Of more than 100 NHS hospital trusts that have not achieved Foundation Trust status, only a third will do so, according to the King’s Fund.

The health think tank warned that ‘mergers’ with more financially robust trusts, the current most popular solution, will rarely be feasible.

The problems of making acute care services sustainable in FT terms are “systemic” and not caused by individual hospitals, said Candace Imison, King’s Fund Deputy Director of Policy.

Speaking at an event titled ‘NHS Providers: is Bigger Better?’, Imison observed that more than 100 of 248 trusts required to achieve FT status had not yet done so.

She warned that “the FT pipeline has almost dried up”, with only 14 FT authorisations in the last two years.

“The NHS Trust Development Authority reckons that only about a third of the current pipeline might proceed in their current form,” Imison noted.

The National Audit Office has predicted that 20 hospital trusts will not achieve FT status by 2014, and Imerson said that 17 of these have declared an intention to merge with bigger trusts.

However, she added, “the evidence is not great about mergers”, and other solutions – takeovers, franchises or shutdowns – were more likely.

Franchising by a private hospital chain such as Circle might be the most realistic option, Imison said.

Finally, she noted: “There is a real risk that we treat failure as a single organisational problem when the issue may well be a lot more systemic and linked to the overall configuration of services in a patch.”

Pf’s Iain Bate examines how contract sales organisations are taking their place among the industry heavyweights.

There can be little doubt that pharmaceutical employees – in particular sales and marketing executives – have taken some metaphorical hefty blows in recent times. All of pharma’s biggest heavyweights have announced ‘austerity’ measures as part of widespread job cuts across the majority of divisions in recent times.

Whilst pharmaceutical CEOs have enjoyed champion pay rises, the humble employee at ground level has been unable to duck and weave away from the dreaded knockout blow. As a result, the job market has been on the ropes. However, candidates searching for a career in the medical sales industry do not have to throw the towel in just yet.

The employment market has suffered many bumps and bruises in recent years – but Contract Sales Organisations (CSOs) are leading the fightback. Now regarded as a leading contender for those looking for a prolonged career in the medical sales industry, CSOs continue to punch above their
weight in a challenging environment.

Pf spoke to four leading CSO companies to provide a blow-by-blow account of how contract organisations have boxed clever in recent years. Why have they gained in popularity despite the employment market suffering a bloody nose? And what does the future hold for the contract sales movement?

The gloves are off

In the modern working environment, when uncertainty accompanies everyday challenges, the flexibility CSOs offer clients is a major attraction. “The fundamental driver is the requirement for an increase in flexibility from our biopharma customers,” says Helen Molloy, HR Director at Quintiles Commercial. “This is nothing new – but what has changed is the nature of that flexibility. It’s not just about numbers of people, it’s about expert teams with specific skill sets and evidence tailored address local priorities.

“Customers are increasingly looking to partner with us to help navigate challenges around proving cost effectiveness and long term value of a drug to a wider range of stakeholders. We are moving away from what has historically been seen to be the fundamental core of our services, and into much more specialised areas.”

Flexibility is certainly an attractive proposition for clients who have slimmed down sales teams yet still require the prowess to impress customers. However, flexibility isn’t the only factor driving CSO growth. Specialist skills are now required by clients to outwit the opposition. “Contract sales organisations are moving away from large-scale build, high noise proposition and are becoming much more specialist,”
says Emma Busby, Project Director at CHASE. “Organisations are demanding to have specialist skills and capabilities either to be equitable to their teams, or, in most cases, to offer more opportunity and more value within their teams. Their key objective is to heighten the level of capability that they have got on their headcount team.”

Pharma’s increased reliance on contract methodology is now reflected in the number of candidates turning to CSOs to develop a career in UK medical sales. “CSOs are becoming the only way into the industry,” says Emma. “We work with many blue-chip companies to provide an influx of trainees every year. Again those people go through organisations and develop. The trend went away from that for a few years, but it’s definitely coming back now. Companies recognise they need high-quality sales engagement. We can regurgitate skills but fresh attitudes and capabilities coming in will actually challenge the status quo.”

At a time when, as far as job security is concerned, pharmaceutical representatives fear the next barrage of punches, CSOs are doing more than ever to provide a shot at the big time in the industry. David Alexander, Contract Business Unit Team Leader at Star, says there are a number of reasons why CSOs have gained
in popularity recently. “Security, variety and skill development are key,” he said. “Working for a CSO
means people can move from one assignment to another and gather experience with different companies,
in different therapeutic areas and with different customers over time. Transferable skills and flexibility
are important qualities in today’s environment and working with a CSO will help people profile both.”

Swapping gloves

That value is also being recognised by clients seeking to boost sales at various stages of a brand’s life cycle. With the industry well on the way to manoeuvring itself away from the traditional sales model to a sophisticated fighting-fit key account approach, contract sales organisations are perfectly placed to augment teams or, in some cases, replace them. “A CSO can help do both,” says David. “It can either enhance a team or, if necessary, it can replace it. You can either have a bolt-on campaign, where contract reps target specific areas in fixed time periods, or, you can replace an entire team with a CSO key account team, enabling flexibility and resource in particular areas of the UK. This allows clients to be much more outcomes-focused.”

The next round

But what next for contract sales organisations? Will pharmaceutical companies decide to completely
shed their entire headcount and outsource functions to specialist organisations? Andy Holgate, Business
Unit Director from Ashfield In2Focus, believes this may be the case. “Contract sales organisations are expanding into new areas,” he says. “The model for CSOs in the next 20 years could be where pharmaceutical companies simply concentrate on research and development and strategic marketing and finance. Contract sales organisations will, potentially, then do all of the rest. I think that is the trend that CSOs are driving towards.

“We may be in a bit of a perfect storm at the moment where pharmaceutical companies, many of whom are being squeezed from above and are tinkering around the edges, are considering outsourcing services in areas where they would never previously have allocated external resource. Contract sales organisations are extremely good at being able to help pharma companies, and other clients, differentially resource people when and where they want them and when and where they don’t, be that in sales or other value-adding roles.”

In an austere environment when pharmaceutical companies are fighting against a whole host of external
pressures, it’s difficult to see how contract sales organisation will fail to grow in the coming years. The powerful combination of being an inviting proposition for individuals seeking a career in medical sales industry, and strategic allies for companies in need of flexible and specialist commercial expertise, CSOs are rapidly establishing themselves among the industry heavyweights.

A new medicines dictionary has been approved by the Department of Health in an attempt to reduce the chance of medical errors by NHS staff and healthcare professionals.

The NHS dictionary of medicines and devices (dm+d) provides a common language when referring to medicines to ensure information exchanged electronically is accurate and safe.

Dr Charles Gutteridge, National Clinical Director for Informatics at the Department of Health and Medical Director, Barts and the London NHS Trust, said the dictionary will mean “clearer and consistent communication throughout the NHS”.

“I encourage all clinicians to accelerate their use of this common medical dictionary for the benefit of the patients we care for.”

The dm+d is already used within the UK for the exchange of clinical information.

Scarborough and North East Yorkshire Healthcare Trust has officially merged with York Hospitals Foundation Trust after failing to gain foundation trust status.

The Trust has suffered financial difficulties for the past decade and health bosses decided a merger was required with the York trust to maintain high standards.

Patrick Crowley, Chief Executive of York Hospitals Foundation Trusts, says the merger is a “momentous occasion” as no two acute trusts within a 45 mile radius have ever merged together.

It’s reported that the newly-merged trust will be given additional funding towards the basic operational costs of the Scarborough trust – which has around 2,500 staff. The trust also received £8m last year as part of the deal.

“I’m looking forward to welcoming staff from Scarborough trust into our organisation and to hearing their ideas about how we can continue to provide the very best services for our patients,” said Mr Crowley.

He added that “much of the detailed work” will now be conducted to “integrate the two organisations” to generate the best results and services for patients.

The East Leicestershire and Rutland CCG has appointed its senior leadership team.

Graham Martin has been appointed as the CCG’s Chairman and Dr Dave Briggs as its Clinical Managing Director.

The CCG’s Board will be responsible for managing health services in Harborough, Rutland, Melton Mowbray and neighbouring towns.

The Leicester, Leicestershire and Rutland PCT cluster is currently handing over responsibility and budgets to three local CCGs.

Mr Martin is the retired head of a management consultancy firm and a former non-executive director of Nottingham City Hospital NHS Trust.

Dr Briggs is a Melton GP who has been interim Managing Director for the new CCG.

Mr Martin commented: “I’m looking forward to leading the CCG and working alongside the Board to develop innovative practical ideas for healthcare across East Leicestershire and Rutland.”

Outlining the CCG’s priorities, Dr Briggs said: “We remain focused on improving care and health outcomes for patients with chronic conditions and we are putting a particular focus on improving services for patients with dementia and tackling long-term conditions including diabetes and lung conditions.”

Stephen Whitehead outlines the ABPI’s latest initiatives to facilitate collaboration – and how sales professionals have a key part to play .

This year the ABPI is launching a Regional Partnership team to help the industry establish and develop sustainable relationships with the NHS at a regional level. The team, deploying experienced industry professionals in each of the four regional SHA clusters, aims to promote and facilitate collaborative working as a means to improve patient outcomes. Its key objectives are to identify and remove existing barriers to accessing innovative medicines, to help develop regional partnership projects and to share best practice across the country. The initiative reflects the growing recognition that improving patient health in a constrained financial environment will be best achieved by adopting a more collaborative approach. And there is an increasing consensus across both parties that, after years of developing adversarial relationships, the direction of travel towards NHS/industry partnerships is the right one for patient care.

But progress is an incremental process. The perceived cultural barriers that have historically plagued the relationship and impacted access will not be overcome overnight. “Trust and reputation has widely been acknowledged as an issue for industry – but it’s getting better,” says Stephen Whitehead, CEO at the ABPI. “In fact, it has dramatically improved. You can 12 see that from the Innovation, Health & Wealth (IHW) review: the NHS really wants to partner with pharma. In turn, as an industry we know that we are operating within restricted NHS budgets, and that we need to make it clear that we are not always there to sell something. Joint working is not about developing something that can help companies achieve a sales target on a quarterly basis, it’s about establishing a new way of working that will redefine the relationship between us and the customer. That will take time.”

In an evolutionary process, the ABPI appears determined to take the lead – to trail-blaze the concept of partnership working from a top-line strategic position and help ease the concerns of more anxious NHS customers. “The driving platform for joint working from the side of the industry should be the ABPI,” says Stephen. “We established the joint working protocol with the DH, and have developed the code of practice and regulatory infrastructure to enable it to happen. We’ve therefore created the headroom to allow partnerships to be established. Most parts of the NHS have understood and grasped this. It’s now up to us to lead, and for companies to take the opportunities within that.”

IMPROVING ACCESS

With access to NHS customers a perennial problem for UK pharma, the battle to develop the joint working agenda is a challenging one for individual companies. Medical sales professionals are tasked with advancing discussions, but attempts are often stymied due to diminishing levels of customer access. The ABPI believes its NHS Partnerships initiative will play a major part in raising awareness of partnership working, and overcoming access issues on an industry-wide basis. “NHS Partnerships will help industry
engage with key NHS stakeholders in England and ensure partnership conversations happen at a regional level. It’s not about individual products – we will not be talking about those – but we will be a facilitator of dialogue around joint working, aligned with the partnership principles set out by David Nicholson. We will be looking closely at the national issues on uptake and access, and any policy that emerges around that – and reinforcing it locally. Critically, NHS Partnerships isn’t the creation of ‘talking shops’, it’s about being able to facilitate on the key issues – which are fundamentally about access and uptake of innovation.”

NHS Partnerships has already been welcomed by the Department of Health, whose Director of Innovation & Service Improvement, Miles Ayling, said: “The ABPI partnership team will help build stronger links between industry and the NHS, as described in IHW. Beyond medicines, we are also looking at how all concerned can share skills, expertise and knowledge to improve the health of UK patients and help transform lives.”

REPUTATION

The long-standing issue of industry mistrust does, at long last, seem to be fading within the NHS. This was reflected in the ABPI’s seat at the top table of discussions around IHW last year, and has been reinforced by Stephen Whitehead’s involvement on the IHW Implementation Board. In addition to the partnerships initiative, the ABPI (along with ABHI) has also established a series of pilot projects with the NHS Confederation to look at how joint working can make a difference in selected disease areas. Pilots are already underway in mental health, circulatory diseases, diabetes and long-term conditions. “This is about providing examples of best practice within the NHS so customers can understand what we mean and establish that there is nothing for them to be worried about,” says Stephen.

“We have a strong status, but we’ve not yet fully utilised it in the context of joint working capability. That’s what these initiatives have been set up to do. This is a whole new world and a very exciting one – ten years ago we could never have had these relationships. But now that we are here, we need to approach customers gently and appropriately, and work with the NHS collaboratively and co-operatively to ensure that we dispel any of those old misunderstandings.”

And so, in the new environment, what role will sales professionals and Key Account Management play in NHS engagement? “The role of sales is evolving quite rapidly,” says Stephen. “Sales engagement is increasingly about liaison, as well as detailing around a product. It’s about facilitating collaborative working – and the salesforce has a key role to play in this.”

Many people with dementia are facing “barriers” to diagnosis and treatment at primary care level, according to a new Parliamentary report.

Only two-fifths of people with dementia in England are formally diagnosed, and referrals to memory clinics show “shocking variations”.

The All-Party Parliamentary Group on Dementia said that GPs often blocked access to support services by failing to make a diagnosis or referral.

The report echoes the recent statement by the National Audit Office that diabetes care is suffering through a shortage of GP referrals.

The ‘national dementia challenge’ launched by David Cameron in March called for early diagnosis and intervention to become the norm.

The new NHS Outcomes Framework notes that an indicator “needs to be developed” for “enhancing the quality of life for people with dementia”.

However, the Parliamentary report found that waits for referrals to memory services ranged from a few weeks to over a year, averaging three months – and many people received no support following diagnosis.

The proportion of people with dementia receiving a diagnosis was estimated as 41% in England – better than Wales (37.5%) but worse than Scotland (64.5%) or Northern Ireland (61.5%).

The report called for “major improvements” to local services, and for a national register to raise standards of dementia care.

Care Services Minister Paul Burstow stated: “We are driving forward measures to improve the quality of memory services, including work to increase the number of accredited memory services and work to help local commissioners map the need in their area.”

“It is quite clear that every part of the health service is going to have to adapt to the needs of this growing group of patients – from the GP surgery to the hospital ward,” commented Jo Webber, Deputy Policy Director, NHS Confederation.

NHS Warrington Clinical Commissioning Group has launched a new campaign to tackle medicines waste in the region.

Research found that more than £1m has been wasted on medication which has been left unused or stockpiled by residents in the town.

Dr Catherine Doyle, GP prescribing lead for Warrington, said patients should check around the home what medication they have before ordering repeat prescriptions.

Posters and leaflets will be distributed around GP surgeries and pharmacies in Warrington to help raise awareness of the issue.

A spokesperson for the CCG hoped the campaign would see patients working alongside healthcare professionals to address the problem.

“Once medicines have been prescribed and dispensed they cannot be recycled and have to be thrown away whether they’ve been used or not,” the spokesperson said.

“We hope to encourage people not to stockpile medicines and to only order what they need.”

The CCG estimates that around £300m is wasted across the country on unused medication annually.

Applications from all 35 clinical commissioning groups aiming for authorisation in ‘wave one’ have been submitted to the NHS Commissioning Board Authority on time.

The outcome of wave one applications will be announced by the Commissioning Board in October 2012.

Dame Barbara Hakin, National Director for Commissioning Development at the Board Authority, thanked the groups for their “energy and commitment” in meeting the 2 July deadline.

“I am delighted that the CCG authorisation process is beginning on schedule and that we have received all 35 applications in full from the CCGs in wave one,” she said.

The 212 developing CCGs across England must gain authorisation by the Board before becoming fully functional in April 2013. There are four planned waves of submissions in total, with the final applications needing to be made before November 2012.

In terms of competence, Dame Barbara said there was no difference between CCGs in the different waves. “Proposed CCGs in each wave will continue to develop throughout the year as they take on increasing responsibilities, and could have conditions set irrespective of the wave in which they are placed.”

CCGs are required to self-certify compliance in a number of areas and up to 19 core evidence documents.

Three of the largest CCGs, NHS Somerset CCG, NHS Gloucestershire CCG and NHS Oxfordshire CCG, are included in the first wave of submissions.

The full list of ‘wave one’ submissions is:

• NHS Bassetlaw CCG
• NHS Blackpool CCG
• NHS Bedfordshire CCG
• NHS Calderdale CCG
• NHS Cumbria CCG
• NHS Dudley CCG
• NHS East and North Herts CCG
• NHS East Leicestershire & Rutland CCG
• NHS East Riding CCG
• NHS Gloucestershire CCG
• NHS Great Yarmouth and Waveney CCG
• NHS Islington CCG
• NHS Kernow CCG (Cornwall)
• NHS Kingston CCG
• NHS Leicester City CCG
• NHS Liverpool CCG
• NHS Newbury and District CCG
• NHS North and West Reading CCG
• NHS North East Lincolnshire CCG
• NHS North Staffordshire CCG
• NHS Oldham CCG
• NHS Oxfordshire CCG
• NHS Portsmouth CCG
• NHS Rotherham CCG
• NHS Sandwell and West Birmingham CCG
• NHS Shropshire CCG
• NHS Somerset CCG
• NHS South Reading CCG
• NHS Stoke on Trent CCG
• NHS Wakefield CCG
• NHS Wandsworth CCG
• NHS Warrington CCG
• NHS West Cheshire CCG
• NHS West Leicestershire CCG
• NHS Wokingham CCG.