WHEN JON HODGSON took up his post as Lundbeck’s UK’s Sales Director two years ago, he inherited a sales organisation whose shape sat a little uncomfortably on the recently re-sculpted NHS landscape.
What prompted you to embark on such an ambitious re-structuring of the sales organisation? “The existing set-up was un-sustainable. We had very large territories with independently managed, multi-disciplinary sales teams labouring under an overly-complex reporting structure. “ Jon told us. “Performance management was unsophisticated. Some teams did better than others but the complicated organisational structure thwarted detailed analysis and stifled the individual ambition and accountability of representatives and managers on the ground.” “Streamlining the sales structure and simplifying reporting lines were basic prerequisites for efficient resource deployment and improved sales performance.” Jon set up a project group and with the assistance of external consultants, formulated a multistrand strategy to re-align the organisation with its customers, deliver better organisational control and improve sales force effectiveness. Changes included:-

• A reduction in territory sizes
• Multi-disciplinary, integrated teams, including dedicated outsourced sales staff, were brought under the control of one manager
• An increase in the numbers of Hospital Representatives and NHS Liaison Executives
• Simplification of reporting lines
• More autonomy and responsibility for representatives and managers

Jon however, had ambitions for the strategy which went far beyond simply tinkering with the nuts and bolts of the organisational structure. A new lean and agile sales structure demanded more individual responsibility and revenue accountability; better teamworking and leadership; improved performance management and real commitment to employee motivation and development. The new set up was the first step. Separate project groups were also working on addressing IT issues, training needs and career development.
How was the new set up received? Jon told us; “We consulted and informed employees throughout the project and in November 2003 we had the whole company together for two days where we explained everything and allocated the new roles and responsibilities.” “I think almost everyone welcomed the changes. We brought in 145 new people into the organisation at the start of 2004, many of them new to the industry. This brought a breath of fresh air into the company. It had the effect of re-energising everyone. We started 2004 with more high-calibre representatives, better resourced, targeted and motivated.” “We knew we already had skilled, committed employees who believed in the company. We believed they had a vital role in delivering Lundbeck’s vision. In fact they played an active role in its very definition.”

“Changing the set-up was key to empowering them. We hoped to enable them to really bring the vision to life; to give them more say in shaping their own and the company’s future.”

How are things now, 12 months on? A recent sales employee survey conducted one year after the re-structure suggests a high level of fulfilment in the workforce: -

• 96% stated their job was interesting and satisfying
• 94% stated their relationship with their manager was good
• 84% stated the company culture, strategy and direction, reputation of the organisation, equal opportunities and general employment stability is good

Regional Business Manager Shilpa Patel is one who welcomed the new order; “Previously, I only looked after the Medical Representatives in my team, but now I’m responsible for Hospital Specialists and NHS Liaison Executives as well.” she said. “It was a steep learning curve for me at first but now I have a better understanding and awareness of the whole NHS environment.” “There is more individual accountability now and I think everyone has responded well to the responsibilities the changes have brought. People can see the real benefits. It is easier for someone to shine – get recognition for their achievements. “As a manager, it is easier to co-ordinate team goals. Teamworking is better, more coherent. Our work is more integrated.” Sue Tank a Medical Representative has no doubt that things are better now. She told PF; “I was frustrated before. I was never entirely sure what the other team members were doing.” “I’m really happy with the new structure: smaller teams, individual reporting. I like the fact that the team has just one manager. Work is much more rewarding now. I know what is expected of me. I am more focused, more motivated and get I more recognition for what I do.”
Was your sales performance affected during the re-structuring? “After only two weeks intensive training, our new sales people, (70% of whom were completely new to the industry), achieved benchmark standards for the industry, so they hit the ground running.” said Jon. “Since the launch of our new anti-depressant, Cipralex in June 2002, we have won a growing market share, which continued during and after restructuring. A better directed and coherent sales effort has certainly contributed to its continued success.”
What does the future hold for Lundbeck sales people? The company is well advanced on a major career development initiative, Project RADICAL (Realising Ambition, Developing and Improving Careers at Lundbeck). This will completely reconstruct the company’s promotional framework, enhance career opportunities, broaden training and development plans. Shilpa Patel, a member of the RADICAL project group revealed; “I think everyone sees Project RADICAL as a really positive step. Amongst other things, in the future there will be 6 levels of Medical Representatives, 4 levels of Hospital Specialists and NHS Liaison Executives. People will have the option to stay in their field but still progress through the different levels. There will also be more scope for people to move into other areas and into management.” “We have fantastic products and a vision I really believe in. Lundbeck has the ambition and ethos of the bigger companies. We are much more forwardlooking now.” Sue Tank again; “Although we are a company with big ambitions, I know that I can still walk into Head Office and people will know who I am. I like that”. Lundbeck is putting in place the building blocks to realise their vision; to be a global leader in psychiatry and neurology. They are walking a RADICAL road to that vision, and aim to take their workforce with them, every step of the journey.

	Jon said: “Our future depends upon three key things – our people, our products and our strategy, all of which we have great confidence in. 2005 promises to be an exciting year for Lundbeck UK.
Jon Hodgson

WHILE HISTORICALLY the KOLs were clearly the hospital consultants, in the last few years the changing face of the NHS, has muddied the waters and the KOL is no longer easily identifiable. While pharma companies are starting to realise the complexity of the situation, most have only a tenuous idea of how to address it. In many cases they have to build relationships with new KOLs from scratch, yet they continue to blanket market the 30 or 40 KOLs in a specific area based on a central model, without tailoring the message or understanding the relative value of each individual measured. Indeed, this unsophisticated approach totally ignores two key sets of opinion leaders: the retired consultant and the up and coming local thought leaders. While the retired consultant may not be seeing patients and prescribing products, he is undoubtedly retaining an interest in the area, continuing to speak and influencing a broad network of still practicing consultants. Yet, once retired, he frequently gets dropped off a pharma company’s KOL list. At the same time, the pharma companies pay little attention to KOLs on a local basis. Yet at this level, the KOL will have specific local knowledge, understand local market needs and is set to become part of the next wave of regional and national thought leaders. Pharma companies may increasingly recognise the importance of these influence networks and KOLs but they do not fully comprehend the big picture. And without understanding the real influence of each KOL they cannot maximise the value of the influence network. But understanding the complex relationships that exist within influence networks is one thing – and, in itself, not something that pharma companies have yet achieved. However, once relevant Key Opinion Leaders within a network have been identified, creating and delivering the right message is a further challenge that will require a significant shift away from traditional sales and marketing techniques – this is not a role for the average pharma rep. Messages must be targeted to the audience. Consultants – who care little for budgets – are unimpressed by talk of cost savings or comparisons; although this will appeal to the pharma advisor at a PCT or local health care trust. The consultant wants to know about reduced side effects or other clinical advances – a message that must be delivered by a peer or other credible person. Adding a doctors’ pack, patient pack, support in prescribing trends over and above core product information will also hit the consultant’s buttons. The ability to map networks of KOLs (Key Opinion Leaders) requires significant research, but repays the effort by enabling more effective targeting and segmentation. In the case of smaller companies, in particular, it is prudent to review vacant territory strategies, evaluating the difference between covered and vacant territories and then using lateral thinking to find alternative ways to cover important vacant territory (mailings, symposia and face-to-face calls with selected KOLs all being viable options). Consideration of these influence networks and vacant territory strategies have led some companies to go for a complete restructuring of the sales force, or even its dismissal in favour of other techniques. Collaborative approaches, where the pharmaceutical company funds education or nurses, have proved a successful way to reach decision-makers, but may be beyond the reach of smaller companies. In a number of ways, technology can help companies evolve and execute their new marketing strategy. Reformulating targeting and segmentation is made much easier if you have the ability to map networks of influence, backed by up-to-date databases that offer the ability to create profile and identify links between individuals. Also invaluable is software to analyse the effectiveness of vacant territory strategies. Having this type of software can put small to medium organisations on a level footing with larger companies when it comes to getting their message across. Indeed, smaller players may actually have an advantage in that it is easier for them to change their business processes. The days of one message fits all are long gone. Pharma companies need to identify the KOL and then create the micro message that fits. In the past, a lack of detailed information made this impossible. Today, however, the systems are in place to gather detailed information that informs pharma companies on both the role of a KOL within the network and the issues that most affect that individual. Leveraging this information to deliver the micro message to the micro market will deliver a significant competitive advantage.

In the NHS, if 2005 is as interesting as 2004 we are in for a treat, and the fun has already started. It appears, according to a Health Service Journal report, that the NHS is currently some half a billion pounds in the red. As with many NHS affairs, some of the details seem surreal. One SHA, South London, was unable to supply financial data, and the report talks of the possibility of multi-million pound deficits being removed by finance directors working long hours and having late nights. What are they doing, printing money?

If a few accountants moving figures from one column to the next can solve the problem, then it can’t be concerned with real money. If the advent of Agenda for Change and the consultants contract are major contributory factors, why weren’t they part of the financial plan? If the NHS is having more money spent on it than ever before, where is the extra going? Why are hospitals closing wards and freezing vacant consultant posts, when the independent sector is setting up treatment centres like there’s no tomorrow? While we are on the subject, why are so-called “perverse incentives” allowed to exist? Isn’t it management’s job to get rid of such things? We are aware that part of the reason that the independent sector is allowed to run treatment centres is to “shake up” the NHS. However, could you believe that there is a master plan in Whitehall to drastically cut the provision of hospital services in favour of community- based care, which, if it were made public would be political suicide for the government? Rather they will simply let market forces mould the system, so that they are not to blame if hospitals have to close.
Answers on a postcard please, and . . . did you know what an “exemplar” was before the DoH used the word to describe a “patient journey” for a young person with chronic fatigue syndrome? We suspect that 99.9% of people (at a rough guess) would have had no idea that it was “an example to be followed” and many would have little idea why the Minister was talking about a “patient journey.” So why use unfriendly language? Is it because there are people employed in the NHS who, if they didn’t spend their time writing such stuff, would be out of a job. The Tories apparently want to sack some 30,000 managers, and it is sometimes difficult not to sympathise with them. What happened in December?

• Agenda for Change was, at last, rolled out
• More treatment centres were opened and five flagship surgical ones got £1.4 million a year to act as models of good practice.
• A review was published on how five-years-worth of the National Service Framework had affected the treatment of mental health and it concluded that, by-andlarge, things have improved, but there is still more to be done.

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• Guidance was issued on practice-led commissioning
• A Hepatitis C awareness campaign was launched.
• £3 million more was allocated to fight obesity
• Cash was allocated to improve the regulation of complementary medicine
• The Chief Executive’s report said what you would have expected it to say
• Guides and Frameworks, included: - HIV and AIDs in the African Community - Cutting heart disease among South Asians
• The 2003 Health Survey for England was published

Probably the biggest surprise in December in the chronic disease management sector was the sudden emergence into the limelight of a homegrown competitor to the Evercare and Kaiser systems. Apparently there has been a system in use in Castleford for years, but no one seemed to notice. Now we know that it is called the Unique System, we can all talk about it. Early in January an NHS and Social Care Model to Support Local Innovation and Integration, entitled Supporting People with Long Term Conditions was published, as the start of a major overhaul of the way health and social services work together, with Community Matrons at the heart of the system. Since home-based patients will need innovative technical support and especially IT support, a research proposal concerning the Role of Technology in Supporting Chronic Disease management was a very logical move.

As the premier source of knowledge about the way the English NHS works, the National Health Intelligence Service is a mine of up-to-date structured and “contexted” information, and its very bulk can be intimidating. If you think you are not yet getting the maximum benefit from your use of www.nhis.info and that you would profit from advice and/or training please contact us at .

THE CUSTOMER who greets you like a long lost relative, especially when they want you to take them out for a meal, the GP who keeps you waiting for the best part of an hour and then hardly looks up from their paperwork. What about that lovely being who sees every representative who walks through the doors – even on a Monday, or the elusive creature with the once a year highly prized appointment, why are they meeting with you? A recent survey conducted by Doctors.net.uk in November last year surveyed General Practitioners about drug representatives and provides an interesting picture as to how representatives are viewed by doctors.
Who sees representatives – and why? Of those 500 GPs questioned 84% said that they saw representatives, of these 67% want valuable information about products or to stay up to date with the latest clinical information. Only 7% are interested in what goodies you may have. However 8% are seeing you as a healthy person with a smile, presumably as a change from the rest of the population that step through the door – worth remembering when they ask, “How are you?” For those GPs that don’t want you to darken their doors the main reasons are that they feel that the information being provided can be found elsewhere, or that they do not trust representatives and that no added value is gained in meeting.

As suspected those that see daily are rare but lovely creatures and account for only 1% of the GPs surveyed. A quarter see representatives less frequently than one a month. In the “other” category that accounted for 65 of the responses 27% of these will see only at meetings. This is nearly 4% of the total GP population surveyed who see representatives – think how you can spend your budget wisely on increasing sales with these customers. In this area there is much less bias than you may have thought. Half of the GPs surveyed leave the choosing to the receptionist, who makes the appointments and selects who will or will not be seen. The next largest category is those reps that have a product of special interest to the doctor. This leaves 12% of GPs will only see representatives who they know already or from companies or products that they are familiar with. What leverage are you using to get to see these customers?

Do GPs see contract representatives as different from company representatives? 55% of GPs surveyed did not know of any difference between contract medical representatives and company reps. 2% thought contract sales people could be more pushy, and the same amount thought that they were generally less biased about the products they are promoting and therefore provided a fairer picture. 3% of GPs thought that contract sales people had better selling techniques and 5% thought that their product knowledge and knowledge of the disease and therapy area was less than a company representative selling the same product. So sometimes viewed from within the industry, as on a lower footing than a company representative this view is definitely not upheld with the main customer base

48% of GPs feel that it is important, or somewhat important to know the representatives they see, although we already know that generally it is the receptionists that decide who the doctors will see. What this does indicate is that although a well-known face may not help to get you in front of a customer, once you are there the customer is more receptive to listening to the discussions put forward by representatives. It is important they have already built some rapport with and knows the sales person on some level. This also is backed up by the fact that it is well recognised that more experienced representatives are often more successful than new company employees within a sales call. GPs may often feel that someone who they know is going to come back to them is more trustworthy than a representa- tive they have seem only the once.

So, is all the legwork really necessary? With the pharmaceutical industry investing millions in product promotion and sales force representation do the visits made by representatives change the doctor’s prescribing habits? Do they influence the management of different therapy areas? 54% of GPs agree that sometimes they will change their prescribing habits as a result of their meetings with pharmaceutical representatives. Compare this to 2% who say that they often do. This bears out the thought that a one off visit does not usually increase a product’s sales. Increased sales are as a result of repeated calling on a doctor, persuading him or her with balanced arguments and then getting them to try the product on a small number of patients, before getting commitment to a larger patient population for the product. Most advertising and promotion works along these lines with repeated exposure to a product eventually producing an increase in sales. So your coverage and frequency targets do have a use after all! 41% of GPs state that their prescribing habits seldom change as a result of their meetings with representatives and presumably these are the customers who need even more convincing. As to the 3% who never change what they prescribe – why are they seeing you? More to the point why are you seeing them? Are these the 3% who are only interested in your gifts for them!
So why do GPs see you? More than eight out of ten GPs do see representatives and of these, two thirds feel that you provide valuable information. Half feel that it is important to get to know you, and the vast majority admit to having their prescribing influenced by representatives. All you have to do is work out who is who!

Rachel Clark, Healthcare Development Executive, has worked for Solvay Healthcare for 5 years. She started with Solvay as a rookie rep calling on GP’s and hospitals for three years and has been in her current role as an HDE for 11/2 years covering the Southwest of England.

Pf asked Rachel: What is your role in a nutshell? I focus on long-term projects that positively influence Solvay products and foster a working partnership with a trust or PCO. They highlight mutual gains, shared objectives and focus on a real understanding of our targets and their healthcare objectives creating that WIN-WIN scenario. What is a typical day in the life of Rachel? I cover a large geography; therefore I spend most mornings travelling to see a key PCO customer and in the afternoon seeing key clinicians in hospital. No day is ever the same. I try to see a balance of Primary and Secondary Care customers, as their support is a must-have for success. What is the Sexiest part of your job as an HDE? The sexiest part of my job is when you manage to influence an entire local health economy by your work within the PCO and hospital, furthermore see the result of your products cash sales increase throughout the PCT. What attributes make you successful as an HDE? I think it is my ability to set up and build relationships. PCTs remain weary of the Industry and earning their trust is paramount. I feel the attributes of my success are: • Good knowledge of the NHS • Determination • Patience • Networking • Communication skills What is your biggest challenge Rachel? The biggest challenge for me is keeping at the forefront of the ever - changing NHS. I need to know the local needs and priorities of my customers. Customers would agree this is crucial for any successful working relationship/project. What advice would you give to a new HDE? Make NO assumptions, job titles and responsibilities vary. DO YOUR HOMEWORK and be prepared to speak confidently on any topic! Lucy Randle of STAR Medical offers the following advice on making the move to Healthcare Development Executive: Seek first to understand How many different titles have you come across which define to a greater or lesser extent what Rachel does? Healthcare Development Executive/Manager, NHS Liaison, PCO Representative . . . the list goes on. This type of work varies dramatically from company to company and even within divisions of the same organisation. If you are serious about moving your career in this direction then you must get a handle on the scope of the role and of course, clarity on the results you will be expected to deliver. Fundamentally the role will be the same (working with key NHS personnel to influence your territory sales) but the specifics can vary immensely. As a starter you should seek to understand: • Which customers will I have ownership for? • What will my objectives be? • How will I be measured? • How will I interact with the local representatives? • Who will I report to? Do you have the patience? Patience is a key attribute wherever you work within the UK Pharmaceutical industry. Nowhere is this truer than for Healthcare Development Executives who are tasked with meeting the needs of a local health economy. Due to the very nature of the customer base, quick wins‚ are rare. An ability to take the long term view and remain motivated is a pre-requisite for anyone thinking of a career as an HDE. Knowledge is power and change is a constant Due to the ever changing NHS environment you will need to be passionate about continually building and updating your knowledge. Success in this role is very often linked with a ‘bloodhound spirit’ - an unrelenting drive to understand the local and national picture and how your products fit into that picture. This may mean dedicating more of your own time to reading around the subject to help make the connections that aren’t immediately apparent. Unlike more direct product based selling you will need to have a far greater appreciation of the broader NHS environment and how this impacts on you and your products.

PHARMACEUTICAL COMPANIES live with the fact that a sales force involves ‘sunk costs’ to some extent. This is the time the company has paid for, but does not see any return on, such as travel, administration and making appointments. With huge pressure on sales and marketing costs, companies are now asking whether representative time can be used more effectively. Achieving more selling time within the day is one way to get a return on this cost and improve the bottom line. You’ve heard it before, but it is all about working smarter . . not necessarily harder. mediary, the on line appointment service, continues to grow from strength to strength. Over 130 representatives from more than 40 companies have already taken advantage of the FREE 14 day trial or participated in full pilots in key areas. These representatives have been able to get a taste of how mediary can help them, to maximise their time. Making appointments is part and parcel of a representative’s role but it is becoming an increasingly difficult task that is very time consuming for practice managers and representatives alike. With over 190 (Yes! it is not a mistake!) different representatives endeavouring to book and manage appointments with each practice, the days of phoning up and getting an appointment in a couple of minutes are long gone. What is involved in making those crucial appointments with medical professionals? Most representatives will be able to relate to the following:

• Several telephone calls over days to speak to the right person.
• Being continually asked to call back at a later date.
• Continual calls to target practices in search of cancellations.
• Afternoons spent ‘off the road’ phoning around.
• Often a few journeys to and from a surgery to book in person
• Having to call at a certain time, on a certain day
• Waiting for hours in queues at ‘book openings’

Keeping on top of appointments takes many hours in a week, so if the same appointments can be made in minutes on line, the time that is freed up can be used to make more calls on customers, as demonstrated by this recent event: At a ‘book opening’ recently, many representatives spent at least an hour and a half trying to secure 2 appointments for this year at a practice. Add in travel time, and effectively they spent the whole afternoon at this surgery. Several other representatives used mediary to book their appointments at the same surgery on line in about 2 minutes and did not have to attend the book opening. We asked what these mediary users were doing when the other representatives were waiting in the queue to get an appointment:

• Some saw extra GPs because with the majority of representatives at the book opening, mediary users had NO competition in seeing GPs in that area, that afternoon.
• Other mediary users completed pharmacy and hospital calls.
• One mediary user had other appointments to try and get that afternoon – booking some on line meant he had the time to secure all the appointments he needed.
• Another mediary user reported that she would have struggled to get to the book opening because she had an appointment with another key target scheduled. The GPs at the book opening were also key targets - booking on line meant she saw her targets and got key appointments too.

mediary enables representatives to be in more than one place at a time and the feed back has been excellent:

• Fantastic’ – it saved me hours - I booked 4 appointments in 10 minutes
• I’m impressed – I actually got to choose the appointment date and time most suitable for me! My patch is huge, I would have had to drive many miles – this took minutes.
• I think mediary is wonderful - I could match appointments to my diary, pick and choose suitable dates and all without taking up anyone else’s time.
• I wish more practices were using mediary – it makes my life so much easier.

It is estimated that the hourly cost of a representative is between £20 and £45. This is a very expensive way to secure appointments. Finding a less time consuming method to make appointments means that the representative cost is used more efficiently. The maximum cost to use mediary is £2.75 per day per representative but in the early stages is usually considerably less whilst there are a smaller number of practices using the service. With the new www.mediary121.net you can buy your transactions one by one, and still benefit from volume pricing. So, consider this; the average Representative costs over £30 per hour. That same cost can buy at least eleven days of the mediary service where minutes a day achieve the appointments that used to take hours, or days. With mediary121 you only ever pay for what you use, and if you exceed 10 transactions in less than 30 days anything over 10 is free up to the end of the thirtieth day. Finally, the mediary on-line notice board from and to practices invariably wins you extra sales calls. mediary sends thanks to all its new users. For those who have not yet capitalised on the free trial, the opportunity is still available. Your support of mediary contributes to maintaining and improving the access that the pharmaceutical industry needs to sustain its historic relationship with primary care..