So why is pharma keeping so quiet about joint working?

Rumour has it that joint working is happening out there. The NHS and industry are, tentatively, beginning to grasp the benefits of partnership working. So why are most drug companies determined to keep details of their joint working projects a secret? Chris Ross reports.

Last week I received an email from a consultant pharmacist wishing to raise awareness of a partnership initiative that his Trust had undertaken with a pharmaceutical company. It was the third similar enquiry from a healthcare professional (HCP) in as many weeks. And it was an indication of just how far NHS-industry relations have come in the past decade.

Thirteen years ago I interviewed a handful of GPs to write an article on HCP attitudes towards pharma and, in particular, their willingness to work in partnership with drug companies. The subsequent piece was called “Sleeping with the Enemy” and it presented a rather cautionary tale of why NHS professionals were wary of “getting into bed” with pharma. Fast forward to 2011 and it’s clear that while both parties are still very much sleeping in separate beds, they have, metaphorically at least, begun to “co-habit” through a growing number of joint working projects designed to improve patient care.

Back in 1998, pharmaceutical companies were queuing up to position themselves as ‘partners to the NHS’. In turn, HCPs appeared keen to maintain their traditional, transactional relationships with the industry and to keep the suggestion of partnership at arm’s length. And as an increasing number of GPs installed “No Reps” signs in their surgery windows, the more proactive and visionary doctors that recognised the potential of partnering with industry preferred to keep a relatively low profile rather than risk developing a reputation for ‘sleeping with the enemy.’

Times have, of course, changed. The intervening years have not only seen exponential growth in the size, shape and identity of the industry’s customer-base, but the pressures of a failing economy have meant that NHS attitudes towards joint working have relaxed as demand on the service increases. But the biggest change, and indeed perhaps the biggest surprise, is that it now appears to be the NHS that seeks to promote its joint working initiatives.

The Government’s recent modification of its plans to establish GP Commissioning Consortia will see the emergence of ‘Clinical Commissioning Groups’, with support and cross-speciality advice provided by ‘Clinical Senates’. The apparent aim is to secure the involvement of the full range of clinical expertise in the commissioning of NHS services. The redrawing of the commissioning map will undoubtedly have major implications for the pharmaceutical industry’s sales and marketing strategies, but in truth, companies have been building relationships with a broader range of clinical decision-makers and influencers for many years. In fact, even in terms of fledgling partnership agreements, practitioners from right across the clinical team are increasingly getting involved in the implementation of joint working projects. What’s more, as they battle to demonstrate progress in line with their QIPP objectives, they are ever keen to raise awareness of the outcomes such initiatives have delivered. Since the turn of the year, Pharmaceutical Field has been approached by HCPs ranging from GPs and consultants to clinical pharmacists and specialist nurses, each seeking the oxygen of publicity for their joint working projects. It’s a far cry from inferences of Sleeping with the Enemy in 1998.

In the coming months, as the principle of partnering becomes more established, Pf will explore individual examples of joint working in more detail. But to do so, it needs the pharma industry to wriggle free from its self-imposed straitjacket of silence. At present, while their customers endeavour to raise wider awareness of their efforts, many pharmaceutical companies appear keen to keep their partnership cards close to their chests – preferring instead to preserve apparent competitive advantage by maintaining stereotypical corporate secrecy over their joint working strategies.

This is surely counter-productive. At such an early phase in the establishment of a partnership agenda, the most nagging question uninformed NHS professionals continue to ask are around definition. “What is joint working?” they implore. “What are the parameters of what we can do, and how do we go about doing it?”

Other than face-to-face human interaction, there are few better means of increasing understanding than practical demonstration. But too many examples of joint working remain locked in the basement of corporate HQ, in the process depriving potential stakeholders – from both the NHS and the industry – of insights into best practice that can help accelerate the collective progress of joint working and, more importantly, significantly benefit patient care.

Despite welcome signs that stakeholders within the NHS are becoming more open to the principle of joint working – and in some cases are willing to promote their involvement in it – progress to date has been limited. The early adopters are considerably outnumbered by the laggards. But the many in between offer great hope for pharma if it can look at the bigger picture and recognise the value of sharing best practice.

The industry still needs to drive the partnership agenda. According to the former Director-General of the ABPI, Dr Richard Barker, the industry is merely at base camp in the evolution of joint working. Progress, says Dr Barker, is all about attitude and will rely on a change of mindset. “The industry is changing. It knows it needs to prove the value of its products, not just their uniqueness. That value has to be in terms of improving the pathway of care and the outcomes for patients. If the new clinical consortia are going to be measured by outcomes and the industry’s products are going to be valued according to their outcomes, there’s an obvious marriage. We should be sitting down and talking about how we can improve the overall outcomes by creating value pathways, not just value products. That should be a natural conversation.”

Equally naturally, the conversation between pharma and NHS will most likely be delivered, from an industry perspective, by medical sales professionals. Once again this is an area where perceptions have needed to change. Mike Farrar CBE, Chief Executive of the NHS Confederation, says the relationship between NHS and industry has traditionally been perceived as an adversarial one best characterised by the image of the ‘pushy drug rep’. “Attitudes on both sides have begun to change,” he says. “There is now a much broader understanding that prescribing plays a massive part in care pathways and that without effective prescribing as part of an overall care package, some of the interventions being made can be undermined. As people have begun to understand care pathways, an increasing number of examples demonstrating the value of a good relationship have emerged.”

But those examples need to be shared, explored and, where possible, improved. And this is a collective responsibility. As Mike Farrar says, both parties must continue to demonstrate the benefits of what can be achieved by working together, to provide “almost a moral obligation that everyone should be exploring it.”

Mark Wilkinson, Director for Life Sciences Innovation and a key member of the NHS Life Sciences Innovation Delivery Board, says that partnership is a contact sport. “It’s all about building relationships,” he says. “The best joint working schemes have been where people have developed a mutual trust and, as a consequence, started to identify areas of common interest. Collaborative goals are important. NHS and pharma need to find those out.”

And so, almost 15 years since a BT ad campaign coined a national catchphrase, the pharma industry and the NHS are finally waking up to Bob Hoskins’ advice. It’s good to talk. Critics will argue that when it comes to partnership working, there’s been a lot of talk and not much action. This is largely true – people have been talking about the opportunity for over a decade and the rhetoric is still running ahead of the reality. This is underlined by the fact that conference presentations dedicated to joint working are, as Mike Farrar concedes, frequently delivered by the same voices imploring others to seize the opportunity.

But the debate does need to move beyond theory and rhetoric. Evidence that joint working works is growing all the time. It just needs to be shared with a wider audience. According to the experts, partnership working is built around the twin principles of transparency and disclosure. Ironic then that pharma seems to want to keep its activities such a secret. Advocates of partnership within the NHS appear more willing than ever to raise awareness of their joint working initiatives. Isn’t it about time that pharma did the same? It’s good to talk.

Parts of this article are taken from Partnership in Practice, HSP’s new publication for pharmaceutical sales professionals and NHS management. To download a digital copy of the first issue, please visit www.pharmafield.co.uk

Merck KGaA has submitted an application to the EMA to extend the indication of its leading multiple sclerosis (MS) treatment Rebif.

The requested extension is for the use in patients who have experienced a single demyelinating event and who are at high risk of converting to MS.

Dr Bernhard Kirschbaum, Head of Global Research and Development at Merck Serono, says the application is based on the results from the REFLEX study.

The study evaluated the effect of two different doses of Rebif – the currently approved 44mcg, three times a week and the 44mg once a week versus placebo – on the “Time to conversion to McDonald MS” in patients with a first clinical demyelinating event and having magnetic resonance imaging (MRI) brain scans consistent with early signs of MS.

The study met its primary endpoint for both doses by demonstrating it significantly delayed the conversion to McDonald MS in patients treated.

The HSA-free formulation of Rebif was used to conduct the study, which is now available in all EU countries, plus Australia, Canada and Switzerland, as well as a number of countries in Asia, Latin America, Africa and the Middle East.

The BioIndustry Association (BIA) and its counterpart in Canada BIOTECanada have signed a Memorandum of Understanding.

The two have agreed to work together to increase business opportunities for their member companies.

Peter Brenders, President and CEO of BIOTECanada, says he hopescompanies “prosper from the arrangement in years to come”.

The alliance aims to promote cooperation in bioscience in areas of mutual interest; increase the exchange of views in supporting the formulation and application of bioscience policy by Government; and facilitate interaction between officials, scientists and technologists.

Nigel Gaymond, BIA Chief Executive, commented on the agreement: “The BIA is delighted to have established this partnership with BIOTECanada and we look forward to working together with them in future.

“This collaboration recognises the significance of the Canadian biotech sector and its potential for partnerships between our members and BIOTECanada’s members.”

A lack of a strategic and competitive recruitment process often sees organisations miss out on finding the right people. Apodi’s Tony Swift examines what companies can do to drive improved performance through excellence in team recruitment.

It is unfortunate but the majority of companies do not measure the impact their recruitment processes have on performance. This may well explain why, in many companies, the establishment of a world-class recruitment process is not seen as a strategic imperative.

However, there is overwhelming evidence that recruitment processes are critical in helping companies achieve the performance they need to deliver success. Very few companies measure the effects of recruitment, but those that do, quote improvements in productivity of between 25% and 600% when recruiting a top performer over an average one.

In some sectors, such as sport, it is immediately obvious the effect that good recruitment has on a team’s performance. Even in companies who deploy standard recruitment processes, key executives will acknowledge that recruitment is strategically important and yet will often do little to change the situation.

Extensive research on performance, such as Jim Collins’s Good to Great, expresses the view that getting the right people is a more important factor on performance than any other key process in the business.

Senior executives in most companies are driven by similar agendas and these often include the following key issues; that budgets are tight and the need to control costs, driving performance, and finding the best people.

All of the above make sense but, when we examine what these companies are actually doing to find the best people, we are struck by the fact that:

· Their recruitment processes are very similar

· These processes make it a challenge to find the best people, and

· Few companies have established world-class recruitment processes as a strategic imperative.

So, whilst the evidence is clear that excellent recruitment can drive performance and that companies want to employ the best people, very few companies are actually doing what it takes to establish world-class recruitment processes to actually make this happen.

Recruitment – a strategic must

Companies with world-class recruitment processes have all firstly established that these are of strategic importance. Then they have implemented most, if not all, of the following elements:

· A business case has been made to, and accepted by, senior management and other stakeholders that great recruitment is a fundamental necessity

· To aggressively seek out the best recruits, rather than implement a traditional and rather benign recruitment process

· The goals of the recruitment function will include:

· The recruitment department will be managed as an industry-leading strategic function

· The company aims to dominate the talent market in the industry

· The recruitment function aims to build the pre-eminent talent acquisition department in the industry

· The recruitment function aims to be agile, responsive to demand and cost effective.

· In terms of importance, the leader of the recruitment function will be at least equal to the executive leaders of other core business departments, and

· The success or otherwise of the department will be measurable and visible.

Clearly, some of these elements will depend on the size of the organisation but, even for smaller organisations that might not be able to dominate their industry, these goals can be realigned but still be part of a strategic thrust.

For example, in English football the recruitment market has been dominated for several years by just a few clubs – Manchester United, Arsenal, Chelsea and, latterly, Manchester City. There is clearly no way that a team in the lower divisions can compete with these clubs. But they can establish superb recruitment processes to compete effectively with similar clubs and move forward as a result.

I was involved with Bath Rugby Club when it was on a journey to world-class performance. It always out-recruited its immediate competitors, improved performance and moved to the next level until it reached the point where it could attract the very best and dominate the recruitment market. During this journey, recruitment was always viewed as strategically important and central to the club’s ambitions.

The holistic approach

To secure the best people a holistic approach should be taken to recruitment that encompasses the following:

· The offer – why a candidate will want to join the company

· The recruitment process itself

· Performance management, development and motivation.

Initially, the offer has to be sufficiently attractive to persuade people to join the company. Management must then identify any mistakes made – hiring mistakes can always happen – and then ensure that top quality people are developed, motivated and treated appropriately. It is a prerequisite that to maximise performance, each of these elements are implemented successfully.

The average solution

Whilst many firms state they want to attract the best people, they actually deploy very similar recruitment processes to their competitors. Companies adopting ‘me too’ recruitment strategies cannot expect dramatic improvements in performance. This can only come from doing things differently and better, and benchmarking processes and practices with the very best in the industry.

A case study: A primary care sales team. Most sales teams are recruited in the same way. A salary package is developed, comparable with the competitors in the market. Preferred recruitment consultants provide candidates from their databases at the time. Interviews and assessment centres are used to choose the best candidates. Occasionally, internal candidates are available for interview and bounty schemes are sometimes introduced to encourage existing staff to recommend people from their own networks. The process is usually managed by HR with input from sales managers, and the whole procedure is normally ‘off the radar’ of senior management who never receive appropriate metrics assessing the effectiveness of their organisation’s recruitment.

The world-class solution

At first glance you may say that there is not much wrong with the average process. It is Apodi’s view that such an approach, rather than guaranteeing companies will attract the best, more often than not, ensures that they will not.

Here are some of the characteristics of world-class recruitment processes that companies must adopt if they are to attract the best and drive performance:

The offer: the offer itself has to attract the best. The constituent parts of the offer can include the package, additional benefits, the culture, line management and so on. These have to be better than those offered by competitors and often should be customised to the individual candidate. Of course, some companies simply do not have the resources to recruit the best for every position. Therefore, it is important to prioritise those positions that will have the most impact on performance and focus recruitment resources on these.

Recruit top talent from rivals: most companies tend to rely solely on third-party agencies to identify candidates for them. Unfortunately, the number of top performers on the databases of agencies is often low. Such people tend to be coveted by their existing employers and need to be enticed away. Direct poaching is an aggressive recruitment strategy, but it is extremely important if you want to attract the best.

Continuous recruiting and workforce planning: turning recruitment off and on like a tap is ultimately ineffective. Companies need to continually plan for changes in the workforce and constantly be monitoring the market to identify who and where the top performers are. Recruitment is a continuous process that should operate independently of short term revenue fluctuations.

Respect the recruitment department:

in sport, recruiters and scouts are a critical part of the management team. In films and theatre, the casting manager is held in high regard. In both sport and the arts, senior management takes a huge interest in who is being recruited to the team and know how important their recruiters are. Sadly, in many businesses this just isn’t the case.

Integrate recruitment and performance management: even companies with strong recruitment processes can still fail to drive the company to the required performance levels. Mistakes may still be made, although these will be fewer if the recruitment processes are effective. Companies should assume a percentage of failure in recruitment and ensure that performance management identifies inappropriate hires and replaces them rapidly with new outstanding recruits.

Unfortunately, some companies allow poor performing individuals to remain in a position for too long, which can have a catastrophic impact on performance, particularly if they are in important roles.

Assess for talent and attitude first – competencies second: whilst experience can play an important part in succeeding within a role, talent and attitude are non negotiable attributes that all successful candidates must have. Unfortunately very few assessment processes are set up to identify the talents required for the role and whether individual candidates actually have those talents.

Recruit proven performers: top sporting organisations always look for proven performers. Even the youngsters they recruit have already excelled at their age group and have displayed the talents required to fulfil the role. It is extremely risky to rely on training to develop skills.

These are just some of the characteristics of great recruitment practice, although unfortunately they are not always evident in an organisation.

From average upwards

Apodi has developed a model to transform recruitment processes that drive performance within organisations. This model is a step-by-step approach which all companies can follow and show rapid improvements.

The model includes:

· Obtaining senior management
buy in

· Establishing and training the recruitment team

· Establishing simple but world-class recruitment, performance management and performance development processes, and

· Developing key metrics to measure the success of the new processes.

As with most things in business there is no magic ingredient. But success depends on the superb execution of relatively simple processes that transform performance beyond the capabilities of competitors and into something truly special.

Tony Swift is the Managing Director of Apodi.

Professor Bernard Crump, the Chief Executive of the NHS Institute for Innovation and Improvement, has decided to take early retirement.

The departing Chief Executive has lead the Institute since it was formed in 2005 and will officially retire after honouring a secondment at the Academy of Medical Royal Colleges.

Professor Crump says he has “taken the opportunity to consider his future at this time of transition”.

The Institute is to be restructured under the Government’s plans to save £180 million by reducing arm’s length bodies with certain functions earmarked to go to the NHS Commissioning Board.

His decision comes at a time when pharma and the NHS have been encouraged to use innovation as a basis for joint working.

Mr Crump is the third senior figure to announce their departure from the NHS or the DH within a week. Clare Chapman, DH Director General of Workforce, and Christine Connelly, DH Chief Information Officer, both recently revealed they would be leaving their roles.

After eight weeks of pausing, listening and reflecting, and a whole host of Health Bill amendments, NHIS’s Hannah Boylin asks, has anything really changed?

The last few weeks have been privy to twists and u-turns galore; the Government has listened to the Future Forum, who themselves listened to all concerned parties and, as a result of it all, the Health Bill has been recommitted to the Commons with some 181 amendments (and potentially more to follow).

Clegg and his Lib Dem posse are beaming from ear to ear as it appears their demands have been met (you may recall, back in May, Mr Clegg put his foot down and refused to support the Bill unless “substantial changes” were made). And the parties in the coalition are once again BFFs, with many predicting that the amended Bill will sail through Parliament as a result of renewed support from the Lib Dems.

It would seem, then, that everything is fine and dandy in the world of NHS reforms; the changes so desperately sought have been made and the Health Bill is laughing all the way to, well, being made law.

And yet, at the BMA’s Annual Representatives Meeting in Cardiff this week the majority of attendees (59%) decided that – despite the amendments – the association should call for the scrapping of the whole reform package.

At this point, you may – like me – have an overwhelming sense of déjà vu. Was it not at a Special Representatives Meeting only in March that these exact sentiments were expressed? And did chair, Dr Hamish Meldrum, not state – quite plainly – that he did not support the Health Bill?

It was.

So after a nationwide tour of the Future Forum, eight weeks of pausing, listening and reflecting, and a whole host of amendments, it would seem that the critics are not quite placated and we are still in the same position. (Actually, that’s a little unfair. Meldrum seems to have been won over this time, and actually called for the motion to be defeated – although it is unclear whether this is through his own conviction in the reforms or in resignation of the fact that the Government are unlikely to accommodate further change).

However, the fact remains that despite the Government’s best efforts, the NHS reforms are still plagued by distrust: recent HSJ articles report that “Proposed commissioning groups will be ‘unsustainable’” and “‘Specialist’ doctors on CCG boards could be GPs”, rather than the hospital doctors that were promised.

Further, the overriding opinion expressed at the BMA’s meeting was that the Government had simply sold the profession a ‘respray job’. Dr Jacqui Davis argued that “competition is still there, rebranded as choice, foundation trusts are still there with no cap on private patients”.

Whether or not this is indeed the case – that the Government have merely dressed the reforms up differently – is something that could be debated over and over. However, the bigger issue (surely) is how we move forward. With the NHS still acting as ‘ball’ in a game of political football, will a happy medium ever be found; or will we merely continue in this cycle of discontent?

For, while the discussion rages on, there is still a £15-20 billion efficiency saving to be made. And we can’t forget the NHS staff who, despite being incredibly de-motivated, still manage to do a good job for their patients. Perhaps it’s time that the Government and their critics sit down, put their claws away and actually listen to each other, before we push it too far and lose the talent that has this far given us an NHS to be proud of.

Hannah Boylin is Editor & PR Manager at NHiS.

NHiS provides healthcare organisations with insight based solutions, to assist engagement with NHS customers and to ensure patient and commercial outcomes are optimised.

Contact the author: hannah.boylin@nhis.info

Novartis’ Votubia (everolimus) has been granted a positive opinion by the CHMP for patients aged three or above with subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC).

The Committee’s decision is based on a Phase II study which showed that 78% of patients experienced a reduction of 30% or more in the size of their largest SEGA and a third saw a reduction of more than 50% at six months.

Hervé Hoppenot, President of Novartis Oncology, says the positive opinion is “encouraging” news for patients.

Votubia would become the first medication available for relevant patients in the European Union (EU).

SEGAs, or benign brain tumours, occur in up a fifth of patients with TSC. The condition is a genetic disorder which affects between one to two million people worldwide. In Europe, there are an estimated nine cases per 100,000 people.

The CHMP’s recommendation has now been passed on to the European Commission. A final decision is expected within the next three months.

“Our focus on tuberous sclerosis complex research reflects the commitment Novartis has made to develop innovative therapies to help address unmet medical needs,” said. Hervé Hoppenot.

UK surgical instrument firms that outsource their manufacturing to Pakistan are putting patients at risk of injury and infection, according to a BBC Panorama report.

Factories in Pakistan used by most UK surgical instrument suppliers have a significant rate of mechanical faults and biological contamination, the programme claimed.

Two-thirds of the world’s surgical instruments are manufactured in the city of Sialkot in northern Pakistan, where 70% of the UK’s registered surgical instrument manufacturers are based.

Panorama found evidence of small firms in Sialkot inspecting finished surgical instruments only with the naked eye, or outsourcing manufacture to backstreet workshops that lacked quality control.

Faults observed in the instruments included rough edges, steel burrs and corroded metals. These are a possible cause of MRSA infections, because fragments of steel can penetrate surgical gloves and damaged surfaces can trap biological materials.

Barts and the London NHS Trust, the only Trust to check every surgical instrument rigorously, rejects almost 20% of them as potentially unsafe, the programme claimed.

Tom Brophy, technologist at Barts, said: “On more than one occasion a supplier has rung me up and said that the instrument you rejected, I passed it onto another hospital and they accepted it. Of course they’re going to accept it, because they haven’t checked it.”

He also said that he had received used instruments, contaminated with blood, being sold as new.

MHRA commented that it had “no evidence that non-compliant instruments are being supplied to the NHS”.

The programme follows reports on child labour and dangerous working conditions in the manufacture of medical equipment in Pakistan.

The prospect of a simpler and cheaper patent system for UK medical technology manufacturers has moved closer with agreement on the details of a single EU patent by the Competitiveness Council in Luxembourg.

Ministers agreed on a general approach to the Regulations for the new unitary patent, and these will be adopted later in the year.

Significant aspects of the agreement include technical details of the unitary patent and the first ever consensus on the languages regime: the number of translations that applicants need to file.

The unitary patent, valid in all 25 EU countries, is expected to reduce the cost of patent translation by up to 80%.

“The creation of a single European patent and patent court is crucial for UK industry,” said UK Intellectual Property Minister Baroness Wilcox. “The savings to UK business are likely to be around £20 million per year in translation costs alone.”

A recent study of intellectual property by Professor Ian Hargreaves found that establishing a unitary patent could increase UK business revenues by over £2 billion a year.

Currently, businesses seeking Europe-wide patent protection can either apply for national patents in each country or apply for a European Patent: a bundle of national patents that must be litigated in each state, and usually must be translated into each national language.

Disagreement on the languages regime has held back the project of a single European patent for 60 years. In March 2011, the 25 EU countries agreed to create a unitary patent system.

Team Sky, a British professional road bicycle racing team, has adopted UK wound care company Systagenix as its official supplier.

Members of the team, which includes Olympic cyclist Bradley Wiggins, have used the company’s Tielle Lite dressing to assist with the healing of cuts and grazes.

Designed for sporting use, Tielle Lite provides a seal for the wound regardless of weather, movement or sweating.

Dr Maher al-Ausi of Team Sky’s medical staff commented that Tielle Lite “is very practical as it can be applied in the first instance for uncontaminated abrasions. Given time the border actually appears to adhere even better, meaning that riders can travel in comfort before a dressing change two or three days later without the worry of leakage and infection.”

Cyclist Alex Dowsett said: “You crash and... you’ve got at least a week of sticking to bed sheets because you try to leave the wounds open so that they dry quicker. But with a Systagenix Tielle Lite dressing you just leave it on and don’t really have to worry about it. When you take it off it doesn’t stick to the wound bed. Everything has just healed up a lot quicker.”

 
Alex Dowsett with Tielle Lite dressing