This month Brigadier Pinching shares a surprisingly palatable civil service coffee with the Department of Health’s NHS/big pharma relationship expert, Naima Khondkar.

I love Elephant and Castle. If you are in any doubt about where you are, just outside the station, there is large sculpture of... an elephant and a castle. Oxford Circus, King’s Cross and Cockfosters have clearly missed out on a neat trick. Anyway, I digress, for I was in central London on important business – to chat with Naima about how the private and public sector could make their marriage work. Having spent six years in curious governmental buildings, this was my territory. Bring on the future!

Hi Naima, what’s your story?

At the Department of Health I work in the Medicines, Pharmacy and Industry Group. The head is Giles Denham and he has a number of teams which sit under him. One looks after the pricing environment – which is very topical right now because of the negotiations – while the pharmacy team takes care of community and pharmacy issues. Another concentrates on prescription policy, and I’m in the industry sponsorship team.

How do you guys roll?

We’re almost account managers for the pharmaceutical industry, within government, and also the first port of call on health policy issues concerning research-based pharma companies, including global outfits that have locations in the UK. There’s a very high-level of strategic engagement, driven by the Ministerial Industry Strategy Group, which combines global heads of pharma, from as far afield as Japan and America, and ministers from health, business, the treasury and UKTI (UK Trade and Investment). The discussions are a great way to highlight how government policy can help partnerships. Our minister, Earl Howe, is a particularly engaging contributor, while ‘No 10’ frequently sends along a representative, indicating how serious the Government is about forming cohesive inter-sector partnerships.

How has the concept of joint working progressed?

Over the last few years we have carefully considered how to fundamentally improve the relationship between industry and the NHS, and a lot of this consideration has been carried out in conjunction with colleagues at the ABPI. There is still a lot of mistrust on both sides, however, and that is one of the greatest challenges reform needs to overcome. The NHS has the perception of pharma as being a big bad wolf, just above the arms and tobacco industries in terms of popularity! For some reason people have a big problem with the pharmaceutical industry making any kind of money. Sometimes I think the level of suspicion is unjustified, but then again, I don’t think pharma do themselves many favours sometimes. It’s important to be open and honest about these things! Equally, the NHS can sometimes be over-sensitive – they don’t like to be told by other people how to do their job.

What needs to change?

There needs to be a shift in how people on both sides view one another and they must learn to wipe the slate clean. Bad relationships can date back to minor incidents that happened 25 years ago, when a young, naive rep went into a meeting with a box of doughnuts to help flog a new product. Something as trivial as this may have resulted in a door being shut. Whereas now NHS representatives need to re-engage, open doors and think about the broader benefits of working together with the pharmaceutical industry towards joint goals. It’s really important that both sides build allegiances and forget past animosities. Ultimately this will benefit everyone.

Do the ‘different’ motivations of the public and private sector make gelling difficult?

There is an incorrect perception that, because pharma makes money, someone else has lost. We must remember that if people have their lives extended due to better treatment then NHS, industry and wider society has won. Recently Helen Bevan, NHS Director for Transformation, said both industries have been very target driven in the last 15 years and, consequently, the humanity factor has eroded. Healthcare professionals on the frontline have been too busy with waiting lists and reductions, while sales reps have been under enormous pressure to shift products and been too focussed on sales. Patient cases have become about performance measurement rather than health outcome, or quality of experience. Clearly there needs to be a radical change in priorities.

What can big pharma do to engender trust?

Their approach can be ill-informed sometimes. Often they think they know the NHS, but actually they need to fully appreciate the complexities of what is an ever-evolving beast. Companies need to consider who they make responsible to forge vital connections and forming sustainable relationships. They regularly send an under-qualified person, who might have the enthusiasm, but not the authority. With joint working one of the big issues has been compliance and, often, the pharma representative at the table can’t actually make a decision about whether a company can work in a certain way. This is one of the areas we are really trying to help with.

How should they alter their approach?

If pharma goes in simply looking for a market share increase, they’ll get figured out straight away. Representatives of the big companies need to prove that they genuinely want to improve a health economy or health outcome, before profits. These are the aspects that make the whole system better, and ultimately everyone wins. The CCGs want more people appropriately treated and that means less hospital admissions and, in turn, more financial resources will be available for commissioning. In this respect pharma needs to look at the bigger picture. Remember, every service that the NHS uses is a business – from nurses to bed sheets – but because of the fractious history, the NHS is suspicious about pharma making money. When they do engage the NHS needs to feel like pharma is an integrated and credible part of the solution, as opposed to a procured service. It’s a fine balancing act.

What are the priorities when it comes to galvanising joint working?

Since joint working was outlined as part of NHS reform we have been keen to establish how it can be improved. A policy working group in 2007 carried out some market research and they came up with some recommendations. The two major areas of focus, on our side, were the issuing of guidance – clear definitions of how the NHS works - and the language that should be used. This is a refreshingly concise 11 page document. We also addressed the practical side by combining with the ABPI to launch the, ‘Joint Working tool kit’. It’s an interactive quick-start guide, which includes exactly what the NHS’s definition of joint working is, essential templates and a versatile project management tool. Above all, it avoids jargon and allows people to understand what is required straight away. This has been endorsed by NICE, the NHS Alliance and Confederation among others. We will be looking again at how we can update these documents and make them more practical in the ‘new world’ and also partnering with industry [through the ABPI] and the NHS to review and revitalise both these tools.

Are you optimistic about fruitful partnerships?

Joint working will continue to be an important focus and a part of my day job. QiPP came and went, so we had to hold fire for a while, but now Innovation Health and Wealth (IHW) has provided a restructure, we are pretty sure of what is happening; six months ago we sat down and established that the shift of power is moving to CCGs. Now individual CCGs. Director of Partnerships, Ivan Ellul is particularly keen on localised, dynamic relationships and Mike Farrar is also a champion. Ian Carruthers is the NHS England lead for IHW and is also keen to encourage this type of engagement.

Do you feel that the tide is turning already?

I’m resolutely positive about changes within the NHS. I’ve had heated discussions with clinicians and pharma about joint working, because a lot of them see it as more rhetoric. Some companies, however, are hugely proactive and want to be pioneers of change. GSK are a good example. They’ve shifted their entire salesforce to encourage new ways of working with NHS counterparts. Their leader, Andrew Witty, is passionate about successfully transforming approaches and he’s someone you can believe in, because GSK have freed up patents, conformed to the ‘alltrials’ ideology and shared data. This has filtered down to the way they engage with the NHS and the company have been very smart, as they realise it’s about increasing the whole market. If a healthcare pathway improves it will produce better diagnosis, and better diagnosis means more appropriate and timely use of medicines.

Well said, thanks Naima!

The 27th Pharmaceutical Marketing (PM) Society Advertising Awards had the largest number of entrants ever (350) and saw the event expanding into the digital and exhibition arenas.

Notable winners among the advertising agencies included Langland Advertising, which won in seven categories (with 10 commendations), and VCCP Health, which won in three categories (with two commendations).

Of 36 pharmaceutical companies competing for the PM Society Awards, the most successful was Abbott with four wins and five commendations.

Three pharmaceutical companies – Astellas, Bayer and Johnson & Johnson – won two awards each, and another five – CSL Behring, Eisai, Janssen, Sanofi Pasteur MSD and Takeda – won one each.

Neil Smith, PM Society Advertising Awards Chairman, commented: “As ever, the truly aspirational creative treatments stand head and shoulders above the rest and their success is reflected by our industry and healthcare judges.”

From over 50 campaigns entered for the Awards, the most successful on the day were Langland’s campaign for Abbott’s drug Hidrasec (four wins and one commendation); the same agency’s campaign for Bayer’s Sativex (two wins and two commendations); and Lime’s campaign for Astellas’ Protopic (one win and two commendations).

Remarkably, Concentric Advertising won both the Primary and the Secondary Care Target Awards for one advertisement.

Two of the most coveted awards were the Healthcare Industry Award, won by relative newcomer VCCP Health, and the Geoff Brook Innovation Award, snagged by the Woolley Pau Gyro agency.

New awards were presented in three digital advertising categories, and exhibition displays were recognised in a new category for the first time.

The lunchtime awards ceremony in London was hosted by broadcaster and former MP Gyles Brandreth.

The PM Society, which promotes marketing excellence in the healthcare and life science industries, is a non-profit organisation with members in over 230 UK companies.

In 2012 the Society launched Interest Groups addressing key challenges facing UK pharmaceutical marketers: market access, digital marketing, NHS partnerships, patient engagement and personal development.

The ABPI and the Pharmaceutical Marketing (PM) Society have formally agreed to work together in promoting and advancing the UK pharmaceutical industry.

The two organisations have signed a memorandum of understanding (MoU) committing them to align activities that are relevant to their shared interests.

Areas of joint working suggested by the MoU include training, events and member surveys to identify issues and facilitate planning in the industry.

The PM Society promotes marketing excellence in the healthcare industry. Run by volunteers as a non-profit organisation, it has members in 230 UK companies.

In 2012 the PM Society introduced a number of Interest Groups focused on current challenges: market access, digital marketing, NHS partnerships, patient engagement and personal development.

The ABPI represents research-based biopharmaceutical companies in the UK, and is recognised by the Government as the body negotiating on behalf of the branded pharmaceutical industry.

“The PM Society reaches out to the operational heart of the UK pharmaceutical and life sciences industries and is a natural partner to promote debate and discussion with the people we serve,” said ABPI Chief Executive Stephen Whitehead.

“The working groups in market access, NHS partnerships and patient engagement, aligned as they are with many of our strategic imperatives, offer particular potential for joint working.”

Neil Copping (pictured), Chairman of the PM Society, commented: “Since we redefined the Society early last year, we have looked to address members’ needs more effectively in the rapidly changing healthcare environment.

“Aligning strategic and grass roots level activities by joining forces with the ABPI, we aim to open new doors and deliver increased value and benefit to both organisations’ membership.

“It will also avoid duplication on initiatives that are relevant industry-wide and might otherwise have been under discussion by both organisations.”

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.”