NHS engagement is about combining thorough market intelligence with a robust targeting plan.

The imminent authorisation of the first wave of Clinical Commissioning Groups (CCGs) promises to provide Key Account Managers with yet more information on which they can base their call strategies. By November, 35 CCGs will hope to have successfully navigated the comprehensive authorisation process and be approved to take on their new commissioning duties from April 2013. A further 177 prospective CCGs will be reviewed across the final three authorisation waves, with decisions on all the new local organisations expected by the end of January 2013. The dawn of a new era for commissioning is almost upon us. And as the reform rhetoric turns into reality, a new customer landscape for UK pharma will have emerged.

The four-wave authorisation process will place into the public domain a wide range of important documentation that was required not only to support individual CCG applications but, more importantly, to provide strategic blueprints for the long-term development of these embryonic local health organisations. Key documents include Joint Strategic Needs Assessments, Commissioning Intentions, Integrated Plans, Joint Health & Wellbeing Strategies, Organisational Structure Plans and draft Joint Commissioning Agreements. In some of the more proactive local organisations, such information is already available.

Elsewhere, it remains in late-stage development. Either way, the data and plans set out in these documents will undoubtedly provide crucial insights for KAMs targeting existing, new and emerging decision-makers and influencers at the local level.

And therein lies the problem. Identifying the most important and influential stakeholders in a changing NHS remains one of UK pharma’s biggest challenges. Earlier this year, the NHS Alliance’s Chief Officer, Mike Sobanja, said that the industry was about to embark on a game of ‘Spot the Commissioner’. He was not wrong. But to win, medical sales professionals tasked with the responsibility for identifying and developing key customer accounts must take the gaming metaphor a stage further and set about playing a conventional game of ‘Guess Who?’ Unfortunately, winning won’t be child’s play – it will require an insightful and educated approach.

But guess who, indeed. The current reorganisation of the NHS is bringing an increasing number of players to the table. Alongside CCGs, the Department of Health has recently published further details on the establishment of 27 Local Area Teams (LATs). Ten of these will be specialist commissioning hubs; the remainder will be afforded a variety of commissioning responsibilities. In addition, commissioning will be supported by 12 Clinical Senates, whose full remit is, as yet, unclear. Beyond this, the NHS Commissioning Board (NHS CB) – which itself will exert major influence over local commissioning plans – has more recently rebranded commissioning support services as Commissioning Support Units (CSUs). The NHS CB is currently conducting an authorisation process that will determine which organisations will provide ‘scale services’ to support CCGs – and has approved 23 to date. Critics claim the new CSUs look suspiciously like PCTs.

Regardless, it’s clear that in the very near future, pharma will find some of its key customers are housed in a CSU. They will also reside in fledgling Health & Wellbeing Boards. Undoubtedly, the new commissioning landscape will present a complex customer matrix for the industry.

Such is the speed and scale of the reforms that targeting customers in an environment that appears to be changing on a daily basis could easily be reduced to a guessing game. But pharma’s approach needs to be much more sophisticated than that. KAMs know that the old-school ‘noise-based’ approach to customer engagement will no longer work. Call plans must be targeted and efficient. But how?

Guess who?
The challenge really is like playing a giant NHS-themed game of Guess Who? Figuratively, every KAM has their own game board. The characters on it will differ, in terms of remit and influence, from one local health economy to another. And they will also be dependent upon disease area. A fully comprehensive board will comprise a mixture of clinicians and payers, as well as, potentially, influencers from social care and local authorities. Crucially, the game is as much about ruling out irrelevant customers as it is about identifying key targets. The former will determine the latter. The most adept sales professionals will be those who command sufficient market knowledge to be able to discern between an important stakeholder and a non-starter. They will then be able to use this information to form an efficient call strategy. Market data will clearly inform these targeting decisions. And there is a lot of it out there.

The imminent arrival of strategic documentation emanating from the CCG authorisation process will be just the latest in a deep mine of useful NHS data available to the industry. From QOF data to QIPP plans, HES data to CQUIN frameworks, the modern NHS is generating performance data, indicators and metrics at a rapid rate of knots. Used properly, it can be gold dust.

Local health organisations are being measured on their ability to eliminate variation in care, reduce hospital admissions and improve health outcomes. And they are increasingly required to report on how they are faring against these objectives. Proactive KAMs can use this data to develop messages that target commissioners of care and demonstrate how their drugs can impact service delivery in line with known priorities.

But data is only part of the answer. On its own, information is not enough. Success will only come from having an understanding of what it means, and establishing how it can be targeted in the right direction. A KAM can have all the data in the world, but if they are not able to translate it into an offering that demonstrates a meaningful gain for a customer, it is worthless.

The key account management game of Guess Who? will ultimately be led by the messaging you have developed, which, in turn, will have been driven by local circumstances and those customer needs identified within relevant market data. If you have a health economic message, certain clinical customers can be ruled out. If your value proposition can make a difference to a QOF target, once again, it will dictate a more precise customer group and eliminate others.

The rapidly expanding availability of NHS information promises great national and local insights for KAMs – and the Department of Health’s recently published Information Strategy indicates that a growing emphasis is being placed on the need to capitalise on the promise of data to drive improvements in patient care. But medical sales professionals must not lose sight of the fact that once they have reviewed all the available data and determined their product messaging, they still need to identify the key customers with whom those messages will most resonate. And they must then tackle the industry’s other long-standing challenge: gaining access to them. Having something to offer that can help customers meet their own objectives provides the best possible chance to achieve this.

So it’s clear that, faced with an evolving NHS bedeviled by rising demand, reduced resources and major reorganisation, productive industry engagement will only come through the development of a market access strategy that marries environmental intelligence with accurate customer targeting. This all links back to the need to establish a robust CRM strategy that integrates all aspects of customer data into a single platform, and communicates them effectively and efficiently across the commercial organisation. This approach will prevent KAMs going off in different directions and developing flawed strategies based on poorly-interpreted information.

In a dynamic, fast-changing market, only meaningful engagement that communicates the right message to the right customers will make any discernible difference. Anything else will be pure guesswork.

David Round is General Manager, UK at Cegedim Relationship Management.

The Health & Social Care Bill has finally completed its arduous passage through parliament. In normal circumstances, the landmark of Royal Assent would provide a key moment of clarity for the future of the healthcare in the UK. But this is the NHS – and nothing is ever that simple. Whichever way you look, the health service is bedevilled by variability. NHS Alliance CEO Mike Sobanja and Cegedim Relationship Management’s David Round look at the implications of the Bill for industry in the next 12 months.

The Health & Social Care Bill has, as we all suspected it would, survived the onslaught and made the statute book. But the hard work really does start here. In truth, implementation of the reforms on the ground began many months ago – but the process will continue for some years to come. It is a time of great uncertainty for NHS and industry alike. We now have official confirmation of where we are heading, but do we really know how we are going to get there? And with health need omnipresent, what should we be doing to protect the needs of patients today as we journey towards the health system of tomorrow? The wider call is for more collaborative working between the industry and the NHS. And there is much that the industry can do to support the significant challenges its customers face.

So where are we now? And what do pharmaceutical companies, facing an NHS in flux and customer groups in transition, need to do to support the health service and drive improvements in care? At a time of uncertainty, the industry must first do two things: follow the law, and follow the money.

Following the law and the money
At the moment – in law – we still have the presence of 151 Primary Care Trusts (PCTs). These are, of course, clustering together, while alongside them a high number of Clinical Commissioning Groups (CCGs) are steadily being established. For now, however, PCTs remain legally responsible for the delivery of healthcare services in the UK – and will continue to do so until April 2013. PCTs are currently accountable for about 80% of a total NHS budget of roughly £110 billion. It is estimated that approximately £30 billion of this has already been delegated to around 250 CCGs. But whilst PCTs can legitimately delegate their powers, they cannot delegate accountability. If someone in a shadow CCG busts the budget or, worse still, a patient dies by virtue of a poor decision elsewhere – the ultimate responsibility still lies with the PCT.

The situation on the ground is therefore complicated. Power currently rests with a number of PCT clusters acting on behalf of still legal and existing PCTs, who are delegating cash and power on the ground to CCGs. In turn, the CCGs are enjoying increasing control over finances, though technically, they are not yet legally in existence.

So if the task for 2012 is to follow the law and follow the money, pharma must focus on developing its powers of local intelligence. The fundamentals are simple, but the devil is in the detail. The law tells us who is technically responsible, the money tells us who has been delegated the power and the pound. The £30 billion question for pharma, however, is: where has the money been delegated? And the answer, of course, varies from locality to locality.

Developing the knowledge: think local, and national
And so the industry is playing a new game called ‘Spot the Commissioner’. To compete, pharmaceutical companies – and in particular their field-based professionals – need to build and maintain knowledge of local circumstances that, to a large extent, they’ve not previously had.

The move towards a localised health service is a direction of travel rather than an absolute. Moving forward, the industry perhaps needs to view the NHS as a healthcare system that operates within a national framework, but with more local decision-making. The balance of power between local and national is dependent upon which aspect of the healthcare service, and which therapeutic area, is being discussed. NICE provides a good example. In theory, the statutes require that funding is made available for technology appraisals as formal TAGs within three months of NICE making a declaration. But the reality is that whereas NICE doesn’t have to consider affordability, local decision-makers do – and therefore exactly how they implement that will inform their local decision.

As such, pharmaceutical sales professionals need to keep one eye on the national scene and one eye on the local scene – and apply that knowledge to their individual therapeutic area. They need to think very hard about how any national decisions will affect their product at a local territory level. The promotion of pharmaceuticals has moved beyond the traditional sequential sale – it is now much more sophisticated. This sophistication is only likely to increase in the future. An example of this will be the introduction of Health and Wellbeing Boards. These are already establishing under the umbrella of local authorities and will bring together interests from a wide variety of other groups: employers, magistrates, courts, local authorities etc. These will have a significant influence on local health services.

Variability: process, progress and prescribing
In such a changing and dynamic customer marketplace, the challenge of playing Spot the Commissioner becomes ever more difficult. Ironically, the only one constant is the prevalence of variability. There is variability right across the system, particularly in terms of progress around the health reforms. For example, there are local areas adjacent to one another where one locality has seen significant lawful delegation of powers to CCGs, while its neighbours have seen very little. This variability is likely to continue for some time – beyond the point where CCGs are authorised as official legal bodies. Authorisation itself is not a simple ‘yes’ or ‘no’ – it may be conditional. A conditional authorisation may mean that a CCG has power to make decisions over some things, but not others. A CCG may, for example, be authorised to commission acute services locally, but not mental health services.

At a wider level, variability in local progress with NHS reforms is surpassed by the even more significant issue of variability in care across the UK. The introduction of the Atlas of Variation in November 2010 has brought the issue into much sharper national focus and highlighted areas where progress can be made. There is, of course, variability in every disease area. Here are two very different examples. For patients with type II diabetes, the likelihood of suffering a lower leg amputation as a result of the disease is greater in the South West of England than it is in the South East. On the other hand, around the issue of cancer referral times, there is huge variation across the country in terms of GPs referring patients to secondary care for earlier diagnosis. The latter is an example of variability in health care – the former is a great illustration of variability in health outcomes.

Addressing inappropriate variability is a key priority for the NHS. And it is an area where the pharmaceutical industry can help make a real difference. Pharma companies could start by looking at the variability in the prescribing of their own products. If they can identify where that variability is and draw it to the attention of the health service locally, they will be better placed to offer support to help address it. The industry could consider undertaking Health Equity Audits to generate disease-specific data to support commissioning. For example, if you are a sales professional, what could you tell a customer about how your therapy is used in terms of its distribution among social classes, poor or rich and ethnic groups? What can you say about its relative prescribing across geographical areas? This is key information. It’s likely that there will be all kinds of variability going on that the industry could be helping the NHS address – and in doing so, it will also drive the market. By combining publicly-available prescribing data with activity data and other readily-available metrics, companies can improve their sales and marketing strategies by providing customers with the best information to help inform commissioning decisions.

The value of data
Robust data and information is the lifeblood of good commissioning, and good commissioning is the lifeblood of good health outcomes. At present, few, if any, commissioners will have complete and comprehensive access to the right data on which they can base critical commissioning decisions. But, in a collaborative environment, many would be willing to work with the industry to help create that evidence-base. As the NHS restructure unfolds, pharma can be a credible source of information for commissioners – though probably only one of a number of sources. Increasingly the health service will seek to identify data itself, and the Atlas of Variation is a good example of that. Increasingly, there are good examples of joint working where parties have come together and delivered results. In a collaborative era, wracked by challenge and change, the industry and the NHS have a responsibility to develop that relationship further.

Pharma can certainly emerge as a valuable partner to the NHS as it moves through its transition. But the generation and communication of robust and relevant data will be key to progress. In the game of Spot the Commissioner, the best sales professionals will be those who understand the local situation, understand what is driving it and align their key messages so that they are seen as part of the solution, not part of the problem. Undoubtedly, access to good data will underpin everything.

Mike Sobanja is CEO, NHS Alliance. David Round is General Manager, Cegedim Relationship Management.

Tracking and responding to NHS change in a highly competitive Olympic year will be a test of endurance for medical sales professionals. In a light-hearted article, David Round examines why winning a place amongst the medals will depend upon getting your preparation right.

It’s a well-worn cliché that a little knowledge is a dangerous thing. But as the UK pharmaceutical industry heads into an Olympic year when the pace of change amongst its NHS customer-base will undoubtedly increase, medical sales professionals will need to demonstrate more than a little knowledge to achieve a podium position for their products. The Health and Social Care Bill may still be some way from the finishing line, but as the health service continues its transition towards the seemingly inevitable, changes on the ground are already taking place. And the implications for pharma are huge. The industry cannot afford to sit and wait – it needs to act now to ensure its sales and marketing communications are reaching the right customers, with the right message at the right time. For pharmaceutical sales executives, it’s about developing more than knowledge: it’s a question of intelligence. And the answers may be right at their fingertips.

It has been widely documented that the NHS is working its way through a period of unprecedented change – both in its working practices and, of course, in its organisational structure. As a result, pharmaceutical companies – often criticised for being ‘data rich but information poor’ – will, more than ever before, need to maximise their data assets to deliver a more customer-centric approach to selling. And sales professionals will need to draw on all the information at their disposal to develop and deliver relevant and robust value propositions that satisfy customer need.

The noise-driven, share of voice model of pharmaceutical sales and marketing has become like Monty Python’s parrot: it has ceased to be. Today’s approach, which relies on a reduction in call volumes, is less linear, more selective and much more sophisticated. Key Account Management is leading the industry pack. But whilst the approach is, in theory, more measured, making it work requires quality customer data as a platform to identify ‘key accounts’ and, crucially, the ability to translate that data into meaningful market intelligence. Companies are becoming much smarter in segmenting their key customers – but faced with moving targets across a changing NHS, maintaining the accuracy, and in the process the efficiency, of the approach is not easy. It is, however, imperative.

The race to reform
The transition towards the new environment is already well under way. Last year in England 152 Primary Care Trusts (PCTs) were reorganised into 51 PCT Clusters of variable size, while the ten Strategic Health Authorities (SHAs) were restructured to form four large regional clusters. By April 2013, PCTs and SHAs will be extinct and Clinical Commissioning Groups (CCGs) and the National Commissioning Board will spearhead the commissioning of NHS services under a new-look structure. If you throw into the mix the onset of Clinical Senates, Health and Wellbeing Boards and new Commissioning Support units (which may well emerge as private organisations and therefore new customers), it is easy to see that an already complex customer matrix is set to become even more complicated. And that’s simply the start line.

Critics of the reforms claim that the situation on the ground is fast approaching chaos within the NHS, as the wider organisation struggles to implement changes even before the Health and Social Care Bill has achieved Royal Assent. But in the interim period while the health service readies itself for the inevitable, UK pharmaceutical companies cannot afford to let their sales and marketing operations become similarly chaotic. Tracking and more importantly responding to change throughout the transition period will be vital for medical sales professionals if they are to support their customers through the metamorphosis and, in the process, meet their own commercial objectives.

Access to quality data that can not only enable Account Managers to make the right targeting decisions, but can also help them engage in the most appropriate customer dialogue, will be critical to success. It is not simply a case of knowing who to target – understanding why and how they should be approached is equally important. It is this understanding that separates knowledge from intelligence. And separates winners from also-rans.

Keeping on track
Sales professionals not only need to identify their ‘key accounts’, they also need to understand the varied environments in which these individuals operate. What challenges do they face? What are their key priorities? Do they carry out more than one role – or sit on a variety of boards and committees in addition to their main job? If so, how does this impact their spheres of influence? How pivotal are they in driving service redesign, influencing formulary decisions, or facilitating joint working within their local organisation? Where do their roles and their needs overlap with your product or service?

This is standard market access. And it’s vital. Pharmaceutical sales professionals need to define how they engage with the NHS and why their customers should want to engage with them. They need to establish how they are going to deliver value and improve outcomes for the health service and its patients. And to achieve this, they must understand their local health economy, its priorities and objectives, and identify the key stakeholders whom they can help support to meet those needs. What is the structure of the local organisation? What is its indicative budget and its strategic plan? Who is responsible for commissioning in your disease area? What areas are emerging Commissioning Support Units going to be supporting commissioning in – and what are they not? As PCT clusters evolve and CCGs take shape, which customers are most relevant today, and how relevant will they be tomorrow or indeed in two years’ time? Only by tracking customers in real time as they make their transitional journey towards the new NHS can sales professionals be sure that their interactions are aligned with that change, and be prepared to respond accordingly when required.

Technology in a team sport
The Key Account Manager in the modern market must, therefore, have the mental preparation of an Olympic athlete – but work on the basis that the race is never won. The NHS is a dynamic marketplace where change is continual. The Key Account teams that are best able to track, capture and share intelligence will be best placed to emerge victorious. The role of the Key Account Manager is, after all, an individual pursuit in a team sport.

The tools to support ‘informed’ Account Management are already here. Customer Relationship Management (CRM) systems that help capture and share vital customer intelligence have been in common currency across the UK drug sector for many years. But never before has their value to the medical sales professional been so important. Industry surveys suggest that CRM usage amongst front-line sales professionals could still be improved – and this is essential. CRM systems are only as good as the data that is put into them. But when collected and shared properly, that data is there to help medical sales professionals. In a fast-evolving customer environment that will almost certainly intensify as the NHS continues its inexorable march towards a new structure, key account management can only be enhanced by the knowledge and intelligence a good CRM system can help deliver.

In fact, the sheer volume of likely NHS change in the next 12 months could provide a catalyst for 2012 to become the year when CRM finally comes of age. And those sales professionals who recognise its potential to significantly support customer interactions – and make for a more intelligent and appropriate engagement – will undoubtedly reap the rewards.

But the time to act is now. In an Olympic year, the fast track is the only option. After all, a little knowledge is a dangerous thing.

David Round is UK General Manager, Cegedim Relationship Management.

Despite huge investments into CRM systems some pharma companies still struggle to get all of their staff to embrace and fully interact with them. Pf’s Iain Bate explores why, and what the future holds for technology in the industry.

There’s no doubt that technological developments have changed the way we live and work from year to year – maybe even from month to month in the 21st Century. But has the world of healthcare been travelling in the slow lane of the intergalactic highway?

The potential that technology offers to pharma, and the general world of healthcare, is enormous. But is the pharmaceutical industry, and its staff in particular, using it to maximise the returns of billion-dollar investments?

It would seem that technology is the ‘buzz word’ on the lips of a few of healthcare’s major players at present. The DH recently invited people to nominate their favourite health-related mobile phone ‘app’ – be it for keeping fit, to locate a hospital or chemist, or helping to manage an illness. Creative minds were also asked to design their own health app with a panel of DH judges deciding on their favourite from the most popular entries.

Health Secretary Andrew Lansley says it’s the Government’s intention to give people better access to information using modern technology and the exercise is a “unique opportunity for the NHS and those who develop apps to not only showcase their work, but to bring to life new ideas and realise true innovation in healthcare”.

As part of the DH’s technology revolution, patients may also soon be offered online consultations with their GPs using programmes such as Skype. Clearly the Government is embracing the convenience technology offers to patients, but are other sectors in healthcare as interested? It would seem there is still some way to go.

 

In two minds

Pf ’s 2010/11 annual Company Perception, Motivation and Satisfaction Survey suggests that not all respondents are completely convinced by the power of technology in the workplace. Although the Survey – which relates to 2010 and the early part of this year – found that nearly 90% of respondents have access to a CRM system, only 43% find time to use it in the field and more than a fifth of people fail to accurately record post-call reports with important clients.

Questions have to be asked as to why, despite multimillion pound investment and training by pharma companies, there remains a percentage of staff that still ignore the power and potential of the technology at their finger tips.

Results from the Survey reveal there’s no difference in uptake by key account managers, primary and secondary care representatives, those in primary care roles only, firstline sales managers and secondline sales managers and the use of CRM technology between differing age groups – although surprisingly 10% of respondents in these positions with less than two years of experience said they did not have a CRM system, compared to just 5% more experienced colleagues.

The launch of the iPad in March 2010 promised to revolutionise the way sales representatives, and those in similar roles, use CRM systems in the field. However, nearly three-quarters (70%) of respondents from the Survey are still presently sent out with laptops containing their customer-relationship systems.

When quizzed on what they’d change about the hardware which houses their system, the majority of respondents said that their CRM was too awkward to carry, with poor running systems an issue and that batteries ran out too quickly. Apple claims its second-generation iPad now enjoys ten hours of use away from a plug socket in the field.

Yet the switch to the latest convenient tablet devices may not necessarily be about high levels of investment, it may be down to maximising value for money as Paul Shawah, Vice President, Multi Channel Strategy, Veeva Systems explains. “I would say the life cycle of devices within the industry is generally about three years, sometimes a little bit longer,” he said. “When a company invests in new technology they typically depreciate that over that period, so they don’t want to replace it in the field for that time to maximise their investment.

“However, with the introduction of game changing technology like the iPad, this has changed. We see a number of our pharmaceutical customers are justifying the business case to move to the iPad even before their tablets are fully depreciated. This speaks to the business benefit that pharma expects to achieve from the iPad and the related applications only available on that device.”

A convenient shield

Despite technology eliminating mundane process in the workplace and offering the potential to assist employees and improve their efficiency at work, it has historically been used as a shield to mask poor performance and abused as a means to waste company time – a recent online survey by AOL found that nearly half of Americans (44.7%) rank surfing the web as their primary activity during the two hours they ‘waste’ each day at work.

But it would seem that a high number of respondents do value the opportunities CRM offers. Almost two-thirds (64%) said they always enter correctly the amount of customer sales they make into their CRM. But 21% admitted they fail to always report face-to-face meetings with clients. More surprisingly, over a fifth of participants said they do not always record the number of products they had sold to clients.

The lack of honest accuracy is surprising considering the amount of time spent using CRM systems each day. A third said they spend between one and two hours a day on their system with a fifth spending three hours or more on their CRM. During their time using the management system, more than half (55%) said that call reporting was the most useful feature.

Although respondents were less impressed with the KAM abilities of their software with only 19% believing it to be the most useful facility. When questioned about what they would change given the chance, 45% said they wanted an improved database, over a quarter (28%) called for their system to be overall more useful, and 18% said they would prefer their CRM to be easier to use.

 

The next level

But what of the future of CRM systems? Will they be easier to use and have improved customer databases? David Round, General Manager, UK, Cegedim Relationship Management, says the regular interaction we now have with technology means we’ve all come to expect the latest developments.

“End users are significantly more ‘technology-savvy’ than their counterparts of even five years ago,” he explained. “If anything, the challenge for companies is to ensure that they provide their end users with the types of technology that they use as consumers. It’s also important to focus on the usability of your software to ensure maximum use. Technology companies – and pharma – must work together to develop a better understanding of the interaction, to ensure it meets users’ needs in the field.”

One main reason that users have become more ‘savvy’ is down to the use and interaction with social media. Whether at home or at work, websites such as Twitter, Facebook, LinkedIn and most recently Google+ have driven an increased use of various forms of technology – especially on devices such as smartphones or tablet devices which reps are calling for in the field.

Pharma companies, both in the US and UK, have flirted with the idea of fully embracing the power social media harnesses, but at present are restricted by the PMCPA’s Code of Practice and by the FDA – who has again delayed the publication of its guidance.

The FDA says it is “difficult to provide a timeframe... due to the extensive work and review process, or ‘Good Guidance Practices’, which ensures that FDA’s stakeholders are provided well vetted guidances articulating FDA’s current thinking on a topic”.

Although the FDA may be unsure on how to direct healthcare companies, David Round believes the introduction, both professionally and personally, of social media has had an impact on staff and their expectations.

“For the modern professional person, much of their everyday life is conducted online – for example on shopping, utilities, insurance or booking a holiday – and many users then want the same level of capability from the tools they use in their job,” he added.

Dan Goldsmith, General Manager, Veeva Europe, agrees there has been a significant shift in the way we operate and interact due to our experiences online through tagged posts or hash-tagged searches. But although the 800 million users on Facebook – more than half which ‘log-on’ every day – and 175 million people on Twitter have no problem saying hello to friends, pharma finds it more difficult reaching out to people.

“Social media create a new avenue for healthcare dialogue and will only continue to pervade our lives,” said Dan. “Consequently, I believe that pharma faces two challenges. The first is to decide how to participate in the online dialogue with stakeholders and then to create those interactions through the channels we’re all familiar with, such as Facebook and Twitter.

“The second is to figure out how to leverage the model of social dialogue internally to support stronger collaboration and more focused communication among employees. Already, we see some companies taking advantage of the latest social business tools to connect employees with one another and to access and share information in real time.”

Clearly CRM solution providers understand the potential modern technology and social media platforms offer to companies. Whether pharma and its workforce get fully up to speed on the intergalactic highway sooner or later remains to be seen.

The amendments in the Health Bill to the commissioning landscape may have
been small but they are significant for pharma. David Round (pictured) outlines the
implications of these changes to the care pathway and the new opportunities
for joint working.

The dust is beginning to settle on the amendments to the Health and Social Care Bill and it is now time to assess just what the changes in commissioning structure will mean in practice. How will the renamed Clinical Commissioning Groups (CCG) approach the creation of care pathways? Will there be much change from the model used by the previous Primary Care Trust (PCT), or will these new organisations opt for a ‘business as
usual’ approach where possible in order to simply get commissioning processes up and running in a timely fashion?

And what opportunities does the increasingly local focus on commissioning provide pharmaceutical companies to deliver added value services over and above drug products
that are increasingly viewed as a commodity across the NHS?

For pharmaceutical companies the good news is that the changes to the Bill, following the ‘pause and listen’ process, are not overwhelming. The coalition Government has accepted
many of the recommendations of the NHS Future Forum but the essence of the shift towards greater local commissioning remains the same.

The newly created GP Commissioning Consortia (GPCC) remain in place – albeit under the new name of CCG to reflect the inclusion of nursing and hospital consultants on the main board. The pressure is also off CCGs to be ready for the 2013 deadline – although those that are ready will be able to proceed with their commissioning plans sooner. In areas where CCGs are not ready to undertake commissioning duties, the National Commissioning Board will take over from the PCT Clusters for an interim period.

There is also a move towards greater local accountability, with CCGs now required to consult with a raft of new local bodies, including Clinical Senates – responsible for ensuring
CCG clinical plans are robust and meet local requirements – local NHS Commissioning Boards, and Health and Well Being Boards.

New constellations

All of these groups will have an influence on the evolution of the care pathway and must, therefore, be considered within the pharmaceutical market access strategy. Clinical Senates will work alongside the existing clinical networks – such as cancer networks – to ensure CCGs take local and disease specific requirements into consideration. If the Clinical Senate believes that care pathway plans are not good enough it can recommend the NHS Commissioning Board steps in before the CCG is authorised to act as a commissioning group.

As yet, the makeup of these Clinical Senates and local NHS Commissioning Boards is not clear. However, with the continuing exodus from PCTs, there is no doubt that some familiar names will reappear in these new roles.

It is also clear that there is a fast developing gap between the most advanced CCGs and the rest. Some, indeed, have already set their clinical priorities and are looking at care pathways. Within this process, these CCGs will have taken into account the views and concerns of local clinicians and local clinical requirements. The difference now is that there will be formal bodies in place to undertake that local clinical accountability.

For pharmaceutical companies the message remains consistent: market access strategy success will depend upon gaining an in depth insight into not only the CCGs and the speed
with which they are progressing and embarking towards clinical decision making, but also understanding the new influencers within the Clinical Senates and local NHS Commissioning
Boards.

Understanding the mission

However, there is one change to the Bill that also presents significant opportunities to pharmaceutical companies – the decision to place medical research at the centre of the
NHS mission. Under the amended proposals, ­The Secretary of State for Health will be given a statutory duty to promote research, while the new CCGs will be actively required to encourage research, innovation and the use of scientific evidence through their decisions.

This move is fundamental, and addresses criticism that the original Bill did not encourage doctors to make use of improved therapies or the latest evidence on clinical best practice.

For pharmaceutical companies, this shift in emphasis opens the door towards more innovative, cooperative working; and for embarking on joint working initiatives with CCGs. It also ensures doctors and pharmacists will continue to be involved in research projects, from clinical research to patient care, patient outcomes and procedures.

Indeed, some of the CCGs are already actively seeking more opportunities to get involved in programmes and projects that can deliver better patient outcomes by reconfiguring patient services. These leading groups want to work with pharmaceutical companies on research projects that could, if successful, be rolled out across a number of CCGs and allow them to deliver care pathways that meet budgetary constraints.

One big leap

For pharmaceutical companies this will necessitate a new approach. It may require a shift in budget towards a significant up-front investment in developing a new service within a
CCG with a view to recouping that investment further down the line when the service is successful. Fortunately, with companies no longer able or willing to spend money on certain promotional items and activities due to ABPI code changes and the new Bribery Act, there are opportunities to redirect funds towards such programmes.

Key to the success of such joint working is openness: both pharmaceutical companies and the NHS need to clearly understand the benefits to both sides of the venture. ­The  pharmaceutical company cannot simply put in a new service in order to improve product sales; that will not work in today’s NHS. The emphasis must be on implementing a service
that raises the profile of the disease area, which in turn leads to an increase in the whole market – generating additional sales – but reduces the overall burden of the disease on the
local health economy. For the NHS, there will be an investment in resource that effectively identifies certain types of disease earlier, enabling cost savings through improved preventative care.

There is a valid concern amongst smaller and medium-sized pharmaceutical companies that they simply cannot fund joint initiatives on this scale. Feedback from the NHS suggests that companies will be encouraged, even expected, to band together to create a joint working partnership.

Looking into outer space these changes are significant. But they are also taking place within an environment of increasing financial constraint. It is essential that pharmaceutical companies understand the genesis of change; to identify the changes in care pathway and patient pathway that are occurring as a result of natural budgetary restraint and those that
are a direct result of the shift in commissioning structure.

Armed with this insight, companies can ensure messaging remains valid and effectively targeted and reflects the changes that can and are being made by CCGs. Messaging must
reflect the huge pressure on CCGs to reduce costs whilst also improving patient outcomes. And it must recognise the fact that many of these organisations are and will be looking
for partners that can offer innovative solutions and services – from specific procedures to drugs or devices – proven to meet these objectives.

It is those organisations that can take that messaging, that can identify and engage with the CCG vanguard and, where appropriate, embark upon joint initiatives that can be extended over time that will be well placed to meet the needs of increasingly local
commissioning policies.

David Round is the UK General Manager of Cegedim Relationship Management.

The reforms outlined in the Health and Social Care Bill have been described as the most widespread and significant since the NHS’ inception in 1948. With change well under way, Michael Sobanja, Chief Executive of the NHS Alliance, and David Round, General Manager of Cegedim Relationship Management, piece together the implications for the industry.

While the Bill still awaits parliamentary approval, there are few significant changes to the original White Paper published in July last year. The time for waiting is over: for the pharmaceutical industry, the market environment is being significantly redrawn.

There are four key changes to consider: the transfer of the public health function to local authorities; the introduction of GP commissioning on a comprehensive and industrial scale; the broad development of an autonomous provider sector, from the creation of Foundation Trusts to the growing role of the private sector; and, the role of the newly created oversight bodies, including the independent National Commissioning Board, Monitor, the economic regulator, and the Care Quality Commission (CQC).

These changes undoubtedly create a far more fragmented customer base for the pharmaceutical industry. But that is not the only challenge. With the NHS’ shift away from measuring process indicators towards measuring outcomes, the industry will also need to think carefully about developing new product messaging which aligns with the changing needs of its customers.

Expanded customer base

The most fundamental change for pharmaceutical companies is the shift in commissioning. While this will continue to take place at multiple levels in the health service, as it does now, the number of organisations involved in commissioning is increasing, most notably in moving responsibility away from Primacy Care Trusts (PCTs) to local clinicians. A large number (141) of pathfinder GP consortia are already in place, providing coverage for approximately 50% of the population by April 2011; with numbers expected to reach 200-300 by April 2012.

However, there will still be national as well as local commissioning. The new National Commissioning Board will have a responsibility for specialised services commissioning, taking over that role from the abolished Strategic Health Authorities (SHAs). It is likely that some GP commissioning groups will team up with others and pool budgets, and some will act similarly with local authorities.

It will also be important for the industry to understand the new role of local authorities in the provision of public health. Whilst it would be easy to perceive the shift of public health responsibility to the local authorities as little more than a change in employers and accountability, there are other considerations.

The new Health and Wellbeing Boards, designed to bond local authorities and local GP commissioning consortia, will be relevant to the industry. Local authorities will retain an overview and scrutiny function for the health service – although it is far from clear how this will be carried out; and new health watch groups are being created to enable the local population to engage with the critical decision-making about local services.

Pharmaceutical companies, especially those that can link their products to the improved health of the population, must now consider local authorities and these associated mechanisms as critical customers.

New messages

While the pace of change across the NHS will be extraordinary, it cannot be consistent. There will be significant differences to understand, from the speed of creation of the 200-300 GP consortia, to the strategies these adopt. While many will be forced by the financial pressures on the NHS to take a cost first approach, all will look to follow the Government’s outcome led model as well. The precise mix will be a matter for local decision, leading to varying prorities within a widely drawn national framework.

For example, recent studies of diabetes patients in the south of England has revealed that despite the current process measures of care pathways and QOF, some people diagnosed with diabetes are much more likely to experience a lower limb removed today than others. In addition to the impact on the patient, this is a cost to the health service of an extended stay in hospital, significant drug requirements, plus the cost of community care post operation. There is also a knock-on effect on the local authority and overall economy, from a reduction in contribution to the treasury to the cost of disability benefits and social care provision, which is a key consideration for the new Wellbeing Boards. This is a good example of unwarranted variation in the outcomes of care which will be a prime focus in the future.

Taking an outcomes led approach, a GP consortia is likely to look for a diabetes care that, while possibly more expensive up front, significantly reduces the likelihood of amputation and therefore delivers a far better long-term outcome for patient and the wider public sector budget.

Pharmaceutical companies therefore now have to think about products and value propositions in new ways. Firstly, what is the real outcome of prescribing this product? Secondly, what is the implication of more patient choice and more emphasis on patient experience? Thirdly, how does this drug reflect the financial challenge that faces the health service – what is the system impact? These are three basic value propositions that may not be used currently by the pharmaceutical industry.

New skills and structure

The pressing issue for pharmaceutical companies planning to adapt to these extraordinary changes is how best to structure teams and what skills are required. Can the remit of the public affairs teams be expanded to support the new regulators such as the CQC and Monitor? And, from a representative perspective, can the same people successfully deliver the clinical messaging required to support outcomes focused consortia and also undertake tough negotiation with those concentrating primarily on price? Should pharmaceutical companies focus attention only on those GPs directly leading in the GP consortia – perhaps 1,000-2,000 out of over 30,000, or is there value in also working closely with their peers?

It is certainly unlikely that any company can afford to expand staffing numbers to meet these diverse requirements. Instead, the emphasis is likely to be on the creation of teams of multi-skilled personnel; individuals who are able to adjust their approach according to circumstances. Critically, these individuals will not only have to be able to pick and choose the most relevant messages from, perhaps, ten created by the company, but they must also be empowered to make local judgements as to how those arguments are deployed, to whom, when and how.

This is a very different model for the pharmaceutical industry and one that will demand not only new skills, confidence and responsibility, but also access to excellent local information. In this fast moving marketplace, there is a clear need to understand which consortia are leading the way, whether there is a geographic variance, which consortia have a cost focus, and which are prioritising long-term outcomes. Without this information, it will simply be impossible to enable empowerment or respond to the diverse approaches of these key GP consortia and local authority decision makers.

Future contacts

There is no doubt that over the next 12 to 18 months, large numbers of managers will leave the health service. But many of the existing relationships that pharmaceutical companies have built up over the years will still be of value. Some individuals currently working in PCTs and SHAs will undoubtedly reappear at GP consortia, national commissioning or regulatory level.

The key for pharmaceutical companies is to keep up to date with these changes, look for market intelligence and work on relationship management with this raft of new Key Opinion Leaders – some of whom will be new, others familiar. No company will be starting from a zero base of contacts, but it will be those companies that work hard to understand the pace of change within consortia and invest in re-messaging to support the outcomes framework, that will be best placed to proactively manage the transition.

David Round is General Manager of Cegedim Relationship Management. Cegedim provides value added information, CRM and marketing solutions to the pharmaceutical industry. Michael Sobanja is Chief Executive of the NHS Alliance – the only organisation that brings together PCTs and GP practices, clinicians with managers and board members, and NHS primary care with its patients.