NHS England has announced a new national system for the Cancer Drugs Fund designed to end regional variation in ‘fast-track’ access to cancer drugs.

However, according to the charity Macmillan Cancer Support, the new system has halved the number of indications for which drugs are covered by the fund.

The single national list of drugs approved for ‘fast-track’ funding contains 28 drugs to treat 64 cancer indications, compared to the 129 previously covered by the ten SHAs through the Fund.

The Cancer Drugs Fund, which was established in 2010 and will end in March 2014, provides £200m per year for access to drugs not approved as cost-effective by NICE but requested by doctors for individual patients.

NHS England (formerly the NHS Commissioning Board) took over responsibility for management of the Cancer Drugs Fund from 1 April, ending the regional administration that had seen variations in access to cancer drugs.

Sean Duffy, NHS England’s National Clinical Director for Cancer, said: “Having one consistent method for consideration of overall clinical benefit and funding means that all applications will be assessed by the same criteria. Regional variation of the past is clearly not acceptable for patients.”

Any patient who is already receiving funding for a cancer drug, or has been told they will receive funding as part of an agreed treatment plan, will continue to receive that treatment where clinically appropriate.

The single drugs fund list was developed by the National Cancer Action Team together with the regional clinical leads for the ten former SHAs. A national Clinical Reference Group for Chemotherapy, appointed by NHS England, has approved the proposed list.

However, Mike Hobday, Head of Policy and Research at Macmillan Cancer Support, commented: “It is worrying that the reduced list of cancer drugs that can be funded will restrict access to drugs which were previously routinely available. For rarer cancers, this will be particularly acute.”

Health Secretary Andrew Lansley has been replaced by Culture Secretary Jeremy Hunt as part of David Cameron’s cabinet reshuffle.

Mr Lansley has been demoted to the role of Leader of the House after serving as Secretary of State for Health for two controversial years.

Mr Hunt said the new role was the “biggest privilege of his life” and that he was looking forward to starting work within his new department.

Lansley’s controversial reign will be remembered for the introduction of the Health and Social Care Act – which abolished Strategic Health Authorities and Primary Care Trusts in favour of GP-led clinical commissioning.

The move – which was which contested by a host of national organisations representing healthcare professionals – resulted in thousands of NHS workers losing their jobs during an era of austerity within the health service.

Dr Kaliash Chand, who was recently elected as BMA Deputy Chairman, welcomed Mr Lansley’s removal and hoped his replacement would end the marketisation of the NHS.

He commented: “He has done an utterly miserable job. Especially considering he was shadow health secretary for six years. He was unable to explain what he wanted to achieve. He was not a good communicator. In my view he has not been a very good health secretary. He epitomised everything that has gone wrong in the last two years in the NHS.”

Stephen Whitehead, ABPI Chief Executive, “welcomed” Mr Hunt to the new role and thanked the outgoing Andrew Lansley for his efforts over the last two years. “The NHS is highly regarded both here in the UK and around the world and Jeremy Hunt will face a number of challenges in not only safeguarding its short term success, but its long term future.”

Mr Whitehead said that one of the first challenges the new health secretary faces is getting the latest medicines to patients. He added that the pharmaceutical industry will continue to work closely with the DH to “design a pricing system” that provides value for money for taxpayers whilst “ensuring a healthy and productive environment for companies to research and develop the medicines of the future.”  

Mr Hunt, the MP for South West Surrey and the former Secretary of State for Culture, Olympics, Media and Sport, faced widespread criticism earlier this year when he urged David Cameron to support Rupert Murdoch’s bid for BSkyB – a month before he was due to decide whether the bid should be allowed.

The Strategic Health Authority which controls London has transferred £2.2m from its budget for mental health services to fund its latest cancer programme.

Its Delivery Group approved the cut in mental health services to match priorities set by the board after it was decided that care could still be provided “under more streamlined” arrangements.

Minutes from the recent board meeting show the budget switch was made following a “detailed process of challenge and scrutiny”.

Cancer services in the capital were recently merged in a move the NHS hopes will save up to 1,000 lives a year.

London Cancer combines hospital specialists, GPs and scientists and allows patients to receive specialist care closer to their homes.

Professor Kathy Pritchard-Jones (pictured), Chief Medical Officer, London Cancer, said the capital has “some of the best scientists and clinicians in the country” but the challenge is to get them working together “much more effectively”.

“I think this is a real opportunity to do something ground-breaking for our patients,” she said. “We’ve been given the opportunity to think really big and to plan services for a population of three and a half million people in north and east London, so this means we can now compete with the very best in the world.”

It’s estimated that around 13,600 people die from cancer each year in London, and around 27,000 people are diagnosed with the disease.

THE NHS Commissioning Board’s role in NHS reform is still widely debated. Pf looks at how it will direct the NHS of the future.

The new NHS Commissioning Board (CB) is unique in three respects. Firstly, it stands to take on more power than any arm’s length body in NHS history. For up to three years at a time, it will be entrusted by the Government to run the NHS and allocate its entire commissioning budget, without regular scrutiny by Parliament.

Secondly, it stands to hand over more power than any arm’s length body in NHS history. Of its annual £80bn
commissioning budget, £60bn will be delegated to the 212 Clinical Commissioning Groups responsible for commissioning local services. While the CB will commission primary care from the CCGs and ensure that they deliver on the NHS Outcomes Framework objectives, it will allow them to devise their own solutions and choose their own partners.

The powers of the SHAs are being delegated ‘upward’ to the CB, while the powers of the PCTs are being delegated ‘downward’ to the CCGs. The widespread concern about a potential gap in responsibility led Sir David Nicholson to say: “The NHS Commissioning Board could turn into the greatest quango in the sky. So it needs to have clinicians at its heart and the powerhouse for change in the system must be the
clinical commissioning groups.”

Andrew Lansley’s letter to the CB’s Chair, Malcolm Grant, in April about the Board’s strategic objectives stresses that its first responsibility is to make a “shift of power from national and regional organisations to CCGs, Health and Wellbeing Boards, local providers and patients.” The CB will not be a monolith within a static system: it will be a facilitator of future NHS transformation. That dynamic role is the third unique
feature of the CB, and the most important.

TAKING THE REINS

The DH plan Developing the NHS Commissioning Board (July 2011) outlines the intended structure and functions of the Board. It will have two broad national roles: to commission primary care and specialised services, and to ensure that the entire commissioning system is “cohesive, co-ordinated and efficient”.

Using £20bn of its annual budget, the CB will commission GP services and specialist health areas, including dentistry, maternity, community pharmacy and ophthalmic services. The Board will not govern the CCGs in a traditional way: it will “support” them and “hold them to account” while allowing them “freedom to innovate.” This support includes authorisation, an outcomes framework, guidance tools such as model pathways, and a means of intervening when CCGs are in difficulty.

The CB will host clinical networks to advise on specific areas of care and multi-disciplinary clinical senates to support CCG decision-making. Another key role of the CB is to lead the NHS Outcomes Framework by supporting local clinical improvement, providing “more services outside hospital settings”, improving acute care and the management of long-term conditions, and ensuring that CCGs implement NICE and other national standards.

In addition, the Board will lead patient-centred care by overseeing “the extension of patient choice and the expansion of information available to patients” and promoting both integrated care and innovative self-care.

Finally, it will develop a “medium-term strategy for the NHS” that will combine with the local priorities identified by the Health and Wellbeing Boards to provide a basis for local commissioning plans.

LEADER OF THE PACK

According to the 2011 outline, the CB will work in “partnership” with many other organisations: patient groups, healthcare professionals, healthcare providers, local government, industry and national organisations such as NICE.

The Board’s relationship with suppliers will “support its strategic approach to innovation and development” – in other words, it will play a part in the dynamic evolution of services and provider relationships.

The CB will be organised nationally around the five domains of the NHS Outcomes Framework, with a national lead for each domain. It will also divide its local teams into four ‘commissioning sectors’ reflecting the four existing SHA clusters, each with a sector lead.

The Board will take over functions performed by 8,000 people. It plans to reduce that number to 4,000 – a reflection of its ‘light touch’ approach.

RIDING THE WHIRLWIND

According to Lansley’s letter to Grant, the CB has a responsibility to “contribute to” improved health for “the whole population”, improved care and outcomes “for all patients”, and improved efficiency. Within this context, the Board Authority’s strategic objectives include “transferring power to local organisations” and “establishing the commissioning landscape”. The new NHS will then develop under its own steam, with the clinical networks and senates providing “leadership and insight rather than oversight and compliance”. The authorised CCGs will have the “assumed liberty” to design local services independently.

In addition, Lansley says, the CB will have a “vital leadership role” in enabling the personalisation of care by improving patient choice. This includes the use of personal health budgets. At the provider level, the CB will play a “crucial part” in developing a “level playing field” for competition.

In short, the role of the NHS Commissioning Board is to facilitate the evolution of a rapidly changing healthcare system. These changes will come not from the Board or the DH, but from the decisions of CCGs and their commercial partners.

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.

The Government looks set to have won its battle over the Health and Social Care Bill after the last attempt to halt the legislation failed in the House of Commons.

An emergency debate by Labour to block the changes to the Bill until a risk register was published was defeated by 328 votes to 246.

Andy Burnham, Shadow Health Secretary – who pushed for the risk register to be published – said that the general public would “struggle to understand” how MPs had made “such momentous decisions” without considering all of the evidence on the reforms.

Final amendments to the controversial reforms were approved by MPs paving the way for Royal Assent for the Bill before the break for Easter next week.

Peers in the House of Lords approved the Bill on Monday evening.

The changes to the structure of the NHS will see Strategic Health Authorities and Primary Care Trusts abolished in favour of local Clinical Commissioning Groups. The move, which will see GPs given budgetary responsibilities and the opportunity to outsource services privately, has been widely opposed.

Mr Burnham admitted that the legislation becoming law was inevitable and the only hope left to defeat the Government’s plans would be a “change of heart” from the Lib Dems.

“We have given this fight everything that we had,” he said. “All I can say is our fight will go on to protect and restore this party’s finest achievement.”

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

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

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

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

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

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

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

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

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

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

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

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

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

David Round is UK General Manager, Cegedim Relationship Management.

Emerging clinical commissioning groups in the Midlands and East SHA are less likely to pass strategic health authority risk assessments, according to information shown to BMJ Careers.

Assessments showed that prospective commissioning bodies in the Midlands and East SHA were most likely to have failed the rating system which measures group size, shape and practice engagement.

Emerging commissioning bodies were found to most likely to fail to assess the impact of their size correctly.

The assessments graded CCGs as “red”, “amber” or “green”. Nearly all CCGs (94.2%) were given either an “amber” or “green” grading and are in a position to take on the responsibility of PCT budgets for local services this April.

No CCGs in London were given a “red” rating and the majority (96%) of emerging groups in the North of England SHA were also graded either “amber” or “green”.

Groups which have been assessed to be in a position to take on budgets will be allocated funds for local services in order for them to act as shadow CCGs until they are fully authorised in April 2013.