This month John Pinching is in the big smoke with Crucell’s high-flying city slicker Kate Evans. She has an almost Dickensian ‘rags to riches’ tale to tell – forced to wash pots in order to make ends meet, Kate had a ‘road to Damascus’ moment, and now she’s one of the industry’s shining stars. What better way to kick off the festive season?

A frosty winter’s morn, Oxford Circus (exit 8, to be precise), I meet Kate Evans (right) – resplendent in an aquamarine cardigan – and we alight to a nearby hot beverage purveyor. This ain’t called ‘Coffee Break’ for nothing, dear reader. Realism is essential – we do actually go ‘for coffee’. Having said that, Kate orders a tea, shattering the illusion. I, true to my word, request a latte. The checkout girl seems a bit stroppy, but we proceed with the interview, we are professionals after all...

What do you think of the new mag? It was very eye-catching when it came through the post, which is a good thing, because usually it gets shoved on a pile. It looked different, therefore I read it. It was fun, more relaxed and sharp.

Thanks, the cheque’s in the post. So, Kate, what’s your story?  I was born and brought up in Middlesbrough and went to university in Durham. I got a 2:2 and was mortified; I cried for an entire day. I thought I’d never get a job, but I’ve realised that it’s actually your personality and drive that get you through, not what’s on your degree certificate.

Where are you based now? I arrived in London two years ago when I joined Crucell. My mum still thinks it’s another country, but I had to go and see what it was all about. I go into the office a couple of days a week in High Wycombe and the rest of the time I’m out meeting people. I prefer to be on the road, speaking to the NHS payers at the coal face: finding out about how the reforms are affecting them and how we can work together. I’m nationally based, so I go wherever people want to talk and engage in interesting projects!

How did you get into pharma? After uni I got a position as a peptide chemist, which after doing a Biomedical Science degree seemed the job of choice. It was based in the north east and we were making synthetic proteins for pharmaceutical research and development. After about a year of doing that I was ready to leave the North East and I got a job at Nottingham City hospital as a tumour immunologist researching how to create a blood kit which could detect breast cancer earlier than a mammogram.

What happened to make you change career direction? I used to chat with the reps who came in to sell pipettes and lab equipment to us. Talking to them was the highlight of my day and I used to think, ‘What am I doing every day, just staring down a microscope?’ What they were doing seemed much more ‘me’. You got to chat to people..  At the time I had to work in a pub during the evenings in order to pay my rent. That was when I became obsessed with becoming a pharmaceutical rep.

How did you get your big break? I started trying to find a rep job, but a couple of companies said you’ve got no sales experience, ‘go and work in a call centre.’ There was no way I was going to do that. Eventually I got into the industry through Innovex and worked with them for two and a half years selling MSD products. From there I went on to various positions at Sanofi Pasteur, MSD, and then on to Crucell in 2010.

How is the relationship between NHS and pharma changing? There is still a lot of mistrust stemming back to the era when everything was about a hard sell. Now you have to be able to sell a value proposition, focusing on the new NHS targets. It’s much more about ‘how we can help you with your care pathway, reduce health inequalities and improve patient outcomes’.

What is the best way to ensure relations continue to improve in the future? The key for pharma is deciding who you actually send to the Chief Executive of a CCG, because a Key Account Manager in one company may be very different to another, and some have only ever covered primary care. It is important to understand the whole local health economy and its needs. You need to have at least read the CCG strategy plan, and understood how your product can link to helping them meet their QIPP and QOF targets. I was very passionate about this at the recent Pf Local Insight Forum: many of the people in that room didn’t know what a Joint Strategic Needs Assessment (JSNA) was. In any other business you wouldn’t go and face a client if you knew nothing about what they do. Other feedback I get from customers is that they want someone who can make a quick decision, not someone who has to go back to head office and get agreement.

Have you established some good partnerships with public sector organisations? My own personal experience of working with PCTs has been very rewarding. The uptake of flu vaccines can be low due to various health inequalities, such as transient population, reduced access to clinics, and language barriers. Using local hospital data, you can start to build a business case about how a project may improve vaccination uptake and therefore potentially reduce hospitalisations. It is important to tailor any project to the needs of the local health economy as each has different requirements. I have worked with NHS, pharmacy and other private providers in these ventures. As well as improving patient care, the projects aim to improve uptake and therefore increase the overall market in the process. It shows you can be commercial and still be part of the NHS’s agenda.

You seem passionate about your work. Vaccines, whether they’re paediatric, flu or HPV, have saved millions of lives worldwide and that’s why I’m so passionate about this area. The highlight for me was being chosen by Crucell Global to visit Bangladesh in June this year to see their vaccination campaigns and how money is being put back into developing countries that don’t have a recognised health service. Since merging with Janssen this year it has been very interesting to widen my horizons and apply my skills to other disease areas. I also contribute to the NHS intranet blog for the company, keeping everyone up to date with the reforms.

What other changes excite you? It’ll be really interesting next year to see the emergence of companies like Circle Health, who have already started to fulfil contracts on behalf of the NHS, easing in the whole ‘competition element’ of reform. NHS hospitals are advertising for marketing and business development managers, perhaps because they won’t necessarily get all the referrals from primary care, given that there are some really impressive ‘Any Qualified Providers’ out there.

You’re clearly a bit of a mover and shaker, what does the future hold for Kate Evans? Everyone always wonders where they will be in five years, but I just take opportunities as they come along. As the NHS changes, so will the jobs within pharma. Companies will soon need specific people to handle joint working, for example, and I am sure more even more niched jobs will start to appear as the new NHS goes ‘live’ in April 2013.

Do you have a good work/life balance? In the days when I was winning Rep of the Year in consecutive years, the ratio was more work/work! I don’t stay on the computer until midnight any more; however, sometimes when deadlines are due, work can still start to eat into personal life. I have learnt over the years how to manage my time more effectively; it’s just part of the job. You’ve got to have relaxation time in order to function properly.

Most high-level medical customers think biopharmaceutical companies should take more commercial risks, according to a new survey.

The New Health Report 2012 from Quintiles also noted that a majority of pharma executives and their customers support more risk sharing in commercial deals.

It also found that 81% of UK patients with long-term conditions would be willing to accept greater clinical risks for the sake of greater benefits.

The report was based on a survey of more than 1350 biopharmaceutical and healthcare management executives and healthcare investors in the US and the UK.

Better metrics are needed to assess both commercial and clinical risks for the sake of wider consensus, the report concluded.

More than half of NHS executives thought the pharma industry was too risk-averse, while 65% of industry executives thought their companies too enough or too many risks.

However, there was widespread agreement between companies and customers on the value of risk-sharing agreements, with 73% of NHS executives and 55% of industry executives convinced they would promote innovation.

More than 70% of biopharma executives and UK payers also believed innovation would benefit from pre-competitive agreements between companies.

John Doyle, Managing Director of Consulting at Quintiles, commented: “Payers’ interest in early involvement in the drug development process, complemented by their experience in balancing risk and benefit, could serve as a wake-up call to the biopharmaceutical industry.”

With the Government aiming to increase innovation within the NHS, pharma has been tasked with helping to meet the challenge. Omar Ali, in his Matrix Revolutions series, focuses on the means to help the industry find the next big thing.  

With so many documents to read – white papers, NHS initiatives and DH directives – keeping tabs on the direction of travel of the NHS, as well as the pace of change, makes life difficult; and that’s not including the latest clinical trials, review publications and NICE guidance. In this issue of the Matrix Revolutions, I want to review one of the most important and potentially game changing documents to have
crossed my desk: Innovation, Health and Wealth.

The document comes under ‘improvement and efficiency’ from the DH and has an impressive circulation list. However, if the cascade didn’t get past those at directorship level, the average GP and healthcare professional may not have received what is a very important document. It also goes hand-in-hand with a story from NICE in February – Improving access to NICE-approved drugs – which provided the NHS with a best-practice guide on the implementation of local formularies in accordance with national guidance.

Innovation, Health and Wealth calls for all NHS organisations to come to ‘action’ by starting planning processes for the implementation of innovative new treatments approved by NICE.

“…while the NHS is recognised as a world leader in invention, the spread of those inventions within the NHS has often been too slow, and sometimes even the best of them fail to achieve widespread use”

I think we would all recognise this symptom of the NHS and list numerous examples. The UK is well known in being conservative with its adoption and prescribing of new drugs. But when NICE makes deep probing evaluations of new treatments it may be disturbing to find such variation in the implementation of best practice and subsequent availability of new medicines for patients.

It’s well known that when HTA agencies reject drugs the NHS is very good at implementing rapid ‘decommissioned’ formularies, which make general prescribing and availability very limited. However, when NICE does approve a new treatment, the variable uptake observed within the NHS as a whole has resulted in this new initiative.

“The challenge both for the NHS and for its industry partners is to pursue innovations that genuinely add value but not cost”

This is interesting how it adds up… I’m supposed to work with you to find innovations that don’t add cost… The problem with documents is rhetoric and direction. In reality, implementation will come down to precise and specific details. There are not many new drugs that ‘don’t add cost’ – they all add cost! The modelling comes in finding those that may offset some of the costs (QIPP).

“This report has been developed as part of the Prime Minister’s UK Strategy for Health Innovation and Life Sciences. The aim of this strategy is to ensure that the UK maintains and builds on its world leading position for life sciences, that the potential of life sciences to contribute to UK growth is realised, and that the UK remains and grows as an attractive location for investment now and in the future”

The flavour of the document paints a clear picture of investment from pharma which will potentially deteriorate within the UK due to poor uptake/diffusion by the NHS. The difficulty lays in that ‘uptake’ criteria for the NHS doesn’t have ‘investment’ as part of the decision process. For example, if a company invests millions into UK R&D and produces a poor, non-innovative and non-cost effective drug, should we put it on formulary due to the fact they have invested in the UK economy? If the answer is ‘yes’, we all need to change the paradigm and throw QIPP out of the window. I guess the alternative is how long can pharma keep resourcing UK investment and see no return? Not long in this climate. Surely then the answer is as seen above: the challenge of making new, innovative drugs cost effective.

Having helped bring NHS payers, CCG commissioners and pharma together, it brings some common ground on market access. I have found that with all of the details, some dedicated quality time with stakeholders and some flexibility from pharma, we can always find some manner of value-added to the product and/or a financial/value proposition that changes the paradigm. The truth is we don’t spend enough quality time talking together about the real issues. We tend to spend poorly co-ordinated NHS/pharma interactions looking at insane cost-models and budget impacts that are largely irrelevant. Add to that ABPI/compliance and internal concordance issues, and the NHS and pharma are often dancing around the tables instead of having decent commercial business discussions that pave the way to a healthier, wealthier future for both.

Potential barriers
“Poor access to evidence, data and metrics”

I have been impressed with some of the data informatics I have seen that actually represent data handling with a view to Secondary Uses Service (SUS) information, hospital episodes and prescribing by the CCG sector or a PCT. Here, pharma is beginning to excel themselves and it does have an influence on working together. This approach is far better than those companies who have a black-box approach to health economics.

“Insufficient recognition and celebration of innovation and innovators”

It’s hard for NHS innovators to ‘step out’ and stick their heads above the parapets when those around them are stuck in the same old ways. Far from recognition or reward, one can expect pushing uphill and against the grain. The only way to succeed here is to believe in the cause of innovation and true improvement. My feeling is those ‘beacons of light’ are beginning to shine in healthcare – and love it or hate it – one of the strengths of the Health Bill is bringing those leaders to the forefront through sheer necessity. My observation is that the pharma culture celebrates innovation from the core – it’s what you do and what you believe in. Being an optimist, I believe pharma has a role on the ground in bringing some of that innovation to ‘rub-off’ on your NHS customers.

“Financial levers do not reward innovators and can act as a disincentive to adoption and diffusion”

You may have read my previous Matrix Revolutions ‘case’ on Prolia (denosumab) – it had a NICE TAG but saw variable uptake, even a year after its recommendation. This case clearly outlined how micro-economics and financial levers can stall the introduction of new innovative therapies. But getting the tariffs to match, commissioning to fund and finding the code to unlock prescribing took a long time… why? Partly because our own informatics is poor – an example of the NHS barrier – and partly because dealing with payer issues doesn’t come first-hand to most brand teams.
Other financial levers that will inhibit uptake include:

• Enhanced LES & DES warfarin payments to GPs which will be a threatened source of income with new oral anticoagulants.
• QoF cholesterol targets of 5mmol/l in the face of innovative agents which may achieve lower cholesterol targets and reduced outcomes.
• QIPP Indicators aiming for a percentage of metformin and sulphonylurea when newer agents for type 2 diabetes reduce incidence of hypoglycaemic episodes and save money on blood glucose testing strips.

In the next issue of Matrix Revolutions, Omar Ali continues to review the DH’s modernisation plans and also focuses on what makes the diffusion of innovation happen. 

Omar Ali is the Formulary Development Pharmacist for Surrey & Sussex Healthcare NHS Trust and sits on the External Reference Group for Cost Impact Modelling for NICE. He can be reached at omar.ali@sash.nhs.uk.