FEWER BLOCKBUSTER products and an increase in parallel imports and generics, not to mention a UK health service changing more rapidly than at any time since its inception, and it is no wonder that the traditional pharmaceutical sales model is looking tired and out of date.
Two factors are contributing to the need for change. Firstly, the majority of products today are mid-sized brands that will never generate the massive revenues of the blockbusters. Hence pharma companies must spend their sales and marketing budget more effectively. Yet with a rapidly changing network of Key Opinion Leaders, from Primary Care Organisations (PCOs) to practicebased nurses, simply identifying and reaching those individuals who determine market success is becoming more complex.
A ‘one size fits all’ sales model, which has traditionally accounted for a massive percentage of the overall spend, is becoming less effective and less relevant to pharmaceutical companies today.
As the influence networks across the NHS change, pharmaceutical companies will need to develop different sales strategies to address every tier of that network. Sales personnel at each level will need different types of expertise, while their approach will need to be more sophisticated and to recognise the different types of interactions that will occur.
These highly-skilled, highly-paid sales individuals, tasked with addressing the bodies that play key roles in influencing NICE (such as the Royal Colleges and Patient Groups), must be able to take on a role akin to that of the political lobbyist. Interactions will be of longer duration, with issues being discussed at macro level: how therapies address NHS strategies, from long-term, and lifetime treatment of a condition, to cost control.
The profile of this sales team is far removed from that of the typical rep, going door-to-door to speak to GPs. And it is also very different from the new account management role required for liaison with the PCO – a tier of the sales strategy that is playing an increasingly key role as PCO formulary guidelines are laid down and local commissioning policies developed.
It is also vital to note that there is still an important role to be played by the traditional pharma sales rep – albeit one that reflects the multiple influences at practice level rather than simply focusing on GPs. However, it is essential that the messages are tailored to reflect the changing focus of the NHS and the shifting roles of practices – especially those that embrace Practice Based Commissioning and offer specialist services in areas such as dermatology.
The new messaging has to reflect changes in the way primary care is delivered. Indeed, as the emphasis shifts towards improved preventative care, pharma companies cannot continue to push therapies based on standard efficacy models. Today’s pharma field force requires far more in-depth knowledge about the role of a drug throughout the patient life cycle, its preventative potential and how best to use it within a complete treatment programme.
It is also becoming important to recognise the influence of the PCO at practice level; for example, regional variations in adherence to the PCO formulary are becoming apparent, while the adoption of local commissioning is far from uniform across the country. As Practice Based Commissioning becomes widespread, only those pharma companies that can empower the sales representative to deliver a message truly relevant to each specific practice will begin to maximise their sales effort.
As the multiple tiers of influence across the NHS continue to change and evolve, there can be little argument that the traditional pharma company sales force is losing effectiveness. Those companies that understand the new KOL networks and develop a highly-targeted, highlyfocused multi-tier sales strategy to deliver tailored messages to each audience will be best placed to succeed in the new NHS.

CRM: THE LINK TO IMPROVING REPORTING ACCURACY

By Nigel Huxtable, Managing Director, StayinFront

Staying in to move up

   It used to be the case that long service with an employer could almost guarantee that you would move up the career ladder. However, in most companies this is no longer the case: rather, promotional opportunities are given to those who consistently perform well and have the right skills and potential to move on and up within the organisation. If you want to get promoted within your company, there are several strategies you can employ in order to maximise your chances of success.

10 top tips on getting promoted
1. Be realistic. It may be expected that you will be in a role for a certain minimum period of time before you apply for another role. If you start as a representative and expect to become a manager within a year, you will probably be disappointed. 2. Success leads to recognition. Once you have started to develop a track record of good performance, you will be noticed by your seniors.
3. Willingness to learn. Demonstrate a desire to learn, to get involved and to contribute to the business as a whole.
4. Prove yourself. You will need to demonstrate that you have the ability to take on a new role with additional responsibility.
5. Know the expectations. Find out from your managers or from HR what you have to do to be considered for promotion.
6. Make your intentions known. During your appraisals, talk about your aspirations and find out whether they can be achieved.
7. Work with your superiors to help yourself. Encourage your superiors to support your ambitions. Agree a Personal Development Plan that states what training you need, what experience you should gain, and what they are expecting from you.
8. Know your competition. There will be other people within the company trying to go for the same roles. Find out about them and find out what you need to do to be considered over and above them.
9. Take control over your career. Do not simply expect or wait for it to happen, because then it probably won’t.
10. Network to raise your profile. Ensure that the right people know about you. Use your networking skills to build these relationships.

However, the reality is still that the actual opportunity for promotion is outside your control. It normally arises when somebody else has moved up within or out of the business, or when the company is expanding and has created a new role. In some cases the opportunity may come sooner than you were expecting, in others it may come later. There will always be an element of being in the right place at the right time. So even if you have ticked all the boxes and done all the right things, you may still have to be patient and wait for the opportunity to arise.

Moving out to move up

   If, for whatever reason, you have decided that the only way for you to move on and up in your career is to move out, you will face a number of hurdles that you need to prepare for: 1. If you have been in your current role for a number of years and have not been promoted, another mployer may think: “Why hasn’t this person been promoted? Maybe he/she is not good enough?”
2. Internal competition. A majority of companies would prefer to promote from within, as it looks better for them to have developed their own people. Most companies will consider internal applicants before external ones.
3. Do you have the right experience? If a company has not been able to promote from within, it will seek to employ an external candidate who has the relevant skills and experiences. For example, they are more likely to hire an experienced Area Sales Manager than take a risk on a hospital representative looking to move into a sales management role.
4. Some companies will offer you a similar role to the one you have applied for, with the potential for further opportunities to progress – but the latter cannot be guaranteed.
5. External competition. If a company has either advertised or briefed agencies that it will consider candidates with less experience, there will be many similar applications. You need to make sure that you stand out from the crowd and sell yourself. Give the recruiting manager a reason to see you, and then a reason to take the risk on you.

Top tips on moving out to gain promotion
1. Make yourself marketable. Gain as much experience as you can with your current employer.
2. Stand out from the crowd. Perform consistently at a high level, and make sure that your experience stands out when compared to the competition.
3. Research the market. Find out about the companies that interest you and what they are looking for.
4. Promote yourself. At exhibitions and other networking events, make yourself known to people in your target businesses.
5. Be realistic. Set yourself realistic goals regarding the type of job you are after and the amount of time it may take you to achieve this.
Should I stay or should I go?

   Finally, we return to the main question: what is the best way to get promoted? Getting promoted is not a given. In most organisations, hard work, good performance and contribution to the business will be noticed and hopefully rewarded. In theory, the best way to move on and up in your career should be to stay with your current employer, as your company will know you and know your potential. You will also have more opportunity to influence the selection process.

   If you find these things are not happening, you need to find out why. Is it due to a lack of opportunities? Or is it because the company just does not think you are right for the role you want? You will then need to consider your options and think about applying elsewhere. Darren Spevick is the Director of Novo Consulting who provide career consultancy, outsourced recruitment management services and interview skills training. To discuss your career or recruitment needs, please call 01923-854600 or email darren@novoconsulting.co.uk

10 top tips on getting promoted

1. Be realistic. It may be expected that you will be in a role for a certain minimum period of time before you apply for another role. If you start as a representative and expect to become a manager within a year, you will probably be disappointed.
2. Success leads to recognition. Once you have started to develop a track record of good performance, you will be noticed by your seniors.
3. Willingness to learn. Demonstrate a desire to learn, to get involved and to contribute to the business as a whole.
4. Prove yourself. You will need to demonstrate that you have the ability to take on a new role with additional responsibility.
5. Know the expectations. Find out from your managers or from HR what you have to do to be considered for promotion.
6. Make your intentions known. During your appraisals, talk about your aspirations and find out whether they can be achieved.
7. Work with your superiors to help yourself. Encourage your superiors to support your ambitions. Agree a Personal Development Plan that states what training you need, what experience you should gain, and what they are expecting from you.
8. Know your competition. There will be other people within the company trying to go for the same roles. Find out about them and find out what you need to do to be considered over and above them.
9. Take control over your career. Do not simply expect or wait for it to happen, because then it probably won’t.
10. Network to raise your profile. Ensure that the right people know about you. Use your networking skills to build these relationships.

   However, the reality is still that the actual opportunity for promotion is outside your control. It normally arises when somebody else has moved up within or out of the business, or when the company is expanding and has created a new role. In some cases the opportunity may come sooner than you were expecting, in others it may come later. There will always be an element of being in the right place at the right time. So even if you have ticked all the boxes and done all the right things, you may still have to be patient and wait for the opportunity to arise.

Moving out to move up

   If, for whatever reason, you have decided that the only way for you to move on and up in your career is to move out, you will face a number of hurdles that you need to prepare for:
1. If you have been in your current role for a number of years and have not been promoted, another employer may think: “Why hasn’t this person been promoted? Maybe he/she is not good enough?”
2. Internal competition. A majority of companies would prefer to promote from within, as it looks better for them to have developed their own people. Most companies will consider internal applicants before external ones.
3. Do you have the right experience? If a company has not been able to promote from within, it will seek to employ an external candidate who has the relevant skills and experiences. For example, they are more likely to hire an experienced Area Sales Manager than take a risk on a hospital representative looking to move into a sales management role.
4. Some companies will offer you a similar role to the one you have applied for, with the potential for further opportunities to progress – but the latter cannot be guaranteed.
5. External competition. If a company has either advertised or briefed agencies that it will consider candidates with less experience, there will be many similar applications. You need to make sure that you stand out from the crowd and sell yourself. Give the recruiting manager a reason to see you, and then a reason to take the risk on you.

Top tips on moving out to gain promotion
1. Make yourself marketable. Gain as much experience as you can with your current employer.
2. Stand out from the crowd. Perform consistently at a high level, and make sure that your experience stands out when compared to the competition.
3. Research the market. Find out about the companies that interest you and what they are looking for.
4. Promote yourself. At exhibitions and other networking events, make yourself known to people in your target businesses.
5. Be realistic. Set yourself realistic goals regarding the type of job you are after and the amount of time it may take you to achieve this.

Should I stay or should I go?
   Finally, we return to the main question: what is the best way to get promoted? Getting promoted is not a given. In most organisations, hard work, good performance and contribution to the business will be noticed and hopefully rewarded. In theory, the best way to move on and up in your career should be to stay with your current employer, as your company will know you and know your potential. You will also have more opportunity to influence the selection process.

   If you find these things are not happening, you need to find out why. Is it due to a lack of opportunities? Or is it because the company just does not think you are right for the role you want? You will then need to consider your options and think about applying elsewhere. Darren Spevick is the Director of Novo Consulting who provide career consultancy, outsourced recruitment management services and interview skills training. To discuss your career or recruitment needs, please call 01923-854600 or email darren@novoconsulting.co.uk

“Quite simply what sets us apart is our focus on patients. They are central to our strategy, we never forget that our medicines reduce suffering and improve the quality of life for millions of people in the UK.

“This fundamental principle of patient-focus drives our vision, that every eligible patient in the UK is prescribed a Roche product,” said John.

Continuing he explained that it’s with this simplicity of vision that he and his colleagues have built a dynamic, exciting and progressive company at the fore-front of UK patient care.

“I know that with a growing team of talented professionals we can unlock further potential in the UK market and deliver even more to patients.

“So confident are we of continued success we’ve just completed a £75m investment in new offices to house our 800-strong team.

“This group, responsible for innovative marketing solutions; training & development; NHS liaison; medicial support and ongoing sales force services; are justifiably buoyant as its oncology portfolio alone is now greater than the entire company was just five years ago.”

John added that he sees the diversity among his workforce as a distinct advantage, appreciating that differences of culture, professional background and ethnicity can be brought together by core values and a common vision that defines the organisation’s character.

Values
First among these values is teamwork because we know that by combining energies, skills and experience we can achieve more.

“But that doesn’t mean giving up individual autonomy, far from it, we encourage our employees to take ownership of their career development and actively look for people prepared to challenge the status quo and test out new ideas.

“This is evident in another of our core principles – a drive for change – essential as both personal and organisational change are integral to being part of such a dynamic company.

“It’s true we demand a lot from our people and our Performance Culture is very much in evidence. We reward people with competitive salary and benefits package and recognise outstanding performance with comprehensive aspirational and incentive schemes that encompass individual and team effort.”

Roche has already made a public commitment to transparency with stakeholders, physicians and patients and this carries through to the company’s values with open and honest communication inherent throughout the business and knowledge-sharing activities actively endorsed.

“Finally, and perhaps most importantly, we believe in a sense of urgency.

“Patients need life-saving and life-enhancing drugs now. That means each and every Roche employee must be prepared to tackle their role with a sense of urgency, particularly those in the field who play a vital role in conveying the qualities of our clinicallydifferentiated medicines amongst physicians and healthcare professionals,” said John.

Robust Pipeline
In addition to a vibrant culture, people are attracted to Roche for its exciting product portfolio and robust pipeline. Already a leader in the field of transplantation, cancer and viral diseases, such as HIV and Hepatitis C, the company is focused on healthcare solutions for the individual that target unmet medical needs.

Simon Harris, Head of Sales & Marketing for Hospital Products tells us more:

“Roche is, of course, well known for its oncology drugs with many of its treatments based on the molecular response profiles of tumours.

Jim spoke to Pf about his lifetime career with one company.

The BIG question most of us want to know is . . . what keeps Jim at Merck after all these years?
There is something special about Merck that encourages quite a number of people to stay. My current boss was my first training manager and now, 23 years later, as Head of HR, we are working together. I have many other colleagues who have been here during much of my time at Merck. The work environment it creates has encouraged lots of well-respected colleagues to develop their careers with Merck and share the satisfaction of helping Merck grow. These sort of special relationships make for a great culture and are a feature of working for Merck.

What are your main responsibilities?
The majority of my time is spent on recruitment and, consequently, over the years, I have seen many people join the company and go on to achieve great things and, therefore, share in Merck's on-going success. I am also involved in other areas like benchmarking, remuneration and benefits, the Company’s web site, staff feedback, and car policy.

What is your biggest challenge?
This is ensuring that Merck stays competitive in attracting new people and that the culture is one that encourages the ongoing success of both the company and the individuals within it. We conduct an annual telephone survey of a random sample of the field force to obtain their views on the climate within the company – what is going well, and what needs reviewing. We will adapt where possible in order to remain as effective and as competitive as we can and also add value to the job and to the company as a whole. It is a challenge to aim for the best possible culture in the Pharma Industry and we ask our employees for their thoughts to help us achieve this aim. Innovation is really important to the Company’s future success and we get some fantastic ideas from colleagues.

What is the sexiest part of being an HR Manager?
"I am not sure I would describe it as sexy…perhaps rewarding, often pleasurable, frequently challenging...and occasionally just crazy.” I am just high on the job . . . I love people. The reward of the HR role is playing a part in developing an environment which helps people to achieve success, whilst at the same time helping make Merck in the UK what it is today - a great company, full of great people making their contribution to a great culture!

What advice might you give someone considering a career in Human Resources?
I think the best advice I could give would be to always retain your belief in the power of people. If you stop believing in people and just how much they can achieve with trust and support, then "Cynicism Boulevard" is the next stop on the journey . . . and people will sense it.

What is it that makes people want to stay?
Why would you leave a successful company where you have enjoyed personal success, where you enjoy working with your colleagues to make a real difference and, after 23yrs, have many of my friends around me? Merck is an innovative, people-oriented company with a good reputation, great products and great people that I am proud to be part of. 2004 was the most successful year both in the UK and globally for Merck Pharmaceuticals. In 2004 and 2005, Merck was among the Financial Times Top 50 Places to Work, and was ranked 19th in the Guardian’s Top Employers Directory. These fantastic results are primarily based on the feedback of colleagues. They know what they are talking about!

Lucy Randle provides some insight into how to avoid career mistakes by thoroughly researching your potential new company’s culture:

Jim’s 23 year career history with Merck is testament to the fact that he made a very wise career choice and joined the right company with the right organisational culture for him all those years ago. Today, however, we are living in a society where frequent career changes seem to be more the norm. Candidates are increasingly comfortable moving from company to company to quickly build their skills/experiences and/or rapidly inflate their salaries. With more moves however, today’s candidates are at a greater risk of making career mistakes by joining organisations where there is little or no cultural fit. Here are some top tips to make sure you don’t fall into that trap;

THINGS HAVE JUST GOT DARKER – and it has not gone unnoticed by me, my colleagues, patients and patient groups and, of course, you – the pharma industry. Why are the omens for the immediate future not looking so good?

The waiting game

“Cuts keep patients waiting for drugs” – The Daily Telegraph, 20th August 2005

It’s the national sales conference season, and much is in the air. While you have been gathered together looking at sales targets, market share, new papers and licences, it seems that I and my colleagues are obstructing the availability of the products you are selling. In fact, “tens of thousands of patients face potentially fatal delays in receiving the best drugs for their diseases because of Government cuts” is the stark reality that looms over us all, affecting you, me and the patient in different ways.

The reality of the situation is not new – costs, savings, budgets – but the manner in which these problems have presented themselves to the patients and the general public is sending out shock waves of significant magnitude. Recall your last sales call – did your customers seem happy, proud and satisfied with their jobs? Or did they appear somewhat caught up in this complex decision-making process, burdened by intangible responsibilities, toeing party lines and, in some areas, compromised by clinical decisions based on short-term cost savings? “Doctors can prescribe a drug when the MHRA has licensed it; but in practice it is rare to get NHS funding until NICE has made a recommendation.”

Thus we have the following pattern repeating itself around the country. A new drug is launched, a company promotes it, the customers receive messages, physicians try to prescribe, but the process is blocked, prevented or blacklisted. Dig beneath the surface on your next call, and you may find that the doctor really wants to prescribe, but some pain-in-the-******** adviser like me won’t let it happen . . . Then the patient hears about a ‘new wonder drug’ and goes to see the doctor . . .

Talking in the dark

“Patients left in the dark about life-saving drugs” – The Daily Telegraph, 22nd August 2005

It now appears that “doctors are concealing treatment options that are not available on the NHS”. But why would they do this, when it conflicts with their own ethics? And when your company has spent a fortune researching, developing and marketing a new treatment?

The answer is actually quite logical. There is an interesting principle in psychology known as ‘cognitive dissonance’. This is an effect of the human desire to appear ‘rational’ to oneself (and others). Just look at the following experiment, which actually took place.

A young man was hypnotised and told to go to the shops, as he usually would on a Saturday afternoon. However, he was also told to carry out three anomalous tasks: take an umbrella, despite the fact that it was hot and sunny; buy some wine, despite the fact he was a teetotaller; and walk by a very long and unusual route. On his arrival back, the following discussion happened:

What’s striking about this is the fact that had we not been party to the ‘instillation’ of certain actions into the subject’s mind, this conversation would seem perfectly normal. But what is more astounding is the fact that when you read about this particular experiment in its full context, it is quite obvious that the subject was not lying: he truly believed in his answers.

This is the nature of cognitive dissonance. The subconscious mind has already thought about the answers to the questions before they ‘emerge’ into the conscious brain. Thus the subject, with no knowledge of the hypnotist’s instructions, will truly believe in the answers he or she provides.

What does this have to do with prescribing?

More than you might expect. When the doctor faces the patient, the doctor’s thoughts may run rather like this:

• The patient has breast cancer.

• There is a new drug for breast cancer that seems to be the best on the market.

• I am unable to prescribe this new drug for breast cancer.

• I want to do the best for my patients.

How does the doctor resolve this? Well, they may prescribe the drug – and get told off. They may be able to continue prescribing and getting told off, or they may actually not be allowed to prescribe the drug at all. In the latter case, there will be an ongoing conflict in the doctor’s mind, between wanting to do the best for the patient and believing they are not prescribing the best treatment available . . . In order to stop the brain suffering uncomfortable ‘dissonance’, the doctor needs to believe that

• Maybe I don’t want to give my patients the best treatment (don’t like the sound of this because it makes me look like a bad doctor!) . . .
  

  OR

• Maybe this new drug isn’t the best treatment available after all (mmm – plausible, maybe we need more evidence, maybe the drug has side-effects – either way, I am not a bad doctor for not using it).

Remember that many of these thought processes are unconscious. In the experiment I described earlier, the subject truly believed the reasons for what he had done – the alternative would have been that his behaviour was irrational. We can’t cope internally with a sense of unreason, so we ‘rationalise’.

Please think about this on your next call to a GP, prescribing lead or consultant. It’s important.

Looking for a guide

“Breast cancer sufferers fight for new drug” – The Daily Telegraph, 22nd August 2005

So why are we here? I find myself asking this question with increasing frequency. Am I here to treat patients? To save the Trust from financial disaster? To keep my head above water? I have many reservations about what the future holds, now that planning is turning into evolution. There are bodies, agencies and organisations telling me what drugs to approve and not approve, and there are different ones telling you how to promote, market and run educational meetings.

So have our jobs become simpler with all these people helping us? How can we reach our goals through this forest of policy enforcers? And if you and I are doing our jobs so wonderfully with guidance coming out of our ears, why is it that a group of women in the UK suffering from breast cancer are having to invoke the Human Rights Act to seek a Court Judgement in order to receive their chemotherapy – with the sad prospect that many of them will pass away before the Courts make a decision?

Welcome to the real world.

 OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on alipha@aol.com

Waiting Rooms
Some surgeries are a delight to wait in. The magazines are up to date, the staff are friendly and the patients are quiet. I imagine I am not the only rep to have been annoyed by the call of ‘Medical Rep to room four’ when I am in the middle of a gripping article in National Geographic about how Polar Bears hide from their prey. Usually I am, of course, happy to see a Doctor. They are after all one of our most important customers. But I consider it a perk of the job to be able to learn how to build my own PC from scratch with parts from old fridges and to read about how ‘I forgave my husband after he had a child with my best friend’. I have even been known to rip articles out of magazines to read later. There is a pile of them at home on my desk, next to the company branded stationery set which doesn’t get used.

Twenty minutes in a waiting room is not always a relaxing experience though. You will see me go white in an instant at the mere mention of a baby clinic. Then there are the surgeries that are, to be diplomatic, in need of some modernisation. You don’t want to sit on a chair for fear it would break and you would end up spending a sizeable proportion of your dwindling budget on replacement furniture.

And then there are the surgeries without magazines. These are the worst of all. What do people do in these waiting rooms? If I have to read once more that ‘If I was around in 1940 I could be at serious risk from Pneumococcal disease’, or spend another second of my time looking at that picture of a girl at a festival with a can of beer in her hand warning against the dangers of meningitis, I fear I shall rip the posters off the wall.

Yet there is a solution to waiting room hell, and it doesn’t involve laptops, planning or sales analysis. Just carry a good book everywhere you go. And write about your experiences. It makes you feel a lot better.

That’s all for this month. The Doctor is waiting for me in room four, and I am ready to see him now.

THERE ARE CURRENTLY 10,460 community pharmacies in England and Wales that dispense 665 million prescriptions per annum and are visited by over 6 million people every day. 80% of the typical community pharmacies turnover is derived from dispensing NHS prescriptions.
I worked as a community pharmacist between 1987 and 1995 for an independent pharmacy and a supermarket chain. During that time, the quality of the service I provided was mainly judged by how quickly I could dispense a prescription. The familiar cry from a patient who had to wait longer than they wanted was “But they’re only tablets!” based on a perception that community pharmacy was purely a supply function with no professional input required.
This perception among patients was often reinforced by other community pharmacists who did not provide any ‘additional services’, but saw themselves as running a ‘prescription factory’ with the focus purely on the number of prescriptions that could be dispensed within a given time period. This attitude was understandable, as most of a pharmacists’ NHS remuneration under the old contract was based on the number of prescriptions dispensed and not on the range and quality of other non-dispensing services provided.
This has all changed, however, and the new pharmacy contract introduced on April 1st 2005 focuses much more on the range of services that the community pharmacist provides, rather than on the volume of prescriptions that he/she dispenses.

The purpose of the new contract
In September 2000, the Department of Health publication Pharmacy in The Future stated that the existing national contractual framework for community pharmacy would be modernised to establish minimum standards and to promote and reward high-quality services, not just volume of prescriptions.

The new contract for community pharmacy aims to: