The rapid pace of NHS reform means that the pharmaceutical industry needs new strategies for joint working to create and sustain commercial opportunities. Diana Vegh, NHS Partnership Manager at the ABPI, describes how the Association is working to develop a joined-up partnership strategy across the new NHS landscape.

The NHS has been going through one of the largest reorganisations since its inception – Sir David Nicholson famously describing it as “so big, you can see it from space” – and the implications for the pharmaceutical industry, particularly regarding the joint working agenda, are significant. So much so that the ABPI has established an NHS Partnerships Team, led by Kevin Blakemore, with one senior manager covering each of the four NHS England regional offices. The concept has been driven by Stephen Whitehead, our CEO, and was piloted several years ago as the ABPI Outreach Team – which made constructive inroads in the South-West, a challenging health economy to work in.

I am one of those regional managers, ex-NHS and industry, based in Devon, and covering a territory that stretches from Penzance to Margate. The population is 13.4 million, with a budget of £21.1 billion and 110 NHS organisations. There are 1,873 GP practices, 34 local authorities (with three unitaries), four clinical senates, five Academic Health Science Networks, seven Area Teams, three specialised commissioning hubs and 51 CCGs. And it’s a 14-hour return journey from one end to the other. Plus we’re a trade association, with limited resources. With such a large number of potential customers and new organisations, how do we make the best use of our time?

RIGS strike oil

Each of us has produced a regional business plan, aligned to member company priorities, broadly supporting our themes of value and partnership, and clustered around 11 core corporate objectives. These have all been discussed and agreed by our Board of Management, which is made up of member company executives. The most important objective for my team is improving the environment for access and uptake of innovative medicines. We’ve segmented our rapidly evolving customer base and developed stakeholder maps for engagement. But pivotal to helping us navigate this complex structure has been the establishment of our Regional Industry Groups or RIGs, one per region, which meet monthly. General managers of our member companies have nominated senior representatives to sit on these groups, and we are adding associates who will join us virtually, i.e. online, via WebEx and telephone conferencing.

My RIG is chaired by Lisa Rosewarne from MSD, and our deputy Chair is James Steed from Pfizer. We have agreed our Terms of Reference and work plan for 2013, with a series of five workstreams and virtual task and finish groups led by RIG members, focusing on industry-wide issues from medicines optimisation to the Formularies Good Practice Guide. We often have external speakers who may not meet with single companies but are happy to talk to a group – such as Steve Sparks from NICE, who manages the field-based Implementation Team, and who recently gave an excellent presentation at one of our meetings. We also connect our RIG to the national policy work we do, and communicate across the other ABPI teams.

We’ve had a number of ‘bids’ from the NHS and healthcare companies who are interested in working with the pharmaceutical that there is a need for external organisations to understand better what joint working truly means in terms of the ‘Moving Beyond Sponsorship’ work done by the ABPI and the Department of Health in 2010. Our key tool for this has been the Joint Working Guide, and in particular the sections on pages 7 and 8. One of our RIG workstreams is to use these guidelines to engage with potential partners in order to share constructive feedback and highlight examples of best practice that we are collecting from member companies.

We showcased this at a conference with the NHS Confederation in February this year, in London. We have a Memorandum of Understanding with the NHS Confederation and the ABHI to work on the Innovation, Health and Wealth agenda collectively; and this national policy work is essentially what we’re putting into practice in our regions.

Rules of engagement

In my day-to-day job and in my meetings with NHS stakeholders, I work to promote the whole pharmaceutical industry and a more mature working relationship with us. The majority of my discussions have been very positive, with a clear desire to move away from the old models of promotional metrics and explore a new way of working. Some CCGs, such as Torbay and South Devon, are striving to be ahead of the curve. Others are more conservative and prefer to agree a new policy on joint working first, and we’re trying to encourage the use of our toolkit and case studies.

But one thing I’m very clear to emphasise is that my team isn’t ‘the’ route into pharmaceutical companies. If an NHS organisation wishes to work directly with a company, of course it can. We are not competing with market access teams – we are enablers and facilitators – and the ABPI Code of Practice gives the NHS assurances about governance and conduct. But some organisations remain difficult to reach. I’m using good examples of joint working elsewhere in the NHS, or pragmatic discussions in other parts of the organisation, to overcome those barriers.

After all, partnership isn’t about pretending that everything’s fine and there aren’t any problems. But it is about moving to a place where you can agree to disagree, and solve your problems together even if you have differences. . e table above shows the framework I base my work on.

On the whole, projects seem to fall into three categories. The first category is disease specific projects, which often relate to long-term conditions such as COPD, diabetes or vascular health. Some of these can be quite broad, while others can be about specific service redesign projects in a particular health economy and relate to implementing new national guidance. The second category is projects that relate to an NHS priority, such as reducing inequalities, where industry expertise in social marketing and media has been put to excellent use. The final category, and the one expanding most rapidly, is where we have shared aims: improving patient safety, reducing medicines wastage, better adherence, realising the benefits of treatments – i.e. the medicines optimisation agenda.

Moving the goalposts

Those of you with a lot of experience may be reading this with a sceptical eye. Hasn’t this all been done before? Talked about before?

Yes. But this time, there are some key differences. The clinical voice is louder, and often in a leadership position. Attention is far more on quality than in the past, and the sanctions are greater. And while our austere financial climate is squeezing medicines spending, increasingly senior people are seeing that it is disingenuous to look at medicines solely as a cost pressure, and far more beneficial to see them as a means of improving health outcomes – on which the NHS is now being more tightly measured. New organisations also have a legal duty to innovate, which is now in primary legislation as part of the Health and Social Care Act. The new Academic Health Science Networks have been set up as companies, and though many focus on the earlier part of the medicines life cycle they will all be looking for new partnerships.

Pharmaceutical companies are also changing. We’ve gone from Share of Voice to Key Account Management, and the skills and competency mix of pharmaceutical field teams is very different from how it was a few years ago. When I’m out and about I’m meeting people with new roles, such as service development managers, NHS business managers and strategic account managers. And there have been a lot of redundancies in the NHS which have seen knowledge and skills move into the pharmaceutical industry. Today I had an email from a CCG asking me how they could second someone into an ABPI member company.

We are in a ‘perfect storm’ of policy, and the organisational turbulence we’ve all experienced is bringing some very forward-thinking and creative people into senior positions. Let’s make the most of that, and work together to get better outcomes for the populations that we live in and for the organisations that employ us.

Classified drugs, which are potentially dangerous and liable to abuse, have legitimate uses but also turn up on the black market. What does this mean for industry – and how has the internet affected this problem?

Take a look at any list of ‘drugs’ banned in the context of recreational use – or more accurately, abuse – noted by the Home Office, social services or avant-garde novels. They fall into three categories. Drugs made from natural sources – marijuana, opium and magic mushrooms. Synthetic drugs that have no medical function – ecstasy (MDMA) is the classic example. And drugs that have been patented by pharmaceutical companies and released for medical use – that’s all the rest.

Heroin, cocaine, amphetamines, tranquillisers, barbiturates – you name it, doctors have prescribed it and addicts have taken it, with or without prescription, and often with bad consequences. In the past, many psychoactive drugs were shifted from medical sources to the black market via theft or bribery. Today, they are more likely to be manufactured in secret labs in Latin America, the Far East or that odd little house in your street with the blacked-out windows. You might be surprised at how strong the UK pharmaceutical manufacturing base really is.

You may wonder why that’s a problem for industry. When you’re talking about drugs that affect the nervous system – killing pain, inducing sleep or keeping people awake – the subjective factor is important. If a patient knows the drug they get on prescription is also available on the street corner, they may react in various ways. They may decide, on the basis of news or hearsay, that the drug is too dangerous to take. Alternatively, they may decide they want more of it than their GP will provide – and their friends want some too. Either way, the drug’s value chain gets tangled up with barbed wire. It’s not your fault, but that doesn’t mean it’s not your problem.

Two recent events reflect the pervasiveness of this issue. Firstly, the Advisory Council on the Misuse of Drugs recommended that the painkiller tramadol should be made a Class C drug – with penalties of up to two years for possession and 14 years for supply. Tramadol has both opioid and antidepressant properties, making it a potent euphoric but increasing the clinical dangers of overdose.

Secondly, Roche took Valium off the market after fifty years of iconic status as ‘mother’s little helper’. Forty years after patent expiry, the black market had finally pushed the brand into the red.

The only chemistry

The UK’s classification system for ‘dangerous drugs’ is based on the Misuse of Drugs Act 1971, which gave the Home Offie a role in drug licensing by defining the boundaries between legitimate and illegal use of medicines. The Act defined four types of drug crime: unlawful possession; possession with intent to supply; supplying, even if no money changes hands; and allowing your premises to be used for producing or supplying a controlled drug.

The Act also divided controlled drugs into three classes in terms of the penalties for illegal use:

• Class A – up to seven years’ imprisonment for possession, up to life imprisonment for supply

• Class B – up to five years’ imprisonment for possession, up to 14 years’ imprisonment for supply

• Class C – up to two years’ imprisonment for possession, up to 14 years’ imprisonment for supply

An unlimited fine can be imposed instead of, or in addition to, any of these sentences. The law is designed to come down most heavily on illegal manufacturers and suppliers – in other words, the people doing illegally what you do within a legitimate business framework. In practice, of course, it’s mostly the end users who get caught, tried and jailed.

Down at the doctor’s

What should pharmaceutical sales professionals keep in mind when working with controlled drugs? I won’t insult your intelligence by telling you not to break the rules. It’s the things that can happen that aren’t your fault you need to worry about.

Doctors and pharmacists have strict guidelines about using only legitimate suppliers. However – as the recent scandal of counterfeit cancer drugs being found in US pharmacies proved – the pressure to use cheaper suppliers means the audit trail of many drug supplies is extremely complex. If the drug is a controlled one, the threat of illicit sources to the supply chain is much greater.

It’s important to distinguish between ill-effects of drug abuse and potential side effects of legitimate drug use. The negative impact of abuse on a drug’s reputation is considerable – and, in addition, studies of abuse provide genuine insight into the risks and benefits of a drug. So be prepared for that side of things to make your discussions with customers more complex – maybe more difficult, but also maybe more fruitful if you’re well informed.

The internet has made the supply network for illegal drugs both more diverse and more immediate. The user can access a global black market without needing to hang out in dangerous places or carry cash. Every bedroom is a car park now: the black market in drugs has no limits as regards time, place or who is involved.

Be aware of security issues. Andrew Bolan at ABPI comments: “All activities related to the legitimate manufacture, distribution, supply and storage of controlled drugs are subject to the regulations made under the Misuse of Drugs Act. All actors in the legitimate supply chain will hold the appropriate licences and have the necessary facilities and systems to ensure the secure supply of these products to patients, and all these elements are subject to scrutiny and control by the appropriate authorities.

“While every effort is made via these systems to prevent the illicit diversion of these products, the issue of theft is a concern and, despite the best efforts of all in the supply chain, there will always be a risk of such events. The pharmaceutical industry is always willing to work with other partners in the supply chain to seek to enhance the already high level of security that is applied to the movement of controlled drugs.”

Blues run the game

One of the great blockbuster drugs, Valium (diazepam) helped to make Roche a leading global pharma company. While known primarily as a tranquilliser, it has also been used as an anti-convulsant, a muscle relaxant and an anti-depressant. The brand’s popularity among the general public as a means of coping with stress earned it the nickname ‘mother’s little helper’, and kept Valium on the market for forty years after its patent expiry.

However, the addictiveness of Valium soon became notorious, with some experts arguing that it induced serious physical dependency. This, combined with the emergence of SSRIs as more successful anti-depressants, led to diazepam being increasingly used only for short-term sedation, where branded Valium had less commercial traction over generic equivalents.

But users – in both senses – rush in where doctors fear to tread, and ‘blues’ are now a staple of the illegal drug world. Their widespread legitimate use has helped to fuel an illegal supply chain via many forms of theft and fraud. While Roche gave the long-term effect of patent expiry as its reason for taking the brand off the market, it would appear likely that a fuller explanation lies both in Valium’s dwindling legitimate market and in its rapidly growing online illegal market.

Diazepam tablets that look like Valium, thus retaining elements of brand appeal, are being marketed by MSJ Industries, a subsidiary of the Sri Lankan manufacturer J.L. Morison Son & Jones (Ceylon) PLC. Stamped ‘MSJ’, they are legitimate pharmaceutical products, but are being diverted to the black market – where they are known as ‘MSJs’, ‘vals’ or ‘blues’ – in large quantities.

As an example of the information available, Pf found an easily accessible online forum with a thread titled ‘MSJ blue pills (Vals?)’, featuring comments from people around the UK. One forum member offered to supply MSJs at the remarkably cheap rate of £20 for a hundred 10mg pills, or £80 for 500. Others commented:

• “I took two of them last night meaning it should have been a 20mg dose. But these two I took sent me well off.  It was like I had just taken 60mg or something. Couldn’t move.”

• “the msj are from sri lanka mate. they are the real mccoy. due to no standards and/or no quality control means that some msj tabs have 8mg-28mg per pill. i hope this helps you.”

• “msjs are the best valium about beat roche hands down”

 These words leave you wondering what ‘controlled drugs’ really means. For the pharmaceutical industry, that’s not a comforting thought.

Most UK pharmaceutical companies will disclose the payments they make to healthcare professionals (HCPs) from 2015 onwards.

ABPI member companies have agreed to publish details of payments made to individuals in fees and sponsorship for training.

As a start, they will shortly publish aggregate totals of payments made to HCPs in 2012, estimated to amount to £40m for the UK pharma industry.

The ABPI said it hoped the greater transparency would not only improve trust but also raise awareness of the benefits to healthcare of industry sponsorship.

From 2016 (covering 2015 figures), ABPI member companies will disclose the payments made to sponsor and support HCPs – for example, paying for them to attend international conferences – as well as fees for advisory and speaker roles.

They will also reveal how many HCPs they have made payments to in each year from 2015 onwards.

The new transparency standards for industry have been developed by the Ethical Standards in Health and Life Sciences Group (ESHLSG), which is seeking to promote partnership between industry and the NHS.

Stephen Whitehead, ABPI Chief Executive, commented: “The industry is proud of its collaboration with healthcare professionals. By publishing these figures industry’s aim is to ensure these vital relationships are open and transparent.

“It is right that professionals are reimbursed fairly for the time and expertise they regularly provide the industry in developing the next generation of medicines. These figures also show another way in which the pharmaceutical industry adds value to the NHS by supporting training and development and medical education.

“It is right that companies are transparent about the support they provide and it is important that we also recognise the benefits this delivers the NHS.”

With the NHS in flux, there has never been a better time for joint working – but pharma might need some help to negotiate the new relationships. Pf looks at the key role of third parties in bringing industry and the NHS together.

Pharmaceutical companies in the UK might be forgiven for wondering if this is really the right time to engage in joint working (JW) projects with the NHS. There seem to be a few questions in the air. What is the NHS now? Who is making decisions there? What are the real priorities? Going into partnership with the NHS might seem like dating someone with too many unresolved ‘issues’ for it to stand much chance.

However, if you keep your nerve, there has never been a better time for JW. The combination of profound structural change and austerity budgeting means that the NHS badly needs support – and the need for healthcare to shift its focus from acute to chronic illness means that the right ways to transform the care pathway are at a premium. Suddenly that mythical bird of business transactions, the win-win, has to be real.

But the opportunities for partnership are highlighting the culture gap between pharma and the NHS. Meeting on the internet and getting married on the run may be romantic, but it won’t lead to a sustainable relationship. The partners need to learn each other’s language, meet each other’s family. This is where mediators and consultants can really make a difference by providing expertise and experience.

Pf talked to two companies that are actively involved in guiding and building JW relationships – one as a facilitator, the other as an active participant. Three common points emerged from their perspectives:

1. The major changes in healthcare in the UK are creating opportunities for pharmaceutical companies to work in partnership with CCGs, local authorities and providers.

2. The payoff for the pharma company is in terms of better medicines management, leading to the company’s products being used more widely and effectively.

3. Realistic mutual understanding is critical for JW – no amount of rhetoric about values and beliefs will help unless there are shared objectives and ways of working.

Embracing the unknown

Chris Morgan of ZS Associates argues that JW does not come easily to either side: “A true appreciation of the value of partnership is still fairly rare, within both pharma and the NHS.” For years, ZS Associates has emphasised the critical importance of key account management for pharma. The current NHS reforms and the development of the JW agenda have strengthened this argument and underlined the consultancy’s role as a thought leader for pharmaceutical sales and management.

“The established relationship between pharma and the NHS can be pretty toxic,” Morgan says. “ There isn’t a whole lot of trust established there. Before we can partner, we have to earn that trust.” He gives the example of a company ZS worked with that had spent six months piloting a new service idea with a PCT. “The PCT loved it, it worked well for the company, the patients loved it – and then they packaged it up and gave it to all their other account execs to sell, and a year later they had sold none.”

Why was that? “The first time they sold it, they thought they were developing a service – but what they were actually developing over six months was the trust required for the customer to buy that service. Then, when they showed up to every other PCT subsequently, the response was ‘Who the hell are you?’”

Too often in pharma, ‘trust’ is interpreted as meaning ‘goodwill’. That might work when the culture is the same on both sides, but between pharma and the NHS it won’t hold. Morgan explains that without clear mutual understanding “it’s not clear who is living up to their end of the deal, and it’s not even clear to you whether you’re living up to what the other person perceives as being your end of the deal.”

In addition, he argues, “those circumstances for partnership where it’s clear that everyone has something to gain end up being easier to defend, and more ethical, than those JW situations where there’s no apparent gain for the pharma company.” If a company sponsors an initiative in a therapy area where it has no products, two questions arise: does the company have the expertise needed, and what are its motives? JW has to be about “genuine mutual interest”. Quid pro quo agreements are not only non-compliant, but make no business sense: “I can sell you £10 notes for a fiver all day. There is no rational economic reason why you should reciprocate to a value greater than what I’ve just given you.” JW has to generate value, to the objective benefit of both sides.

Another key issue is defining who the customer is, and here Morgan illustrates the value of the KAM approach. “Too often we try and define the customer as being the doctor, the patient or the payer – but the only time you find genuine mutual value is when you think about all three stakeholders together.” Pharma companies need to involve providers as well as commissioners in JW projects, since the most successful providers “are actively going out and engaging with commissioners” to redesign care pathways – and thus are already on the JW road.

The best JW projects, Morgan says, often involve “care pathway re-engineering”. An area ripe for partnership is diabetes care, as its problems are well-known: poor service integration, poor medication compliance, high levels of complications. The JW opportunity is for the pharma company to help commissioners and providers improve care by improving diagnosis, monitoring or compliance, thereby reducing complications and hospital admissions. “The pharma company benefits as well because its product is used earlier, more persistently or in a larger or more appropriate group of patients.” The win-win is not only real, it is flying.

A time of change

Karen Bell, Business Manager at Ashfield In2Focus, argues that a window of opportunity exists now for pharma in terms of JW, and that there’s no time to waste. Ashfield In2Focus provides a range of services to pharmaceutical companies to help them develop and implement JW relationships with the NHS. Most importantly, it provides quality healthcare development managers (HDMs) and key account managers (KAMs), many of whom have NHS backgrounds, to mediate between the two sides and facilitate the process.

There are three reasons why this is a crucial time for JW, Bell explains. Firstly, the drive towards more patient-centred care, the QIPP agenda and the increasing role of private provider competition are all making the NHS engage with industry in new ways. Secondly, the Department of Health and ABPI guidance around JW have made the NHS “less nervous about working with industry and more open to win-win types of partnership”. Thirdly, its new emphasis on innovation has made the NHS more aware of its weaknesses in that area, and more ready to involve people with different experience.

The focus of JW projects is closely linked to the NHS’ need for increased patient throughput, especially in primary and community-based healthcare. “Typically the JW projects which we tend to see succeeding are in CHD, diabetes, women’s health, mental health – really any long-term condition, and also where there’s a drive to keep patients out of hospital” – while “for the sponsoring pharma company it means more patients going into the total patient pool for their product”.

However, the current business climate does not reward risks. Aren’t those pharma companies who decide to wait until things settle down being sensible? Bell’s response is emphatic: “They’ll miss the boat. Because we are now in a time of change or flux, with innovation and efficiency high on the agenda, the NHS is very open to hearing about and indeed engaging in new ways of doing things. Those pharmaceutical companies who go out there and talk about these initiatives now, and those NHS organisations who engage with them, will be the ones who will capitalise in the longer term.”

Even so, why is a mediator needed – isn’t that one partner too many? Bell argues that as a service provider already working with the NHS and industry, Ashfield In2Focus is a key link between the two cultures. It provides experience of working on both sides and knowledge of the regulations around the provision of NHS services. Any service it provides is backed up with the necessary documentation to “protect the NHS, the patient and the pharmaceutical company”.

In addition, Bell argues, Ashfield In2Focus is well placed to bridge the culture gap between the NHS and pharma: “When our HDM teams talk to an NHS customer, they can often be having a peer to peer conversation, and that facilitates the whole partnership process, building engagement, mutual understanding and trust from the start. As many of them have come from that background (we employ a number of ex-commissioners or Department of Health personnel), they understand the world of the NHS, and they can more effectively identify and implement a solution.”

JW projects require the right people to engage with “the new NHS stakeholders” and “to develop and carry through these initiatives and make them sustainable”.  They also need to be able to influence local authorities and Health and Wellbeing Boards, and to “talk coherently around the joint strategic needs assessment process”.

In classical mythology, Hermes was the messenger between worlds. Bell uses a similar image: “People sometimes see our staff as being one step removed from pharma – working for us on behalf of a pharmaceutical company, but not directly for them. Our nursing services are a perfect example of this.” In addition, she says, Ashfield In2Focus attracts and recruits quality personnel for these roles, through its vast database and network of contacts, by offering a permanent contract of employment to potential employees in uncertain times – reafirming the value of the third-party role for pharma and the NHS.

We’re often plagued by the idea that somehow – perhaps in a different city, company or even civilisation – we could be reaching new, higher, dizzier heights. Especially when you see rival colleagues using the latest mobile, tablet devices or driving off into the sunset in that brand new hatchback – yes, the one with the heated seats you saw on Top Gear last month – and giving you an obscene salute as they do so.

But is there any definitive way of knowing if you’d be better off somewhere else? Of course, there are those generic online tools that give you the average salary of every Londoner under the age of 90. But they are probably not the best benchmarking tools to use when plucking up the courage to ask your boss for a pay rise, during one of those awkward appraisals. Although, there is another way.

The Pf Company Perception, Motivation and Satisfaction Survey – which is now in its 12th year – provides a comprehensive temperature check on the essential elements of everyday working life for those toiling away in the medical sales sector. It gives those working within the pharmaceutical industry in the UK the opportunity to have their say on what matters the most to them.

The Survey has now been completed by more than 14,000 medical sales professionals since it was first launched in 2001. It accurately portrays the views of the industry on important motivation and satisfaction factors such as remuneration, bonuses, work-life balance, job security and company culture. Pharmaceutical bosses can also see how long their staff actually spend on CRM systems whilst in the field and also discover whether employees have had their head turned by that eye-catching aqua blue sports car and are ready to jump ship.

Yet it’s not just pharmaceutical companies who bene t from the results. The Survey is a friend to all. Much like a Swiss army knife, it has various tools and attributes to help those who access it. It’s a pen knife one minute slashing dated contracts of employment then a bottle opener the next popping open the bubbly to celebrate an improved Employer of Choice ranking place.

The Employer of Choice

Another facet to the Survey is the coveted Employer of Choice rankings. Respondents are asked to choose the company they’d most like to work for within the industry – bar their own of course! ­The company chosen the most wins the Employer of Choice gong. Simple.

In recent years it’s been a two horse race for the EoC accolade. Boehringer Ingelheim and Roche have got toe-to-toe for the top spot since 2007. But it’s been Boehringer which has come out on top for the last six years as the company which is deemed to be the most desirable to work for within the industry. Nick Doe, Sales Director, BI, says the credit must be placed at the company’s skilled workforce for keeping the company in the prized top spot for so long. “It is a real credit to everyone in our field force, our managers and all at Boehringer Ingelheim who are dedicated to putting the patient at the centre of the everything we do.”

The Employee

One experienced key account manager – who wished to remained anonymous, from a medium-sized pharmaceutical company – used the salary comparison tool to negotiate an improved deal after finding out she was being paid less than her industry counterparts. “I was quite surprised actually when I first read in Pf that I was being paid less than other people doing my job in the industry. In fact, I always considered myself to be well paid for the job that I do. For that reason I’d never really explored what other KAMs with the same level of experience were on – especially as I’d been with my company for a few years. I just assumed we’d all be on around the same figure. However, when I read one of the articles on salary in Pf and realised I could be getting more money elsewhere I couldn’t just ignore that fact.

“I went to speak with my superior to discuss a pay rise and showed him the comparison with other key account managers with my level of experience and how much more money they were receiving compared to me. Discussing money is always a tricky subject but the facts and figures were there in black and white to support my case. Thankfully the matter was addressed pretty swiftly. I’m so glad I took part in the survey and read the survey articles. Without the Pf Survey results I’d still be underpaid and none the wiser.”

Anonymous Key Account Manager from a medium-sized pharmaceutical company: you’re welcome.

The Employer

€The results from the Survey may have seen certain pharma companies having to dig a little deeper into their pockets to ensure valued staffŠ members are kept happy and motivated. But the data resulting from the survey results is valued in other ways. It’s not only field-based employees who keep a keen eye on the main motivating factors which matter to respondents. Pharma companies use these to entice hot talent away from competitors and keep their own main players happy.

When employees at Astellas raised concerns around a recent change to the car policy one year, the survey witnessed the biggest ever shift in one parameter when it acted upon the suggestions of staŠff and improved its company car scheme. Astellas wasn’t the only pharma company to listen to its staffŠ after the survey results were published.

Lundbeck UK calls upon its staffŠ to voice opinions on important decisions – a move which has seen them outscore industry rivals in a number of parameters. “€The scores that we have had for the latest survey results are significantly higher than that of our industry colleagues,” Helen Carberry, Lundbeck UK Head of Human Resources and Development said.

“We consistently outperform in the industry averages. Ratings for ‘belief in products’ is really strong and that is our highest satisfactory score. Also, for ‘company culture’ we are almost double the score across the industry in that parameter,” Helen added.

Yet these top-of-the-table rankings have not come about by chance, as explained by Helen. “We do have a real focus on people here at Lundbeck UK,” she said. “It’s something which is important to us because that is ultimately how we achieve our results. We have high levels of loyalty and commitment within the organisation, and our own internal satisfaction survey highlights that.

“In terms of our strategy, there are three pillars which support everything that we do. One of those pillars is being great place to work. We set out this year, very much like the 12 months prior to that, that our focus is on delivering excellent results, delivering value to customers, whilst also being a great place to work. As part of that, developing people and living our culture are the two main foundations which support that strategic pillar of being a great place to work. People are really, really important to us.”

This was re™flected as Lundbeck UK was awarded the Best Companies One Star Accreditation in 2012. € The company now aims to build on the success of its survey results as it adapts to the changing market place in the UK. “We are a lean organisation, which means we are very, very ™ exible. We have developed a structure that can be either built on as and when new products come through or simply added to over time. Lundbeck UK can only go from strength to strength.”

€The 2013 Company Perception, Motivation and Satisfaction Survey can now be completed at www.pharmasurvey.co.uk. It is managed by Dr B Payne of Conker Statistics (a fellow of the Royal Statistical Society) and provides a benchmark of field force remuneration, motivation, satisfaction, perception and recruitment. Confidentiality is of paramount importance and your anonymity is therefore guaranteed. It takes only minutes to have your say at pharmasurvey.co.uk.

Greek hospitals and pharmacies are running short of around 300 medicines because drug companies are refusing to supply them.

Hospitals failing to pay drug bills and parallel trading by wholesalers and pharmacists are the main reasons for supplies being withheld.

Major pharmaceutical companies that have admitted halting shipments of some products include Pfizer, Roche and Sanofi.

Medicines for arthritis, hepatitis C and hypertension, statins, antibiotics, anaesthetics, antipsychotics and antidepressants are all affected.

Dimitris Karageorgiou, Secretary General of the Panhellenic Pharmaceutical Association, said: “I would say supplies are down by 90%. The companies are ensuring that they come in dribs and drabs to avoid prosecution. Everyone is really frightened.

“The government is panic-stricken and the multinationals only think about themselves and the issue of parallel trade because wholesalers can legally sell them to other European nations at a higher price.”

According to the Greek government, more than 50 companies are holding back products or planning to do so. The Ministry of Health is intending to fine eight major drug companies, which have not been named.

There are reports of widespread panic and anger among patients who are going from one pharmacy to another with prescriptions. “We have reached a tragic point,” commented Karageorgiou.

With austerity tightening in Greece, the debts owed to pharma companies by hospitals and social insurance funds has reached €1.9bn (£1.6bn).

Pfizer has admitted withdrawing four medicines “because alternatives were available and because of the parallel trade situation”: leukaemia drugs Zavedos and Aracytin, the analgesic Neurontin and the epilepsy treatment Epanutin.

Roche said it was withholding supplies to Greek public hospitals, apart from “critical medicines” such as HIV drugs, but was still supplying pharmacies.

Sanofi claimed it was still supplying public hospitals with life-saving and unique products (for which no generic version or recommended alternative exists).

GSK, AstraZeneca, Novartis and Boehringer Ingelheim denied they had stopped supply of any products to Greece.

The pharmaceutical industry has urged the Greek government to set its drug prices in accordance with a eurozone standard. Greek drug prices are 20% lower than the next lowest in the EU, giving rise to widespread parallel trading.

Greek regulator the National Organisation for Medicines has banned the export of 60 medicines and is considering another 300. It will fine wholesalers and pharmacists who have broken the export ban.

When the melting pot of NHS reform is divided into regions for the purposes of constructive debate, suddenly it seems like a battle that can be won.

If Darth Vader and Luke Skywalker had sat down in a bar – perhaps the one in Mos Eisley – to discuss how
the Dark Side and the Rebel Alliance could work together, a great deal of heartache and destruction could have been avoided. The NHS and pharma find themselves in almost precisely the same predicament as those guys, except that this isn’t a galaxy far, far away – it’s NHS reform and it’s happening on planet Earth.

Pf Insights is a space-hopping force for good and, over the last few months, it has been travelling through the known universe, galvanising relationships between two very different civilisations – the NHS and big pharma.

Voices of the revolution

During the first Pf Insights tour of duty, one thing became quickly obvious – people wanted to open the channels of communication. There was a genuine feeling that people were passionate about getting healthcare transformation moving.

The trial gigs – including shindigs in London, Newcastle, Walsall and Bolton – were rolled out in order to find out how responsive the two parties were to constructive dialogue and whether such meetings could assist with the germination of effective joint working. It was also an exercise in establishing exactly what the best platform for these forums would ultimately be.

For these initial meetings, we combined speakers who had vast NHS experience – and who also understood the ambition, challenges and infrastructure of private sector companies – and a combative pharma industry audience. These tailored presentations were designed to trigger debate and, on several occasions, it worked. Representatives from the biggest pharma companies in the land enthusiastically seized the opportunity to air their questions, concerns and opinions about the biggest NHS shake-up in 50 years.

Many of the points raised were pivotal to the success of the reform bill, and those on the front line of pharmaceutical drug sales were anxious to hear about how their products could be integrated into an historically protective NHS, and what it would take to generate the cultural changes necessary for positive
partnerships.

Many of the audiences contained straight shooters who simply asked, ‘is it going to be easier to access
NHS decision makers?’

As these conversations unfolded, it was clear that the old rhetoric about public-private unisons had been
replaced by candid and passionate debate about making change a reality. This was about embracing
a brave new world in which a proud industry and a much-loved institution co-exist in harmony.

Path to glory

As the shoots of NHS reform appear the only way forward is to keep encouraging these galvanising
conversations – not virtually, or even over the telephone, but face to face. This is why Pf has decided to embark on a second tour of duty – bringing forums to people throughout the UK.

Ports of call this time include the East Midlands, Bristol, London, Bolton and Newcastle. The variety of locations will give everybody the chance to get involved, have their say and make a difference in the ever-evolving healthcare landscape.

The speakers will, again, provide a unique insight into the NHS, from both a national and a regional perspective. Take the Pf Insights trip and let the force be with you...

The pharmaceutical industry’s reputation in the last twelve months has declined worldwide, a new survey has found.

Only a third of patient groups now believe that pharma has an ‘excellent’ or ‘good’ reputation, figures from PatientView’s independent 2012 annual review show. In 2011, 42% of respondents had the same opinion.

A global survey of some 600 international, national and regional patient groups showed that 66% of respondents felt the industry needed to do more to improve its corporate image and its relationship with patients.

Respondents were quizzed on their impression of 29 of the largest global pharmaceutical companies, including Pfizer, AstraZeneca, Boehringer Ingelheim and Roche.

Up to half of responses claimed that pharma had a ‘poor’ record in 2012 for its pricing policies. Nearly the same amount (48%) also claimed that the industry had a ‘poor’ record for being transparent over the last twelve months.

There was also a marked change in opinions of the way pharma manages adverse news about its products – down 29% compared to the 2011 results; of whether it has ethical marketing practices – a fall of 23% on the 2011 data; and of its relationship with the media – down 19% on last year’s results.

But the survey was not all bad news for pharma. As part of the study, respondents were asked to provide feedback on six key indicators that influence corporate reputation: patient-centeredness; patient information; patient safety; useful products; transparency; and integrity. Lundbeck topped the charts after it received the highest ranking overall and moved up three places on 2011’s chart – see below.

Gilead Sciences, which jumped from 10^th in 2011 to 2^nd last year, and Eli Lilly, which improved from 18^th to 9^th place, also had reason to celebrate.

The NHS Commissioning Board has identified the enforcement of generic prescribing as one of its key priorities for 2013.

A study commissioned by the Board found the NHS could save £200m per year by replacing two branded statins with generic alternatives, and annual savings of up to £1bn could be achieved across all prescribing.

The study recommends that GPs with expensive prescribing habits should be required to explain their decisions to the CCG – thus potentially creating conflicts between CCGs and pharmaceutical companies.

An embargo on branded drugs where generic versions exist could also see deep erosion of the specialised biopharmaceuticals market by biosimilars.

Branded drugs are often more recognisable, easier to swallow and even easier to digest than generic alternatives – but they can cost up to 25 times as much.

Open Health Care UK and data research company Mastodon C analysed the prescribing of two statins across the country. Many GPs were still prescribing branded versions, despite the availability of generics.

The Board’s Medical Director, Sir Bruce Keogh (pictured), said: “Variation in prescribing habits costs the NHS millions of pounds a year. Sharing of information will help clinicians understand whether they are over- or under-prescribing.

“This will focus minds in a way that will not only improve the quality of treatment for patients but also reduce cost and free up money for reinvestment.”

According to experts cited by The Independent, two mechanisms underlie the over-prescribing of brands: GP practices with on-site pharmacies have an incentive to prescribe branded drugs as they generate more profit; and hospitals buy branded drugs in bulk, reducing the cost but creating an ongoing patient expectation.

Open Health Care UK and Mastodon C will develop software to help the new CCGs target local GPs whose prescribing practices are expensive.

Pf looks at how the pharmaceutical industry is working with WHO to transform the developing world by defeating neglected diseases such as sleeping sickness and river blindness.

In January 2012, the World Health Organisation (WHO) launched a roadmap to defeat 10 key neglected tropical diseases, with support from 13 major pharmaceutical companies. The campaign targets diseases that are widespread only in the developing world and form major barriers to the economic development of the affected countries. The companies pledged to work in partnership with WHO, governments and health and finance organisations to strengthen their drug donation programmes, support drug distribution and implementation, and increase R&D in this disease area.  

Trojan horses
Most neglected tropical diseases (NTDs) are carried by parasites (such as tsetse flies) or are parasites (such as flatworms), which makes them difficult to treat as parasites are well adapted to the biology of the host. The parasite often acts as a ‘Trojan horse’ introducing disease into the human body. While preventative measures such as sanitation are important for controlling infection, only effective drug treatment can strike at the lethal team of parasite and micro-organism. The challenge is not only to develop effective drugs, bu to ensure they reach the populations affected by the disease.

In the ‘London Declaration on Neglected Tropical Diseases’, WHO and 13 drug companies committed to these objectives for 2020: to eradicate guinea worm disease; make progress towards eliminating lymphatic filariasis, blinding trachoma, sleeping sickness and leprosy; and achieve control of schistosomiasis, river blindness, Chagas disease, visceral leishmaniasis, and soil-transmitted helminthes. The companies involved are Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, Eisai, Gilead, GSK, Johnson & Johnson, Merck KGaA, Merck Sharp & Dohme (MSD), Novartis, Pfizer and Sanofi.

Margaret Chan, Director General of WHO, said: “The efforts of WHO, researchers, partners, and the contributions of industry have changed the face of NTDs. These ancient diseases are now being brought to their knees with stunning speed. I am confident almost all of these diseases can be eliminated or controlled by the end of this decade.” For some of the world’s poorest nations, that means an end to a crippling burden of endemic disease.

As a Sanofi video commented, NTDs are neglected because the populations they affect are neglected. For the pharma industry, offering drug donation, training and education to defeat these diseases is an opportunity to put down roots in important future markets, as well as boosting the industry’s public image through concrete achievements. Despite the current global economic crisis, funding for neglected disease R&D has increased significantly since 2007. Corporate social responsibility is a key aspect of any global drug company’s strategy – especially for companies based in Europe
and the US, where reputation can be a difficult issue.

In May 2012, Dr Margaret Chan commented on work to fight schistosomiasis in Africa: “These Cinderella diseases, long ignored and underappreciated, are a rags-to-riches story. We can blanket this part of the world with medicines that rid every schoolchild of worms and eggs, parasites that interfere with their learning, impair cognitive development, and compromise their nutritional status.” Such achievements, which depend on the pharmaceutical industry, are of historic importance on the world stage.

River blindness
Onchocerciasis (river blindness) causes an estimated 270,000 people each year in Africa and elsewhere to lose their sight. Its biological audit trail is complex: a nematode worm enters the body through the bite of a blackfly; the worms spread through the body, carrying symbiotic bacteria; when the worms die, the bacteria trigger the human immune system, causing severe itching and damaging eye tissue. Some 37 million people are infected with river blindness.

The most successful treatment is MSD’s Mectizan (ivermectin), an oral medication that kills the parasite in its larval stage. On 11 October 2012 (World Sight Day), MSD celebrated 25 years of its programme to donate Mectizan for treatment of river blindness. Through this programme, progress has been made towards eliminating the disease in Nigeria, Uganda, Senegal, Mali and Sudan. MSD is committed to maintaining drug donations until the disease is eliminated.

The Mectizan Donation Programme has influenced the development of other initiatives to fight NDTs in two ways: its multi-sector partnership model and its use of community-directed intervention (CDI). Stakeholders working with MSD to build the programme include WHO, the World Bank, governments, NGOs and communities. The CDI strategy, whereby communities plan their own means of delivering treatment, has enabled Mectizan to be delivered to 75 million people in Africa each year.

Former US President Jimmy Carter commented: “In Africa, where it was once thought river blindness could only be controlled, strides are being made to completely eliminate the disease from a number of countries. Thanks to MSD, the commitment of endemic communities, and strong partnerships, we can now envision a world someday free of river blindness.”

A leading distributor of Mectizan in Africa is Sightsavers, an NGO committed to preventing blindness. Simon Bush, Sightsavers’ Director for NTDs, told Pf: “Sightsavers will, through its support to river blindness programmes in Africa, treat over 25 million people this year as well as playing our part in supporting a network of about one million community-directed distributors.

“We have also the proof of the elimination of transmission of the disease in Kaduna state in Nigeria, which shows that elimination of the disease can be achieved in Africa through treatment with Mectizan alone.” 
The contribution of MSD has been “vital”, Bush said: “Sightsavers would not be able to support the elimination of river blindness and blinding trachoma if it were not for the drug donation programmes. We would not have been able to go to scale.” The supply chain reaching from a major pharmaceutical company to a network of community-directed distributors, reaching through society and across the world, is expected to eliminate transmission of the disease in the targeted countries by 2021.

Blood fluke
Schistosomiasis (blood fluke) is a parasitic flatworm infestation. The larvae enter the body from fresh water sources, mature in the liver and travel through the blood vessels, laying eggs that trigger destructive immune reactions. The disease is estimated to affect 200 million people in Africa and to cause 200,000 deaths each year.

The only medicine with which all forms of schistosomiasis can be treated is Cesol (praziquantel) from Merck Serono (a division of Merck KGaA). In 2007, the company committed to donate 200 million Cesol tablets to WHO for distribution to school-age children primarily in Africa, and to support an awareness programme in schools. In January 2012, Merck Serono doubled its annual donation of tablets to 50 million, to be maintained until the disease is eliminated. It has committed to work with partners to develop a pre-school version of the drug.

Seven million children were treated with Cesol in 2012, bringing the total to 28 million. At the end of November, Merck Serono symbolically donated the 100 millionth Cesol table to WHO, and announced a new programme to distribute the medicine throughout Kenya.

The company’s CEO, Stefan Oschmann, said: “Merck Serono is committed to more effectively fighting neglected tropical diseases.” He added that partnership is the essence of the campaign: “The closer we co-ordinate the donation activities, research and development of new drugs, as well as the supply and distribution of drugs with each other, the more effectively we’ll be able to fight these diseases.”

Sleeping sickness
Trypanosomiasis (sleeping sickness) is one of the tropical world’s most feared diseases. It is spread by the bite of the tsetse fly and affects the brain, causing sleepiness, coma and death. Almost always fatal if untreated, sleeping sickness may be the real basis of the ‘zombie’ myth. But now, according to Dr Margaret Chan, “the stage is set for the elimination of sleeping sickness, a prospect that was unthinkable a decade ago”. For over ten years, Sanofi has worked with WHO to provide drugs and develop treatment protocols for the disease via the campaign ‘Human African Trypanosomiasis – Not Neglected by Sanofi’.

In 2011, Sanofi renewed its commitment to fighting sleeping sickness through a $25m donation, extending its partnership with WHO by another five years. The company donates three of the five drugs used to treat the disease. In January 2012, Sanofi announced a global partnership with Eisai and the Bill & Melinda Gates Foundation to eliminate five NTDs including sleeping sickness and lymphatic filariasis. In July, it noted that the sleeping sickness treatment programme had saved 170,000 lives and reduced the number of new cases from 30,000 in 2001 to 6,500 in 2011. By 2020, WHO has said, Africa may be clear of the disease.

Sanofi’s video from Chad illustrates the methods used to implement treatment. By funding mobile medical teams working in towns and villages, the campaign has brought daily drug therapy to people unable to travel long distances to the city hospitals. Seeing the effects of treatment within the community encourages other patients to be treated there. Sanofi is committed to providing the drugs and supporting their implementation until sleeping sickness is eliminated.