The NHS Quality, Innovation, Productivity and Prevention (QIPP) programme has been broken down into its components following the resignation of its leader, Jim Easton.

The role of the former National Director for Improvement and Efficiency at the NHS Commissioning Board will be divided between four other national directors and SHA leader Sir Ian Carruthers.

Easton (pictured), who has left the NHS to head private health provider Care UK, warned in May that QIPP had become a ‘label’ for NHS spending cuts without service redesign.

Then changes mean that the QIPP programme will not have a specific team or individual leader to drive it forward.

According to the Health Service Journal, the decision not to replace Easton was made to reduce the Board’s running costs and because his role had been uniquely created for his skills.

Easton’s former responsibilities will be divided as follows. Sir Bruce Keogh’s medical directorate will be responsible for a new NHS improvement body, led by the five clinical domain directors. Bill McCarthy’s policy directorate will be responsible for strategy, including medium-term QIPP strategy. Jo-Anne Wass’s HR directorate will be responsible for the new Leadership Academy. Ian Dalton’s operations directorate will be responsible for productivity improvement.

In addition, NHS South West Chief Executive Sir Ian Carruthers will take over the leadership of NHS innovation.

A new NHS procurement guidance document aims to bring hospital procurement and healthcare commissioning closer together.

‘NHS Procurement: Raising Our Game’ is the first step in the establishment of a national procurement strategy, and goes out with a call for “evidence and ideas”.

The guidance addresses the organisation and review of NHS procurement, looking to see better collaboration and sharing of data between trusts.

Sir David Nicholson (pictured), NHS Chief Executive, says that NHS procurement needs to be “focused on outcomes, not cost” and be responsive to “creative ideas from suppliers, procurement specialists, clinicians and managers”.

The guidance claims the NHS can save £1.2bn per year by making its procurement more efficient.

At present, it says, the system is “fragmented” and lacks coherent data. The current system of framework agreements does not address the wide variations in procurement practice and commitment to suppliers.

The NHS needs to bring down both the costs of procurement and the costs of medical supplies – to achieve these goals, the guidance argues, greater transparency and use of IT are key.

Part of the proposed solution is greater use of procurement partners such as NHS Supply Chain, which “can be incentivised to give stronger commitment to suppliers in return for better terms”.

The DH wants Trusts to develop an ‘open door’ policy towards all providers, and will update the NHS standard terms and conditions of contract for goods and services to support its existing guidance on innovation.

The existing National Procurement Council will develop working groups to implement the national procurement strategy as it evolves this year.

Sir Ian Carruthers, Chief Executive, NHS South of England, has issued a call for “evidence and ideas” on ways to develop “world class procurement” to the NHS, industry, the academic and voluntary sectors and social care.

His letter comments: “We need more innovative procurement processes and more widespread procurement of innovation. By harnessing relationships with suppliers, the NHS can adopt existing innovations and stimulate new innovation to deliver quality and value.”

A trio of the NHS’ most experienced leaders have turned down the opportunity to join the NHS Commissioning Board.

Former NHS Acting Chief Executive Sir Ian Carruthers, Dame Ruth Carnall and Sir Neil McKay all declined the opportunity commence to high profile roles on the commissioning committee.

Ian Dalton, Chief Executive NHS North of England, has already been appointed as the Board’s Chief Operating Officer.

However, it was expected that Sir Ian, who is Chief Executive at NHS South of England, Dame Ruth, Chief Executive at NHS London, and Sir Neil, Chief Executive at NHS Midlands and the East, would fill regional positions within the reformed health service.

But the trio told HSJ they had no intention of being part of the new structure. They are expected to continue in their roles until Strategic Health Authorities are abolished in April 2013, but intend to pursue new career paths.

Sir Ian expects to be involved with the NHS when SHA are abolished, the Journal said, but will not seek a major full-time role; Dame Ruth indicated she intends to work as a freelance consultant, and Sir Neil said he was is still considering his options.

The National Commissioning Board, which was established in shadow form in October last year, will support Clinical Commissioning Groups when they take responsibility for the NHS budget this time next year.

With so many pharmaceutical companies undergoing some sort of restructuring plans as a result of mergers, acquisitions or simply cost-cutting measures, field force worries immediately turn to job security. Apodi’s Tony Swift discusses valuable ways to ensure your job isn’t one under scrutiny the next time the axe is wielded, and how to progress in the new pharmaceutical world.

In the past a competent sales representative could look forward to a long and secure career in the same or similar role, often with the same company. For the more ambitious representative it was also possible to climb a well-defined ladder towards seniority – as field trainer, sales manager, sales director and beyond.

However, much has changed. Sales representative positions have reduced dramatically and the ladder to seniority appears far more difficult to climb. Job security and traditional long-term career planning is disappearing into oblivion. The situation is just as precarious for those half way up the ladder, in first or second-line management roles, and restructuring is affecting job security and career planning throughout companies in the industry.

These seismic changes are not temporary. We are seeing a transition to a new world order in the pharmaceutical industry where:

• Traditional career paths are disappearing
• Management roles are fewer and are just as susceptible to restructuring
• Employees can no longer rely on the organisation to develop their careers – career and personal development is an individual’s responsibility
• The company needs to provide support and experiences to individuals to learn new ways of adding value to the customer and the company itself
• Creative expertise to address the new NHS is in huge demand by pharmaceutical companies. This presents an enormous opportunity for representatives and managers who may currently be worried about their long-term future in the industry.
  

Personal development
I recently interviewed a number of successful pharmaceutical industry executives to assess how they addressed the issue of personal development. Almost all of them stated that they could not have solely relied on the organisations they had worked for to either fully develop their skills or, indeed, their career.

In the majority of cases these successful individuals had made a decision to take personal charge of their careers. By keeping abreast of changes in the industry, anticipating new developments and consistently reviewing and updating their skills and relationships, when changes did occur in the industry or company, they were often well placed to take advantage of the new opportunities these presented.

At Apodi, our resourcing division sees first-hand the changing dynamics of the marketplace. Quality market access and key account managers are much in demand and are, at times, very difficult to recruit. There are also lots of sales representatives looking for jobs, with many believing they now have to look outside the industry to secure their future. However, representatives who are aware of the changing dynamics and have adapted their skills are now often successfully obtaining those market access and KAM roles.

Taking charge
One conversation with a successful executive led to a more in-depth discussion about what sales representatives can do if they want a long-term career in the pharmaceutical industry. The executive detailed the steps he had taken, and I believe this serves as an interesting case study for those unsure about their prospects in the industry. He said: ”It quickly became apparent to me that to take charge of my career I had to focus on a number of key areas.” To summarise, these were:

• To develop a clear view of the future of the industry and the likely impact of this on an existing position and potential future roles
• Be successful in a current role –  believe that new opportunities will only arise following success
• Find a systematic way of increasing knowledge, skills and relationships – do this to differentiate yourself from colleagues.

The future
In a previous article, Leading the way – Pharmaceutical Field, September 2011, I mentioned a couple of quotes. One was from a leading member of the NHS responding to how pharmaceutical companies could more actively engage with the health service. They said: “Don’t just bring pills and gadgets in the future, bring us value added solutions that drive the QIPP agenda with a documented and robust cost/benefit analysis.”                                   

The other, by Sir Ian Carruthers, NHS Chief Executive Innovation Review Team, stated: “The pharmaceutical industry needs to think more in terms of working in partnership with the NHS rather than just sending in the sales force… the NHS needs your disruptive contribution to help NHS reform, but too few companies are coming forward.”  

Despite such prominent views from the NHS, many companies are still sending out sales representatives with a very limited agenda – primarily delivering some key messages about a particular product. Indeed, some observers believe that the pharmaceutical sales representative is one of the world’s most underutilised resources! And, given the limited ambitions of each visit, it is perhaps not surprising that HCPs are continuing to reduce access.

To counter this, companies are deploying key account managers whose role is to provide value over and above the ‘noise’ associated with a traditional rep visit. We believe there will be a gradual merging of the functions of sales representative and KAM in the future. This means that everyone representing a company in the field will need to operate to KAM principles and provide significantly more value than before. Indeed, our research shows that historically excellent representatives have effectively operated to KAM principles, irrespective of the training and direction received from head office.

Current success
Whilst each sales representative has key performance indicators (KPIs) to meet – often merely call rates, we believe that individuals need to focus on providing added value to their customers and their companies irrespective of their targets. By taking a more strategic view, identifying the key stakeholders, delivering and developing solutions with the help of their company’s marketing, medical and promotional functions, representatives will become a more valued partner to both parties.

Representatives can only do this if they are experts in their products, the therapy area concerned, the care pathway and the local healthcare economy. Additionally, they will need knowledge of best practice and potential solutions.

Unfortunately, to some this may be perceived as going ‘beyond brief’ and will sometimes result in knockbacks. However, we believe the risks attached to this are far less than continuing with the limited role noted above. The risks of a representative failing to distinguish themselves and failing to provide real value will leave them susceptible at times of restructuring, and with fewer skills needed to attract jobs in the new healthcare economy.

Using initiative 
Fundamental to taking charge of your career is to take responsibility for personal development. A colleague told me about how he had done this successfully with a process that included the following:

A) Yearly audit – produce an annual plan that addresses the following:

• I am currently known for…
• Next year I want to be known for…
• My personal development last year included…
• I currently differentiate myself from my colleagues by…

B) Quarterly plan – each quarter produce an action plan:

• I aim to develop a more in-depth knowledge of the product, therapy area, care pathway and local healthcare economy by…
• I will develop closer relationships with key stakeholders in my company by…
• I will develop closer relationships with key customers by…
• I will develop a better understanding of best practice and consider the most appropriate solutions for my customers’ problems by…

C) Quarterly assessment – assess the potential to drive value into internal/external customers against the following parameters:

• Do I demonstrate more than financial value to key accounts?
• Have I increased the number of internal/external relationships where I add real value?
• Do I possess specialist knowledge that I can share with colleagues/customers to add value?
• Have I influenced any changes to the benefit of the company or customers?

This learning and knowledge was primarily delivered through personal research using books, magazines and the internet. My colleague also constantly suggested projects that he could work on, even in his own time, that he felt could transform the value being provided to customers. Many of these were rejected, particularly initially, but eventually he developed close enough relationships with people in the company who recognised the value these projects might create. These projects were a very valuable learning tool and a superb way of displaying his talents.

In summary
Pharmaceutical companies are looking for new and innovative ways of providing value to customers. As decision making within the NHS increasingly shifts to those regularly interacting with the end user (patients), the opportunity for primary care representatives to adopt a more customer-centric approach based on KAM principles grows exponentially.

The advantages of this may lead to less complicated field force structures, reduced costs and additional value added for customers. With such developments, companies will be in a better position to assist each individual in developing their careers to meet the demands of the new healthcare economy.

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.

At a time when both the Government and the NHS are calling for value for money, how can pharma introduce and promote innovation and value propositions? Tony Swift discusses ways and means of promoting eye-catching solutions through the key account approach.

In my two previous articles, Making it work and It’s all in the execution, I discussed the transition to Key Account Management (KAM) structures that many pharmaceutical companies are currently addressing. They focused on the difficulties of execution and considered various related issues such as:

• The move towards decentralisation
• The role of leadership
• The importance of support from the people in power
• The need to change the culture, beliefs and behaviours of individuals within the business
• The requirement for supporting the new strategy with a process including short-term objectives, incentives and controls that drives the whole execution initiative.

My final article on this topic covers the issue of building innovation and value propositions into a company. This topic is, of course, fundamental to any pharmaceutical company. For example, the rationale for many pharma companies is to build a drug portfolio that differentiates itself from the competition – either through a cost advantage or by improving patient outcomes. This article concentrates on building innovation and value propositions into the KAM process and is based on the premise that to justify moving to Key Account Management, account managers have to be armed with value propositions that are attractive to the customer.

KAM and Jobs
Over Christmas I was lucky enough to receive the recent biography of the late Steve Jobs, the former CEO of Apple. It was a fascinating read and highlighted the pros and cons of working for the guy mainly responsible for building one of the most successful companies in the world. The key message that came out of the book for me was the total focus Jobs had on delivering the very best products for the company’s customers. Apple was able to do this repeatedly with products we are all familiar with, such as the iPhone, iPad and iPod. Jobs also managed to achieve success in the world of animated cinema through his company Pixar, which produced films such as Toy Story, A Bug’s Life and Finding Nemo, before being sold to Disney. Disney bought Pixar primarily because, for the first time in its existence, a company was out performing it in its core area of animated film production.

So why was Jobs continually able to innovate more successfully than his competitors and what lessons can pharma learn from his approach when moving towards a KAM structure? I will address this later, but would note that Jobs’ success had little, if anything, to do with market research and asking the customer what they needed – as Jobs stated, customers don’t know what they want until we’ve shown them.

The demand from pharma
It is clear that pharma’s primary customer, the NHS, is now a series of complex and multi-layered accounts with an increasing number of stakeholders and influencers. Prescribers, payers, patients and policy makers are looking increasingly for pharma companies to offer true value added solutions rather than just products. Key Account Management represents a real opportunity for pharma to develop an effective value proposition and nurture closer and more effective relationships with key customers.

I attended a conference recently and a member of the audience asked a leading member of the NHS how pharmaceutical companies could more actively engage with the health service. The response was: “Don’t just bring pills and gadgets in the future, bring us value added solutions that drive the QIPP agenda with a documented and robust cost/benefit analysis.”                                       

This is an increasingly typical response. Sir Ian Carruthers, Head of the Government Innovation Review Team for the NHS, stated: “The pharma industry needs to think more in terms of working in partnership with the NHS rather than just sending in the sales force…the NHS needs your disruptive contribution to help reform, but too few companies are coming forward.”      

The Government and NHS leaders are crying out for more innovative input, although potential trust problems between the NHS and pharma can impede the implementation of some value added solutions. In any event, there is no doubt that demand for more input from pharma is growing and, given the Government and NHS agenda, it appears this can only continue.

Can pharma deliver?
Our experience at Apodi shows that companies currently differ significantly in their ability to deliver innovation and value added solutions through their Key Account Managers. However, a number of companies are extremely well set up to drive this agenda with specific divisions established to identify new ways of working in partnership with the NHS. Some have managed to integrate the operations of these ‘centres of excellence’ with other parts of the company – particularly brand management, sales and KAM management, and marketing.  In other words, innovation and execution are inextricably linked.
Other companies are not so well positioned or structured to deliver such value added solutions. In this situation, the validity of establishing a KAM structure needs to be addressed. I was recently party to a discussion between a senior executive of a pharma company and a service supplier that went along the following lines:

Service supplier: “Do your KAMs have real value propositions/solutions to take to the customer?”
Senior executive: “No.”
Service supplier: “Why not?”
Senior executive: “There is no real process to identify propositions and any that are identified are blocked because of budgetary constraints, restructuring issues and so on.”
Service supplier: “So why invest in KAMs?”
Senior Executive: (Silence).

Success ultimately depends on the KAM delivering real value to the customer. If that is not possible, companies need to critically analyse whether they should invest in Key Account Management rather than, or as well as, a ‘share of voice’ solution.

An innovative culture
For those companies still at the starting blocks in terms of building and delivering innovative value added solutions to its customer(s), the key question is what steps are needed to drive these processes into the company?

a) Establish a ‘Centre of Excellence’
Firstly, it is clear that it takes investment to truly understand customer issues and develop a deep knowledge of the marketplace to identify how experiences and value can be improved. Such insight is a powerful foundation for strategic, product and service innovations that create value for all parties.
In the early stages, we believe a company needs to establish a function to identify value added solutions. This should be centrally driven and staffed full time by people with the appropriate skills. Whatever these centres of value added excellence are called, their role is to generate propositions that can be shared with other parts of the company to assess whether the propositions should become part of the ‘tool kit’ of Key Account Managers.

b) Develop links with other parts of the organisation
As mentioned earlier, it is critical to link innovation and execution. This may be best done by the company encouraging – even demanding – that the Centre of Excellence coordinates its activities with other parts of the organisation, particularly those involved in executing the value added solutions.
How well a company coordinates these activities and actually makes things happen depends on a number of factors. For example, we have seen companies identifying value added solutions and introduce them to the Key Account Management structure, but then nothing happens. In this situation, the company needs to implement a rigorous process of establishing short-term objectives, incentives and controls to ensure that behaviours change.

c) Focus
Steve Jobs stated that his real passion was to build a company where people were motivated to make great products and that everything else was secondary. The focus he was able to engender in his company was extraordinary. Leaders need to assess whether they are instilling a culture that supports innovation and building value added solutions for their customers.

The impact of value
With the NHS now being a complex, multi-layered organisation with an increasing number of stakeholders and influencers, most value added solutions will differ depending on the company’s particular circumstances, product portfolios, services and so on. They will, however, be focused in one or more of the following areas:

a) Prescribers: solutions may address best patient outcomes, other clinical benefits and cost effectiveness of treatment

b) Policy makers: solutions may address care pathways, disease management targets and integrated care clinics

c) Patients: solutions may address adherence, access, provision of information, support groups and integrated care clinics

d) Payers: solutions that address funding issues, monitoring usage issues, etc.

Back to Steve Jobs     
Ultimately, Apple was so successful in building the most innovative products in its industry because the company, through Steve Jobs, ensured that innovation and value added solutions became part of the DNA of the company.

If a company is establishing a Key Account Management structure, we at Apodi believe that pharma companies need to follow these same principles. After all, what is more important when establishing a KAM structure than making sure account managers are in a position to deliver real value to their customers?  

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.

The DH has appointed the chief executives which will lead the four Strategic Health Authority clusters.

Ian Dalton will lead NHS North of England, Sir Ian Carruthers will head NHS South, NHS Midlands and East will be managed by Sir Neil McKay, and Dame Ruth Carnall will continue as Chief Executive of NHS London.

Sir David Nicholson, NHS Chief Executive and National Commissioning Board Chief Executive Designate, says the clusters are an “important part of our approach to managing transition”.

The clusters are set to be in place until the NHS Commissioning Board is fully functional by April 2013.

A number of existing SHA chief executives have also got new roles within the new structure. Ian Cumming, leader of NHS West Midlands, has been appointed as National Managing Director for Quality during the transition.

Candy Morris, currently the Chief Executive of NHS South East Coast, will become the Senior Responsible Officer for the establishment of the Health Research Authority. NHS Yorkshire and the Humber boss, Bill McCarthy, has been appointed as Managing Director responsible for the set up of the NHS Commissioning Board.

“Managing transition is about keeping a tight grip on today’s service performance, finances and delivery, whilst simultaneously putting in place tomorrow’s new world architecture,” said Sir David.

“By putting the current regional arrangements on the same initial footprint as the NHS Commissioning Board and potentially other new organisations, the SHA clusters form an important step in the journey to the new system.”