales skills when writing your CV.

What is the point of the CV?

First of all, before you even put pen to paper, you should be clear of the purpose and objective of the CV. Why are you even bothering to write a CV? What do you want it to achieve? In my opinion, the ultimate aim of the CV should be to sell yourself to the recruiter and to secure you an interview. This may sound obvious, but I guarantee that most people do not even give this a second thought.

If you are clear that this is your objective, then you must now decide how to sell yourself.

Selling yourself – Be the product!

You are the product! You have features, benefits and Unique Selling Points that will be of interest to the recruiter and you have to decide what information is most relevant. This is not as easy as it sounds. You have to present a lot of information about you and your career, and create a positive feeling in 2-3 pages of black and white. It is at this point that most people fail because they do not think about this and do not take the time and effort that is really needed.

How to sell yourself?

Writing a CV, and selling yourself is not rocket science. If you use the sales skills that you have been trained in, and apply them to this process you will succeed.

The Basics

Rule 1:
If you fail to prepare, you must prepare to fail Before you sell your products to a GP, you will have been thoroughly trained and have the necessary details aids to in increase the chance of making a sale. Equally, before you apply for a new position, you must take the time to prepare your CV so that it effectively sells yourself and achieves the goal of getting you invited for an interview. If you do not take the time to prepare your CV properly, you should not expect to be invited to interviews.

Rule 2:
Create the right impression The success or failure of a sales call is determined within the first 30 seconds. When you visit your GP you are probably smartly dressed, looking professional, and armed with well presented and interesting detail aids. You would not see a GP wearing ripped jeans, a dirty T-Shirt, armed with a scrap of paper and seriously expect them to buy from you.

The same can be said about your CV. If a hiring manager reads two CVs and one is smart, well presented, and shows that the person has put some time and effort into the preparation, whilst the other is poorly presented, littered with spelling mistakes and shows that little effort has been made, which one do you think they will be more interested in?

Rule 3:
Know your customer As a solution sales person, you have been taught to sell the features and benefits that are most relevant to your target audience. When writing your CV, you should think like a hiring manager. If you were recruiting, what information would you want to see in a CV?

For example, if you are applying for sales roles, I would expect that the hiring manager would want to know the territory you cover, who you are selling to, what products you sell, your targets (call rates, sales, etc), and your successes and achievements. Just saying that you are a Medical Representative for XYZ Pharmaceuticals is not enough. Do not save all this information for your brag file, as you wont get a chance to show this if you don’t get an interview.

Rule 4:
Empathy for your Customer As a sales person, you must appreciate that the GP is a very busy person and has probably seen at least 5 other reps that morning before you. Therefore, if you can provide them something that will be of interest and make their life easier, you still have a chance of making the sale.

When applying for a job, you must appreciate that a hiring manager may have at least 10-20 CV’s to read, and will only invite 3 or 4 people to an interview. By making your CV concise, easy to read, with relevant interesting information, and making their life just that bit easier, you have a greater chance that they will want to see you.

Rule 5:
Don’t be afraid to sell yourself When you go into a GP’s surgery, if you don’t sell your product, you won’t achieve your targets. Equally, if you don’t sell yourself in your CV, nobody else is going to do this for you, and you won’t achieve your goal of getting an interview. And if you can’t sell yourself in your CV, a hiring manager will have doubts about your ability to sell their products. As a sales person, you must demonstrate your ability to succeed. Hiring managers do not want to read your job description; they want to know if you are going to make a difference to their business.

Rule 6:
People buy from people. Your GP is more likely to buy from you if they like you.

A CV is a very personal document, yet the toughest part of writing a CV is getting your personality to shine through. You have to use your style of writing and the content to bring this out.

Preparing a good CV is not just about what you write, but how you write it. If you apply the sales skills that you have, and take a little bit if time to think about what you are doing and why you are doing it, you should be able to write an effective CV that will do its job and secure you to an interview. Don’t drive yourself mad either. You can constantly tweak and change your CV. But, at the end of the day, if you believe that the CV is a good representation of you, your skills and your abilities, then it probably is.

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Benign Prostatic Hyperplasia

by Admin 1. February 2004 05:00

AN ENLARGED PROSTATE – known as benign prostatic hyperplasia or BPH – is caused by an overgrowth of prostate cells. This enlargement constricts the urethra so the flow of urine is reduced, making it increasingly difficult to empty the bladder.

The prostate gland

The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder and surrounds the urethra, the tube through which urine flows from the bladder and out through the penis. Please see the diagram, below.

One of the main functions of the prostate is to produce an important liquefying component of semen, which allows the sperm to move freely. The gland is divided into three zones, peripheral, transitional and central. With BPH, it is the central part where overgrowth of cells takes place.

BPH is very common, affecting about one third of men over 50. Although it is not prostate cancer, the symptoms of BPH are similar to those of prostate cancer so you should see your doctor if you start to experience problems passing urine.


• hesitancy (difficulty in starting to pass urine

• a weak stream

• the need to strain to pass urine

• the feeling that your bladder isn’t empty after urination

• the need to pass urine urgently

• frequent trips to the toilet, including having to get up several times in the night

• feeling a burning sensation or pain when passing urine


Your doctor will ask you questions about your symptoms and your general health. You may be asked to fill in a urination questionnaire to help work out the severity of your symptoms.

A digital rectal examination (DRE) will be performed to examine the size and consistency of your prostate by inserting a finger into the rectum. Although this can be uncomfortable, it is not painful. Many men find the prospect of a DRE embarrassing, but should bear in mind that it’s a simple procedure, performed routinely by GPs.

Your doctor will also feel your abdomen to find out if the bladder is distended. A distended bladder may indicate that you are not completely emptying it (chronic urinary retention, which is painless).

Other tests will be carried out to make sure that your urinary problems are due to BPH and not other conditions. A urine test will be done to check for infection or blood. Blood tests, including a prostate specific antigen (PSA) test may be carried out. This measures the amount of an enzyme produced by the prostate. High levels of the enzyme can indicate prostate cancer. Other blood tests include one to assess your kidney function and another for blood sugar to check for diabetes. Both of these problems can cause urinary symptoms.

Other tests

Less common tests may include: urine flow tests; ultrasound to measure urine left in the bladder and to check for bladder stones; urodynamic measurements using a catheter inserted into the bladder to measure the pressure of urine there; and transrectal ultrasonography (TRUS) where an ultrasound probe is passed into the rectum to give a view of the prostate.

A biopsy (samples of the prostate) may be collected using a needle to check for cancerous cells.


The mainstays of treatment for BPH are drugs and surgery. However, as any treatment can have unwanted effects, some men with mild symptoms opt for “watchful waiting”, where no treatment is undertaken. Instead the situation is monitored closely with routine check-ups. If symptoms deteriorate, it is then possible to opt for treatment.

Drug treatment There are two main classes of drugs that are prescribed for BPH: alpha-blockers and 5-alpha-reductase inhibitors.


Work by relaxing the muscles at the neck of the bladder and in the prostate. In this way they reduce the pressure on the urethra and so help increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms.

Around 60% of men find symptoms improve significantly within the first 2-3 weeks of treatment with an alpha-blocker. There are several different alpha blockers. Currently, these are doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Xatral) and prazosin (Hypovase). They can also be used to treat high blood pressure. The most common side-effects of alpha-blockers are tiredness, dizziness and headaches.

5-alpha-reductase inhibitors

These drugs work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement. Finasteride (Proscar) is the most commonly used drug of this type for BPH. Unlike alpha blockers, 5-alpha- reductase inhibitors are able to reverse BPH to some extent and so may delay your need for surgery.

Plant extracts

A number of plant extracts are popularly used to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial. If you decide to try a plant remedy, it’s always best to discuss this first with your doctor or pharmacist as interactions with conventional medicines are possible.


There are three main surgical options for BPH:


Transurethral resection of the prostate (TURP) is the most common operation for BPH. The procedure is usually done under a general anaesthetic. A long thin instrument called a resectoscope is passed into the urethra. With a light source and lens on the end it acts as a telescope, allowing the surgeon to view the prostate either directly or on a video monitor. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate. See the separate BUPA fact sheet on TURP for further details.

TURP is an effective procedure with over 90% of men reporting an improvement after the operation. However, as with any surgical procedure there is a risk of side-effects and complications. A common side-effect of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis. This is sometimes called a “dry orgasm”. Retrograde ejaculation is usually not a problem, although it may reduce fertility. Complications of the operation can include urinary incontinence or damage to the urethra, resulting in a “stricture” that can itself cause difficulty passing urine.


Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged prostate. It is a quicker operation than a TURP and involves removing less tissue. It is performed under general or spinal anaesthetic. As with a TURP an instrument is passed up through the penis, but instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and the prostate. This reduces the obstruction of the flow of urine.

Open prostatectomy

Open prostatectomy is only recommended for men whose prostate is very large. It is a major operation and carried out under a general anaesthetic. An incision is made in the lower abdomen in order to remove the central part of the prostate.

Other treatments

Laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH.

This is a BUPA health factsheet for more details please go to



The Matrix

by Admin 1. February 2004 05:00


11. Out of Hours Services: most GPs are opting out from April 1st 2004. This removes weekends and evenings from terms and conditions. However the new GMS contract has flexibility for extra hours although the politics behind this are not nice.

THINK POINT PF: It is issues such as this that really creates ill feeling amongst dedicated healthcare professionals. Under the current situation, most GPs will opt out of out-of-hours services (OHS) as the monies they will get paid to do it are very poor indeed. Also, one of the requirements of providing an OHS is the ability to store all voice transactions in an electronic format for 3 years (for the obvious reason of legality and claims in a situation where a GP may have refused to come out to see a patient). So given most GPs don’t have this facility they probably will have to opt out or invest into technology. So why is there dissent? Surely GPs would love someone else to do on-call for them ? Well it comes to money (surprise surprise!) Each GP will have 6% of their global sum taken away to pay for the on-call service. This is many, many times higher than the government will pay the GP to do their own on-call. Hence bring up the subject with your customers only if you plan on ruining their day.

12. Enhanced Services Bidding: the consultation exercise is still ongoing. For example, let’s say a GP wants to do minor surgery – the PCT will have to make the final decision, so the GP needs to get in early with their bid. Discussions with both the PCT and the LMC will be imperative in making sure these extra services are paid for. There is a grey area whereby on one hand the PCT will chose who provides what service, but on the other hand, if a GP has been carrying out significant minor op’s procedures to date, they have to offer this work to that GP so that he may continue to provide it if he/she wants.

THINK POINT PF: The GPSIs (GP Specialist Interests) will become specific targets for various pharma & equipment companies. They will be providing minor ops., anticoagulant clinics, dermatology and other specialist services. The PCTs responsibility is to ensure there is availability of the service to the population whereas the GPs responsibility is to provide the care within remits of clinical governance and quality. If an area is lacking a dermatology specialist it is up to the PCT to either convince a GP to take it up or to outsource to an external agency. That in itself is another kettle of fish – external agencies running/providing very specific procedures/diagnostics/treatments either because a PCT doesn’t have the ability or because the agency in question can provide it quicker, cheaper or more reliably.

13. Quality Achievements Software: The GPs are being paid for points. That we have established. But how will they keep track of ‘what they are achieving ?

THINK POINT PF: There are 2 lots of ‘software engines’ which allow GPs to ‘track’ their achievements, points and hence potential/actual salary & payments. The UTILITY SOFTWARE is used for entering figures of quality aspirations to calculate sum of payments. The SEARCH ENGINE SOFTWARE is used to try & see where you are with your current targets. This is useful in calculating how good or bad your payments will be. Not too different from when you attend your national sales conference and see your company predicted targets and how you are ‘tracking’ above/below them. Want to make friends with your practice manager? One of the ‘easy’ quality frameworks is to send out 50 PATIENT SATISFACTION SURVEYS. They get 50 points for doing this! It doesn’t even matter if the patient fills them in! They just need to post them out! You may be able to help them with that…. (p.s. I don’t want practice managers all round the country calling me up with complaints they are being hassled by reps because of me !)

14. Disease Registers: For the 10 diseases within the GP contract, most provide points for creating a ‘register’. Difficult to know how your cholesterol is doing if you don’t have a list of patients who need their cholesterol monitoring !

THINK POINT PF: Disease Registers are easy points– 6 points for each register. Most practices already have diabetes & CHD registers (NSF requirements). As they form other disease registers they will be ‘finding’ new patients and then creating a focus. For example, looking at respiratory medicine, the GP contract encourages ‘spirometry diagnosed asthma’ rather than ‘doctor diagnosed asthma’. I know certain companies that provide practices with spirometers – do you think their products will knocked off formularies ?

15. Population Screening: Practice prevalence of a disease is more important than screening itself. But screening is the buzz word. This activity will find new patients (new diabetics, new hypertensives, etc) who were otherwise thought to be healthy. Interestingly, data from recall of know patients is valid for 15 months. After this, it is no longer valid. Hence too frequent recall is a waste of time and too late a recall will mean you don’t have figures entered into the computer.

THINK POINT PF: Remember there is a difference between incidence and prevalence. The incidence of a disease is the rate of newly diagnosed patients within a population set (ie 5 new cases of diabetes per month). The prevalence of a disease is the total number of patients within a disease set (ie 150 diabetics within a practice). It’s the difference between how many people are jumping into a pool per hour and how many people are in the pool at any given time. Given that there are newly diagnosed patients every day, and there are patients who are diabetic dying every day, the balance leads to incidence and prevalence statistics. Another think point – what happens if people keep jumping into a pool but no-one leaves the pool ? Visualise it. Well this is the problem with treating diabetes (increasing longevity of life) when we don’t have a cure or proper way of preventing diabetes. This is one pool that is becoming very, very crowded indeed.

16. Partnership Agreements: The new GMS contract creates a real need for GPs to plan with partners. Planning whole time/part time equivalents. Planning NHS/non NHS earnings and how it will go through the practice. Much of this accountancy is related to pension protection.

THINK POINT PF: The course of true love never has run smoothly. I am yet to find a practice of 3 or more GP partners who do not suffer from a kind of business paranoia. Am I doing too much ? Am I getting paid to little ? Have I subsidised someone else’s tax rebate ? Why ? Probably because most GPs remember how they shafted junior/new partners who were inexperienced. However, if worst came to worst, GPs could ‘divorce’, move out and take their ‘list’ of patients with them (remember under the current system patients are registered with individual doctors). Interestingly, under the new GMS contract, the patients are registered with the PRACTICE, not with individual GPs. This means, when a disagreement and subsequent dissolving is due to occur under the new system, the GP may move/divorce from the practice, but they will have no patients ! GPs will have to think more than twice before entering a partnership and more than likely, partnerships just can’t afford to break down. Disagreements are going to have to be worked out. Patients are now registered with practices not doctors.

17. Non-Medical Partnership Agreements: Under the new GMS contract, facilities exist for non-medical staff to join and be considered full partners with business share of the running of the practice.

THINK POINT PF: This is quite phenomenal. Never has this been available, possible or even remotely close to being considered. Now, managers, nurses or even the pharmacists can become partners within the practice. Sharing in profits. Sharing in losses. I am still coming to terms with the full implications of this.

18. Opting Out of Additional Services 1: Whilst GPs can opt out of additional services if they want, they will need to think seriously about this. Opting in to do a service does allow option to opt out at a later date. But if a practice opts out of an additional service, changing their mind on this will prove far more difficult.

THINK POINT PF: That is the key. If you opt out you can’t opt back in ! So some wily practices will opt-in, keep an enhanced service, then subcontract it out. Hence the practice holds the core contract, but someone else is being paid to do it… till the time or expertise is right. Then they will take it over. We are going to see a proliferation of ‘service providers’ ranging from dialysis fluid home delivery through to a 1-stop shop for rheumatology patients.

19. Opting Out of Additional Services 2: Certain enhanced services contribute to global sum monies whilst others contribute to quality and enhanced payment services

THINK POINT PF: This is important. For example, take CERVICAL SCREENING –opt out of this and you actually lose monies (ie – money taken away from global sum to pay someone else to do it). However, cervical screening does not appear in the quality & outcomes framework so it’s nothing to do with points or prizes, just hardcore cash !! On the other hand, take a touchy subject like MMR Vaccinations. These are incentivised with ‘bonus payments’. So does the practice opt out ? If they are clever, they may tell the PCT they are ‘opting in’ for ‘CHILD SURVEILLANCE’ , hence hold the contract. Everyone knows that MMR vaccination is very difficult and time consuming. So they may then outsource and pay an external agency to do this. The practice will obviously be responsible for the quality and service provision of the agencies they ‘hire’ (under clinical governance and of course vicarious liability). But what is key here is that they still hold the contract to provide MMR and will take it over themselves ‘when the heat dies down’ as it were !

20. PCT & GP responsibilities under new GMS: NSF targets will be key focal drivers of the PCT and in fact responsibility for achieving these frameworks rests with the Chief Executive of the organisation. The NSF targets, whilst underpinning a number of clinical parameters within the GMS contract, is not in itself included as part of the quality frameworks or incentives.

THINK POINT PF: This is the killer queen ! Look at the cholesterol targets for patients with CHD. The target of reducing cholesterol below 5mmol/L features in both the NSF for CHD as well as the GMS Contract points (see previous issues PF). What is interesting is the fact that the NSF target for cholesterol will drop this year to reflect more aggressive cholesterol reduction. However, the GP contract target of 5mmol/L will not change for a couple of years. So – when a doctor sees a patient, what cholesterol will they go for ? The NSF target or the GP contract target ? Well, once he gets the cholesterol below 5, he/she gets paid. If they reduce the cholesterol any more than 5, the patient benefits, the budget goes up, BUT the GP does not get anymore payments (they have capped the payment at achieving 60% of patients with a cholesterol of below 5). So whilst it is the PCTs responsibility to achieve the NSF target, it is NOT the GPs responsibility ! In fact, I cant see the GP wanting to overspend the budget anymore than what they will get rewarded to do. Lesson in learning – the PCT needs to achieve NSF targets, the GP wants to achieve GMS Contract Points targets. And, low and behold, they are not one and the same.

I love the NHS don’t you?….



French Connection

by Admin 1. February 2004 05:00

AFTER SEVERAL WEEKS of merger speculation, Sanofi-Synthelabo launched a hostile bid for French neighbours Aventis on 26th January 2004. The stock and cash deal valued Aventis at EUR47.8bn ($61bn), a 5% premium to its closing share price. Not surprisingly the hostile takeover was quickly rejected by Aventis’ management who believes “that there are other scenarios with a stronger industrial and social rationale”. Nevertheless, as the merger appears to have the backing of the French government, we would anticipate a rapid round of negotiations between the two companies in an attempt to smooth the creation of a strong French based player in the global pharmaceutical industry.

Global Pharmaceutical Market Share

In the core pharmaceutical business, the merged entity (French Pharma) generated approximate sales of $27.9bn in 2003, market share of 6.6%. Although ranked third behind Pfizer and GSK in terms of sales, French Pharma is forecast to quickly overtake GSK as the 2nd ranked company – our forecasts presume that by 2007 French Pharma will generate pharma sales of $34.2bn.

Core Products

Blockbusters - French Pharma’s portfolio currently comprises six blockbuster products, the cardiovasculars Plavix, Lovenox and Tritace, the insomnia treatment Ambien, the taxane oncology treatment Taxotere and the respiratory treatment Allegra. The portfolio is supported by fast-growing products such as the platinum anticancer Eloxatin and the anti-hypertension treatment Aprovel. By 2007, our forecasts predict that French Pharma’s portfolio will comprise seven blockbuster products generating total revenues of $14.0bn.

Overlap – There is little overlap between Aventis and Sanofi- Synthelabo’s portfolios. Potentially the only significant product requiring divested would be the LMWH anti-thrombotic Fraxiparine, a competitor to Aventis’ dominant Lovenox brand. Sanofi’s anti-thrombotic Arixtra would benefit from the expertise that Aventis has built up in this area and act as a follow-up post Lovenox’ patent expiry (anticipated in Dec 04).

Patent Expiry – A French Pharma merger would help to minimise the forthcoming impact of patent expiry for Aventis’ anti-histamine Allegra. Although patent protected to 2011, the market exclusivity of Sanofi’s major product Plavix is also under threat in the key US market from patent challenge – a lawsuit is anticipated later in 2004. The insomnia treatment Ambien’s patent expires in 2006, however a once daily form is in development to minimise the impact of generic competition.

Therapeutic Coverage

French Pharma’s presence would be enhanced in three core therapeutic areas – cardiovascular, CNS and oncology. French Pharma would be ranked third in the CV market behind Pfizer and Merck with estimated revenues of $7.3bn in 2003, equating to a market share of 11.0%. The company’s presence would also be enhanced in the CNS market where French Pharma would be ranked 5th with sales of $4.0bn. In oncology French Pharma is ranked 2nd behind Roche with sales of 3.1bn.

Geographic Coverage

French Pharma would become the top ranked pharma company in Europe with estimated market share of 8.8%. However, for its size, French Pharma would remain under-strength in the US where market share of 4.0% would rank the company behind a number of US and European majors including Pfizer, GSK, Merck, J&J and AstraZeneca. In Japan, French Pharma would achieve a market share of 2.7% - and thus would rank behind several international companies including Pfizer, Merck and Novartis.


French Pharma had a combined pro-forma R&D budget of $4.4bn in 2002 of which an estimated $4.1bn was directed towards ethical drug R&D. Only Pfizer has a higher annual R&D budget ($4.8bn in 2002). Key products approaching the market from Aventis’ portfolio include the respiratory steroid Alvesco and the anticancer agent Genasense.


The merger of Sanofi-Synthelabo and Aventis would create a company of sufficient critical mass to compete on a global basis against the current leading US and European companies such as Pfizer and GSK. The portfolio would include a number of blockbuster brands while synergies are particularly compelling in the cardiovascular and oncology sectors. French Pharma would lead the European market; however the main issue facing the merged company would be to improve its position in the key US market.



Erectile Dysfunction - Is Three a Crowd?

by Admin 1. February 2004 05:00

ince its launch in March 1998 Viagra has revolutionised the erectile dysfunction (ED) market. A blockbuster drug since its inception, the blue diamond-shaped pill had been the only name in town for over five years. But with GlaxoSmithKline (GSK) and Bayer introducing Levitra to the U.S. market and Cialis from Eli Lilly and ICOS just receiving FDA approval, will they cannibalise Viagra’s sales or expand the ED market? Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. The successful introduction of Viagra, the first phosphodiesterase (PDE) inhibitor, by Pfizer resulted in a substantial increase in men willing to acknowledge ED and seek treatment from their doctors. Viagra is safe and well tolerated, but it does not seem to work in all men. In addition, only 10 percent of the patient population suffering from ED uses Viagra. This huge untreated ED population represents a significant opportunity for the newer players. Levitra and Cialis, the second generation of PDE agents, will provide men with additional options for the treatment of ED.

New Kids on the Block

Cialis and Levitra possess several traits that make them better than Viagra. Cialis is known as “the weekend pill” because it can last as long as 36 hours compared to four hours for Viagra. This long lasting effect is the focus of its marketing campaign. It is also the only pill that can sustain efficacy after a meal. Viagra must be taken on an empty stomach. Men can take a pill on Friday and expect a weekend of enjoyment, providing flexibility that Viagra cannot offer. Levitra is the choice for those that are more spontaneous because it takes the least time to work because it has the highest specificity. It works within 16 minutes while Viagra takes 30 minutes to an hour. Cialis and Levitra offer men with various comorbidities treatment options. Men with enlarged prostates can take Cialis with Flomax, while Levitra works better in diabetes patients suffering from impotence.

Viagra Still King

Viagra is one of the most recognisable brands in the pharmaceutical industry and synonymous with erectile dysfunction. GSK/Bayer and Lilly ICOS will find it extremely challenging to win a marketing battle against Pfizer. Viagra also has a good track record and established clinical data backing it up, unlike its two new rivals. A strong brand goes a long way towards preserving revenues and many doctors and patients have fierce loyalty to products that have served them well in the past. There has been no U.S. clinical trial data published directly comparing the use of either Cialis or Levitra with Viagra. Despite the long lasting effect of Cialis and fast onset of Levitra, they are not that different from Viagra. All three drugs are PDE-5 inhibitors that work on the same enzyme. All three drugs have 70 percent effectiveness. They have side effects such as headaches, upset stomachs, nasal stuffiness and nitrate contraindications in common. The cost of therapy is not significantly different. Viagra is currently the first-line treatment for ED and this does not look to change for the foreseeable future.

Room for Everyone

The advances Cialis and Levitra make will not come at the expense of Viagra but from expanding the market since they can reach parts of the patient population for which Viagra is not a viable option. The potential of the ED market is in its size. As the population continues to age the potential market will only grow in size. These new products entering the market with extensive promotional and sales campaigns behind them will only amplify awareness and discussion concerning ED, making it much easier for patients to consult their doctors. The launch of the two new drugs in Europe has expanded the market. Erectile dysfunction is highly prevalent and a vastly underserved market. Getting men to seek medical help is the biggest challenge. If GSK/Bayer and Lilly ICOS succeed in bringing more men to their doctors’ offices they both can eventually achieve blockbuster status.


Frost & Sullivan, an international consultancy firm, has been supporting clients’ growth for over four decades. Our market expertise covers a broad spectrum of industries, while our portfolio of advisory competencies include strategic consultancy, market intelligence and management training. Our mission is to work with our clients’ management teams to deliver market insights and to create value and drive growth through innovative approaches. Frost & Sullivan’s network of more than 500 consultants, industry experts, corporate trainers and support staff, spans the globe with 19 offices worldwide.



Parallel trade strikes at industry’s ability to invest in search for new medicines

by Admin 1. February 2004 05:00

Parallel trade in medicines is threatening the ability of the research-based industry in the UK to continue its huge investment in the search for new medicines and also threatens the country’s ability to attract investment from global companies, a seminar in the House of Commons heard recently.

At the same time, the NHS gains very little benefit from the income that the parallel traders make and the trade can also lead to confusion and loss of patient trust in their therapy, the Social Market Foundation seminar was told.

The comments were made by Dr Trevor Jones, Director General of the Association of the British Pharmaceutical Industry (ABPI), who emphasised the level of investment that is currently made in the search for new medicines in the UK - nearly £9 million a day - but warned that parallel trade put this at risk.

“If we cannot continue to earn these revenues in the UK - and, indeed, elsewhere - we certainly will not be able to continue to maintain the level of R&D that we currently do nor, importantly, to retain and attract inward investment from companies headquartered overseas,” Dr Jones said. He added: “Ask the parallel traders how much money they are investing in medical research for new products from the profits they are making. I think you will find them silent on this issue!” And he went on to point out that parallel trade - although quite legitimate - reduces the money available to the industry for its research into tomorrow’s medicines.

The NHS gains a small ‘clawback’ by assuming that pharmacists purchase a certain amount of paralleltraded medicines. But Dr Jones quoted a recent London School of Economics study as showing that the NHS saving, including the clawback, amounts to about £39m while the parallel importers themselves made some £325m - nearly ten times as much.

Dr Jones also expressed concern about the effect of receiving parallel-traded medicines on the patient, particularly for older people who are the biggest users of medicines. Because parallel traders are required to repackage, rebox or overstick labels, the medicine’s appearance is often different from the original.

In some cases, where overstickers are used, the instructions on the calendar pack may remain in a foreign language with only the other information - name, batch number, expiry dates, etc - in English. The difficulty is compounded when the parallel traders switch sourcing their supply from one country to another, with the original language also thus changing.

“This can result in a considerable loss of confidence in the therapy and, at worst, patients become uncertain, worried as to whether they have been given the correct tablets and may either miss doses or stop taking the course of treatment,” said Dr Jones.

Pharmaceutical company’s investment ‘is vote of confidence’ in UK

A new multi-million pound investment in the UK by a major pharmaceutical company has been welcomed by the Association of the British Pharmaceutical Industry (ABPI).

The ABPI was reacting to the announcement by Roche, one of the world’s top innovative pharmaceutical research-based companies, that it is investing more than £70 million on a new building to bring together 1,200 staff from its global pharmaceutical development and local sales and marketing teams.

“This is a big vote of confidence by Roche in Britain as a good place to operate,” said Dr Trevor Jones, Director General of the ABPI. “It further proves that the UK can attract top pharmaceutical companies to invest in the country so long as it maintains a welcoming business environment.

“The UK still retains many attractions for the industry, but we must be very careful not to lose sight of the fact that there is major global competition from many other countries for the sort of investment and commitment that Roche is demonstrating.”

Construction on the Roche site, in Welwyn Garden City, Hertfordshire, began this month and is scheduled to be completed late next year.

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