A savage trip through the heart of NHS reform with John Pinching.

My arrival at the Royal College of Physicians, for the annual Wellards Conference, was greeted by a thumping disco beat and the unmistakable brotherly harmonies of the Bee Gees. A quick scan for white polyester garments and ill-advised medallions allayed a nagging fear that I might have boogied into the wrong gig (there were one or two Barry Gibb-inspired beards, however).
I can’t lie, with the effects of three hastily consumed espressos coursing through my frontal lobes, and noticing that the walls were festooned with horrifying surgical instruments from a bygone age, the scene was becoming trippy.

When the funky grooves finally faded, charismatic master of ceremonies and resident DJ Alan Jones (ajc healthcare) explained the nostalgic intro. “We have gone for 70s music because the themes of this conference feel very retro,” he said. “Many of these subjects have done the rounds for decades!” This cat had obviously been here before – who could blame him for turning to Donna Summer for the answers? Granted, Donna is now gyrating across the great dance floor in the sky, but I felt sure that if anyone could resurrect those haunting tones, it was Alan.

Never say ‘never’ again
Among the hired guns at this first shindig was Dr Amit Bhargava, who – in his capacity as a clinical accountable officer at the Crawley Commissioning Group – provided hot gossip straight from the coal face, enthusing about some elements and speculating about others.

He insisted that “the time has come for change in the health service”.

“The structure of the NHS is like a game of Jenga and it is bound to topple eventually as a result of paying more and more for less and less,” he added.

Curious metaphor. Indeed, how interesting to note that, generally, the people who remove bricks from the lurching tower are usually hopelessly drunk. If any analogy should fall down (assuming it has), I suppose it should be one about Jenga.

He also reflected on the challenges CCGs faced when trying to improve patient experiences, with reference to the life span of residents in the Crawley area. “If you take the number 10 bus, within three miles [depending on the stop] you get a seven year age difference,” he said. “Crawley is a relatively new town; these areas don’t look deprived.”

“Look at the maps to identify the need,” Bhargava concluded, “And you’ll do all right.”

All very helpful, sure, but when – like a sniper in the thicket – I fired a slippery missile from the crowd regarding whether Hunt, in light of the Murdoch ‘affair’, was the right cat for the job, he shot me a dead-eyed stare and dodged the ol’ bullet – “I hope so, but I’ve never met him”, he choked. Ye gods, Amit, I’ve never met the Führer, but I’m telling you now, I won’t be breaking Battenberg with him anytime soon. Surely it’s essential for people with influence to hold their ‘leaders’ to account – unelected leaders at that – while forming opinions about their performances, if not their character?

As if by design Hues Corporation’s 1974 hit ‘Rock the Boat’ began playing. Freaky.

Circle of life
Circle Health’s Dr Ali Parsa’s stint at the lectern produced a captivating speech, dispensing with boring Powerpoint slides, and instead relying on the zeal of entrepreneurial spirit. It was a man and his voice, and that voice meant business (quite literally).

After lamenting his own lack of height – “Sorry if you can’t see me!” – Parsa philosophically considered the ‘micro economics’ that influence the future of every individual.

“If I was born in communist Russia or Mao’s China, I was going to do substantially worse than if I was born in the West,” he said. “Bill Gates used to say that the genius in Mumbai did fundamentally worse than the average person born in Baltimore. That world has now changed.

“I look at my children and I ask that question: what will be the micro economic trend that dictates their destiny? The answer to that lies in where Britain sits among those trends. When I first arrived thirty years ago Britain was top five in the prosperity league, it is now 28. One position ahead of Greece.”

He then pontificated about the possibility of a British resurgence, inspired by the candid investment in ‘Team GB’ throughout the years building up to the Olympic Games. He warned, however, against arrogantly assuming we could compete with the manufacturing in Germany or workforce flexibility of China.

“Why can’t Britain have global healthcare companies that sell to the world, like Tesco?” he mused.
Ali reflected on his own rise: from humble beginnings in Iran to a leading light in hospital innovation. He canvassed a firmly held belief that Britain used to be a fertile hotbed of pharmaceutical innovation and could rise once again if only it was prepared to embrace change and look at the situation through the prism of modern patient demands.

Most poignantly, Ali told a story about how he had shown guests around his first private hospital – designed by Sir Norman Foster. The surroundings were so comfortable that after a while someone had asked, “When are we going to see the hospital?” The NHS has conditioned us to assume that hospitals are grisly corridors of uncertainty. How refreshing to hear that it doesn’t have to be this way.

With much to ponder, I lunched on the chicken and apple casserole which – despite my reservations about mixing fruit and flesh – went down well.

Whitehead-strong
The next port of call on my magical mystery tour was the ABPI conference and, while Wellards had provided some interesting sparring, Stephen Whitehead, ABPI’s Chief Executive, ensured the gloves were off straight away, landing some lusty blows.

He started by admitting a handwriting test had revealed he was psychotic and that he was here to explode the myth of a bright new NHS which made pharma a priority.

“Something odd is happening in the UK and I want to take this opportunity to speak out. I don’t want cry fire in a crowded room, but I was raised to tell the truth.”

At this point I sat up and brushed the remaining crumbs of pain au chocolat from my sweater. I think I was about to witness – what do they call it – ‘a happening’.

“The UK is a tough and difficult place. We [pharma] are down 16,000 jobs in four years; we have suffered closures and decline. Pressure is immense. Patients are denied choice and we have the lowest uptake of innovation in Europe,”
he said.

“We have strong new products from the likes of Shire, Novartis and Pfizer, [but] the deal we have, to discover healthcare and provide it to patients, is broken. The industry has changed from the one it was ten years ago. It used to be that the UK was the second market behind the USA: a proud place for discovery, development and launch.

“We still launch great medicines, but suffer from pathetically low levels of uptake. There have been superb breakthroughs in Hepatitis C, for example, but orders are dwindling because of agonising referrals.

“The NHS won’t invest to save longer term and its decision making is often dictated by provider interest rather than patients. Why is my dad, with crippling shingles, given Paracetamol? Why was my good friend given a cancer drug privately, but unable to get it on the NHS? Why was my mum put on a waiting list with a prolapsed bladder for six months? When I called a consultant three days later he said he would do it for £3000.

“The NHS is a religion, but we know what happens to countries that don’t revaluate their faith,” he added.

It’s been emotional
It was a passionate, robust and at times emotional response to what he considered an NHS that was failing miserably in its objectives. What defined Whitehead’s speech was a frustration that manifested itself both professionally and personally. It was terrific to hear him refer to his own personal experiences, adding a devastating cocktail of brutal honesty and spearing clarity, which surely some of the NHS’s policy-regurgitating line-toers can learn from?

All too often we are bombarded by a politically sterilised dogma that jars with reality and falls off the cerebral cortex like so many white papers off a shovel. This was in evidence when one of the NHS’s knights of the realm, Sir Ian Carruthers OBE (no less), attempted to tackle the blaze Whitehead had ignited by randomly dispatching buckets of barely legible civil service twaddle. The numbing jargon that followed was like some kind of linguistic water boarding – “innovative approaches”, “operating framework”, “technology appraisals”, “delivery uptake”, “personal incentives”. Stop, stop, stop! I can’t take it any more!

One sentence contained the word “implementation” half a dozen times. Is it possible that when these ‘honours list parasites’ pick up their prefixes and suffixes, they also agree to wander around in a clanging armour of jargon?

Again, the private sector’s clarity and verve of expression was in stark, embarrassing contrast to some of the insipid management speak on offer here.

Johnny’s final thought
Since the beginning of civilisation words have needed meaning. Organisations which grow out of all proportion to their original concept – like the NHS – often use a dribbling dialect designed to vaporise instantly, lest it should actually seep inside a human brain.

As the multi-tentacled other-worldly creature of NHS reform continues to loom over two very different cultures, it is clear that communication simply has to change – at the moment they are speaking entirely different languages.

Aclimatisation for the NHS has often been the bitterest pill to swallow but now – as Alan would no doubt agree – it’s time to change the record.

The pharmaceutical market in the UK is changing quickly. By April next year just over 200 Clinical Commissioning Groups will have completed the approval process and will be operational. This will dramatically change the customer landscape for pharmaceutical companies and also demand changes in engagement strategies. This, in turn, will necessitate changes in the behaviours of individuals responsible for that engagement (such as Market Access Managers, Key Account Managers and Sales Representatives).

Pharmaceutical companies are continually restructuring in an attempt to keep pace with the rate of change. However, one of the key problems they face is assessing whether their current workforce has the talents and skills to address these new challenges. It is certainly the case that some companies are finding a lack of flexibility and adaptability within their workforce to support the change process.

Critical talents
Given the fluidity of the market environment and to be in a position to proactively respond to it, companies must address the critical talents required by the workforce and start to assess for these talents during the recruitment process. These include two particular talents which are of vital importance, but are often currently not assessed for. These are:

• Adaptability (or flexibility/agility)
• Learning mind set.

Adaptability
Individuals with this talent will respond well to changing demands. They flourish in environments that reward responsiveness and do not require a highly formalised or routine structure with lots of rules and regulations. They also have the ability to recognise current or future anticipated changes and adjust their attitudes, beliefs and behaviours to cope with them.

Learning mind set (Learner)
People with this talent demonstrate a great desire to learn and want to continuously improve their knowledge and skills set. They will also be more likely to understand the changing nature of the marketplace and the need to learn how to engage with new types of customers.

Many Sales Representatives in the Pharmaceutical Industry are being asked to radically change how they work and to start engaging with customers using key account management principles. To perform this
role effectively, more knowledge of the customer and the marketplace is required. There is also the need to change behaviours and attitudes that may have suited the more traditional role they fulfilled previously.
Those representatives with adaptability and learner talents are more likely to succeed than those without them. These talents are now required across the whole structural chain – from Representative to Manager,
to Leader, to Technical Consultant, and across the wide and varied roles within the engagement process. The ability to learn and adapt is now critical within Pharma/Healthcare and beyond.

Selecting for adaptability and learning mindset
As with any other talent, predicting who will be adaptable requires a variety of assessment techniques, including:

• Occupational Personality Questionnaires (OPQs) that assess cognitive ability including reasoning,
  thinking and problem solving
• Interviews to assess personality factors, including results orientation, openness to new experiences and willingness to try new things
• Specific tools which assess mental toughness and the candidate’s ability to confidently cope with change, difficulties and new environments.

Similar approaches can be used to assess whether candidates have a learning mind set. In his book A Collection of Articles on Achieving High Performance in Teams within Pharma and Healthcare, Tony Swift,
a colleague at Apodi, stresses in the article entitled ‘Moving on up’ that successful executives must take charge of their own personal development and not rely on the employer to spoonfeed all learning.

Frankly, it is easy to spot this. Those executives who blame the employer for lack of development, or who are ‘too busy’ to dedicate time to learning, almost certainly do not have a learning mind set. Compare this to the ‘learner’ mind set, which sees individuals organising their working day to set aside time to ensure they keep up to date with developments in the marketplace, new
innovations and the latest practices.

Promoting adaptability and a learning mindset
Whilst it is important for individuals to take responsibility for their own development, this in no way absolves the organisation from also playing its part in developing a culture where adaptability and a learning mind set become ingrained. Whilst reviewing recruitment practices is, of course, a good start, unfortunately cultural change is more complex than this. Cultural change requires fundamental shifts in behaviours and these can be encouraged by:

• Bringing new people into the organisation with the appropriate talents, as above
• Changing the organisational structure
• Short term objectives, incentives and controls that demand adaptability and learning.

In my own organisation, we have realised that it is critical for most of our employees to have an in-depth understanding of the NHS and how our services can best be applied for the benefit of our customers in such a rapidly changing environment. To ensure Apodi promotes this, the company is:

• Running regular workshops that are focused on ‘Understanding the changing NHS and the Apodi proposition and how to apply it to the new market economy’
• Guidance to all individuals on how they can keep updated on all key developments through the use of the web, social media and other sources of information. Whilst guidance is provided, it is stressed that ultimately responsibility rests with the individual for their own personal development.

Stability is a dangerous illusion
For a lot of people, the Pharmaceutical Industry has provided a stable career over many years. For example, there are many Sales Representatives who have had a successful career fundamentally doing the same job in the same way and often for the same employer. Whilst there will always be a need for Sales Representatives within the industry, the number has fallen and will continue to fall. And for many, the role itself will change and demand the acquisition of new skills and knowledge.

Some companies are addressing the need to change rather quicker than others. Those that are slow to act may be creating a situation where some employees still feel they are operating in a relatively stable environment. This may be a dangerous illusion because it is almost guaranteed that the changing environment within the industry will impact on most employees – and probably sooner rather than later.

Given this situation, companies will increasingly be looking for employees who have the adaptability skill to cope with change and fundamental to this is a learning mind set. We believe this is relevant to all employees looking to advance with their current employer and to those looking for opportunities elsewhere. Both short-term and long-term career planning in the new age requires employees having a CV that clearly articulates the capacity to adapt and an in-depth understanding of the changing industry environment. For people with these talents, they should be able to look forward to a varied, rewarding and long-term career within the industry.

Jan Cox is the Resourcing Director at Apodi and can be reached on jan.cox@apodi.co.uk.

Value-based pricing (VBP) is a more fair and balanced way of supplying life-saving drugs for patients than the Government’s Cancer Drugs Fund, a new study shows.

Research by the University of Bangor found that out of more than 4,000 people across Britain 64% agreed that the NHS should not pay more for cancer drugs compared to medicines for other threatening conditions.

Professor Dyfrig Hughes, study author, said “singling out cancer seems to be unfair, but is something which will hopefully be addressed in the value-based pricing system, which has public support.”

The Cancer Drugs Fund was introduced two years ago for the NHS to treat patients with oncology treatments not currently recommended by NICE. It supplies £200m a year until 2013 to pay for drugs.

VBP is the Government’s alternative to the existing 2009 PPRS pricing scheme – set to expire in 2013. It will allow government to set prices for new medicines as they enter the UK market – and set new definitions of value.

Although it has gained support from the general public, the ABPI has raised a number of concerns about the new system and is in negotiations with the Government to create an amended version.

“The funding of high cost cancer treatments is clearly an emotive issue, and it is for politicians to determine the parameters by which the NHS pays for them, however, there are equally distressing conditions affecting patients who are equally deserving, but they have no access to ring-fenced budgets,” said Professor Hughes.

The UK pharmaceutical market is expected to experience slight growth over the next five years, a report predicts.

Research from IBISWorld found that until 2017-2018 the industry is predicted to post annual revenue growth of approximately 1.8%.

Arna Richardson, IBISWorld industry analyst, said the UK pharmaceutical market is “particularly important” to the national and global economy.

The report found the UK is the eighth-largest pharmaceutical market in the world. It also plays a vital part in the UK’s economy being the third-largest contributor to economic growth.

IBISWorld forecast that revenue will be around £18.9 billion in 2012-2013 – a 2.7% increase on the year before.

However, the combination of intensifying global forces and growing internal pressures due to the fallout from the NHS reforms will be translated into further pressure over the next five years and stunt growth.

Pharmaceutical companies will also have to contend with a wide assortment of issues, the report warns, as they adapt to the changing economic and operating environments in the UK.

This month’s Pharmaceutical Field looks at some of the major issues affecting UK pharma at present; the evolution of its customer-base, an increased focus on compliance, the developing training needs of medical sales professionals and pharma companies’ ongoing challenge to attract and, crucially, retain talent.

The DH’s Innovation Health and Wealth document, published at the tail end of 2011, seeks to address the most significant challenge for UK healthcare – accelerating the adoption of innovation within the NHS. There is much that pharma can do to help enable innovative medicines reach patients more quickly.

Regulatory compliance remains a key priority for pharma as recent and impending global legislation puts pharma’s engagement with customers under increased scrutiny. In the process, the changing legislative landscape is having a significant impact on the training needs of medical sales professionals in the UK. This, in turn, is having a domino-effect on the pharmaceutical employment market, where a notable ‘skills gap’ is having a huge impact on recruitment and the quality of applicants for commercial roles.

Faced with an apparent dearth of quality candidates for sales positions, companies are needing to work hard to create the best working environment to retain their most talented employees. Pf’s annual attitudinal survey of the UK sales force reveals that, in some parts of the industry, there remains much to be done to ensure that the company culture advertised in the corporate brochure matches that experienced by employees in the workplace.

Unite has called upon the Government to produce a strategic manufacturing strategy to support the sector following GSK’s £500m UK investment.

The UK’s largest union welcomed plans by Glaxo to build a new £350m manufacturing site in Cumbria, along with other projects, which will create up to 1,000 new jobs.

Linda McCulloch, Unite National Officer, says the plans are a “big thumbs up for the UK manufacturing, pharmaceutical and construction sectors”.

But the union has now called upon the Government to implement a manufacturing strategy to build upon the skills of UK workers.

“The pharmaceutical industry has seen a lot of uncertainty with over 10,000 jobs lost in the past five years,” commented Linda McCulloch.

“This investment is testament to the skills of UK workers. These dedicated workers thoroughly deserve this investment and the long term security of employment this brings.

“But, more needs to be done. We need to invest in the UK’s manufacturing skills base for the future. Once again, we call on the Government to invest in the UK’s manufacturing skills base with a long-term solution.”

The UK pharmaceutical market is expected to experience growth of just 0.4% until 2015, a new report says.

Research and Markets’ The Pharmaceutical Market: UK predicts growth of less than one per cent in real terms due to the effects of the recession, cuts in public spending and NHS savings targets.

The report says that tighter healthcare spending could have a negative impact on the market with the NHS having less capital to spend on new or expensive drugs.

The NHS has been challenged with making a total of £20 billion in annual efficiency and productivity savings by 2014.

However, despite these cost-cutting measures, the UK Government has released additional funding through its Cancer Drugs Fund – which came into force in April 2011.

The report notes the impact of value-based pricing (VBP) in order to promote innovation and ensure better access for patients to new medicines when it is introduced in 2013.

A VBP system will be implemented for new active substances introduced from 1 January 2014 onwards. Existing medicines could be included in the system, but generics are expected to be excluded from the scheme.

As it would not be feasible to carry out a VBP assessment for each new medicine entering the market, the report says, interim arrangements are expected to run alongside the new scheme – which is likely to resemble the existing PPRS, the report predicts.

The introduction of the Government’s Patent Box is expected to generate growth in the industry, the report says. GSK has already confirmed it will invest more than £500m when the programme is introduced, which will lead to the creation of around 1,000 new jobs.

Despite the modest growth expected in the UK pharmaceutical market, the outlook is still brighter than the European counterpart. In a similar report, the European pharmaceuticals market had total revenues of $213.9 billion in 2010 – representing a compound annual growth rate of 4.6% from 2006 to 2010.

But the market is forecast to decelerate by a compound annual growth rate of 3.2% between 2010 and 2015, the report anticipates. This will result in the market value being approximately $250.3 billion by the end of 2015.

Pfizer, the report says, will lead the European pharmaceutical markets, with a market share of 6.7%.

Arrow Generics UK has launched generic versions of AstraZeneca’s Zomig (Zolmitriptan) and Zomig Rapimelt (Zolmitriptan Orodispersible) in the UK and France.

Arrow, part of the Watson Group, released the generics after the patent expired for the two treatments indicated for patients with migraine headache with or without aura.

Last year, the two treatments had sales in the UK and France of around $107 million in the two markets, according to IMS Health data.

The two generics are also set to be launched in the Nordic region later this month on the date of expiry.

Joining Zolmitriptan and Zolmitriptan Orodispersible, Arrow has also launched a generic alternative of GSK’s Naramig (Naratriptan) – indicated for the same condition.

Who exactly is pharma’s customer these days? Jessica Henderson takes a look in the NHS customer showroom and urges sales and marketing executives to examine all the features and benefits when choosing the right vehicle for their brand.

The UK Government’s floundering Health and Social Care Bill has been widely decried as “a car crash that has already happened”. But critics predict further pile-ups around the corner as the beleaguered Health Secretary finds himself increasingly stuck in bad traffic on the road to reform. It’s fair to say that the Bill is enduring a difficult journey towards Royal Assent – but irrespective of when, or indeed if, it reaches its final destination, it’s clear that work on the ground to transform the NHS into its new shape and structure has been ongoing since the White Paper in July 2010. There have been delays and roadblocks along the way, but across the country, local NHS organisations have been moving towards the promised land of Clinical Commissioning Groups for well over a year. And as a consequence, the pharmaceutical industry’s customer-base has incrementally shifted – with the prospect of more twists and turns to come. We may not yet be motoring towards reform – but the wheels are well and truly in motion. And it’s driving pharma companies down a familiar road where they are being forced to revisit the age-old question: “just exactly who is my customer?”

The NHS customer showroom
For UK pharma, NHS customers have always been a moving target – but the rate, scale and definition of impending change has meant that the latest movements are proving more difficult to track. In the car (or should that be ‘care’?) showroom that is the NHS, the staff, partners and customers all know that there’s a new model on the way, but they don’t entirely know what it will look like when it arrives, and whether it will work when it gets here. And it may not even leave the factory. But many also believe that the second-hand model that’s been driven around since 1948 is old, creaking and costing a fortune to keep on the road. It was certainly built for a different era where there was far less traffic. And as demand has increased, the size of the problem, as well as the size of the NHS itself, has increased with it. For pharma, the NHS customer showroom has expanded rapidly.

The Toyota Prius: CCGs
The proposed new model is, of course, an NHS that, in England, is led by Clinical Commissioning Groups (CCGs). There are already a few early models in the showroom – in fact, more and more are being test driven right across the country as we speak. CCGs can perhaps be considered as the health service equivalent of the Toyota Prius – a hybrid model comprising of clinicians and commissioners, with similarly green objectives to save their environment and become sustainable vehicles that use their resources effectively.

From BMW to white van? The depreciation of PCTs
For the past decade, the NHS has been run by PCTs, who issued instruction to clinicians in primary care and commissioned and managed local health services. As we know, under the new proposals, the old PCT model is to be discontinued. The inference is that PCTs have, like a saloon BMW with added extras, become expensive to run and, in austere times, are an unnecessary luxury. Instead, commissioning responsibilities will be passed to clinicians – chiefly GPs – who will be handed the car keys and given the authority and autonomy to drive local services as they see fit.

GPs have become accustomed to playing the role of a reliable Ford Focus, simply and efficiently getting the job done and concentrating on the core competency of delivering patient care. But now they are at the crossroads, deciding whether or not to upgrade and move into the fast lane of a more adventurous commissioning role within a CCG, or to stay within their comfort zone of standard general practice. At the same time, many within PCTs face the prospect of the BMW being downgraded to a simple White Van; delivering support to CCGs from the edges as part of Commissioning Support Services (CSSs),  a marketplace that is apparently – and perhaps contentiously – open to huge competition. 

The Porsches
One customer group that appears to have emerged unscathed from the reforms is Medicines Management, perhaps the Porsche within the NHS customer showroom. These will remain important, high-powered and influential customers that preside over high budgets.

What car?
The question for pharmaceutical sales and marketing executives, then, is which customer vehicle is the most appropriate for their individual brands? With the immediate direction of travel for the Health and Social Care Bill still unclear, an already complicated customer matrix becomes ever more difficult. Will the NHS landscape really be governed by a generation of hybrids? Will there be a power struggle between CCGs and CSSs, or will the previously powerful PCTs allow themselves to be reduced to ‘white van delivery vehicles’ without putting up a fight? Or will they simply be rebadged as CSSs and surreptitiously given the same powers as before?

The answers will, of course, vary from region to region – with a clear message emerging from the reforms that a one-size-fits-all solution to health service delivery is simply not feasible in the modern day. Local health economies are being given the autonomy to develop health services to meet the needs of their patient populations, and as such, regional approaches will evolve at varying speeds. But, despite the alleged congestion at ground level, there are already parts of the country where proactive local health organisations are making real progress along the road to reform. Whilst each local health economy will be unique in its approach, lessons can be learned and best practice can be shared – both from an NHS and an industry perspective – by examining progress within the more proactive health organisations, and how they are approaching the change process.

Learner plates for pharma
Working within the Transformation Team has demonstrated how important it will be for pharmaceutical sales and marketing executives to understand their local health economies – not only as CCGs become embedded, but equally as importantly, as they move through the transitional phase. The opportunities for pharma to help local NHS customers to equip themselves for the new model are great – but to maximise them, and in the process give their brands the best chance for success, companies must ensure they are engaging with the right customers. So which ‘vehicles’ should pharma invest in? The answer will vary from region to region and from disease area to disease area. But some general lessons can already be learned:

The CCG Prius
This will undoubtedly seem the most obvious vehicle choice for pharma, given current trends – but at this stage, it may not always prove the most successful approach. In some parts of the country, real GP leadership is already evident, typified by the movement of QIPP programmes to CCGs. But some readily-formed CCGs may in fact be BMWs disguised as a Prius – and less susceptible to working differently. The GP Commissioner in these organisations may not yet be your best customer – and you may need to change gear to accommodate this.

The Ford Focus GPs
The enormity of the challenges ahead has slowly dawned upon even the most proactive GPs. It is now clear to them that the scale of their prospective responsibilities are vast and potentially intimidating. The responsibilities associated with the ownership of costs associated with high referrals and inappropriate prescribing are quickly being realised – but helping jobbing GPs to minimise these costs could present a real opportunity for pharma. Primary care does not need to be a swanky Ford Focus ST, but it can’t afford to be a 10-year old rust bucket either. The more proactive pharma companies may be able to help them learn to drive.

The Porsche Medicines Management
Medicines management is not only here to stay, but it will remain a key customer for the pharmaceutical industry. GPs have recognised that medicines management has assumed huge importance in a cost-driven climate and, as embryonic CCG arrangements develop, many proactive clinicians are considering employing medicines management directly on headcount rather than parking them in the car lot of CSSs.

The white delivery van CSSs
The power of these organisations is likely to be variable across the country. Less engaged CCGs may well devolve a lot of decision-making to CSSs, which could really put them in the driving seat – to the extent that they become rebadged BMWs. At present there has been real conflict of interest between PCT clusters trying to get their CSS models in place without a definitive financial envelope as CCGs consider how to carve up the £25 a head budget alongside trying to negotiate the authorisation process and design the organisation they want. An outcomes-based approach by CCGs to the development of CSSs may make CSSs a real opportunity for industry to tap into. In addition, there are a number of other vehicles that pharma should not rule out:

• The Rolls-Royce – the National Commissioning Board (NCB). Although the NCB’s role is not supposed to be prescriptive, the concept of sharing best practice and buy-in to initiatives with demonstrable outcomes may present pharma with opportunities for partnership.
• The people carriers – Clinical Senates. These will play an advisory role, with disease area specialists providing a clinical check on commissioning plans for CCGs. At present, the geography of clinical senates appears to be largely mirroring PCT clusters, but their final form may depend on how the NCB develops a regional presence.
• The cross-border ferry – Health and Wellbeing Boards. As integrated care becomes a major priority, in disease areas where health and social care overlap, this alternative means of travel may well be worth boarding
• The 4-by-4s – the hospitals. The integrated care agenda has seen the hospital model of care come in for much criticism for being expensive and unsustainable – but the big providers will remain important and will be working towards improved outcomes. They will need all the help they can get.

Moving through the gears
The NHS landscape continues to change and with it, the industry’s key influencers – and the influences they have – are moving too. In a variable and dynamic marketplace, pharmaceutical sales and marketing executives must be agile and flexible enough to adapt to change. Only by taking the time to understand the environment – not only at national level but, more importantly, at local level – will the industry reap the rewards. There is a new roadmap for the NHS and, for individual marketers, the challenge is to ensure your products reach the final destination: being used by your target patient. Success will depend upon making sure you go to the right customers via the quickest route, and this should be achieved through doing what you do best; networking and tracking where your key customers are going.

Selling into the NHS has always been a challenge – it is a complicated customer matrix. The industry’s influencers are different everywhere, dependent upon region, disease area and economics. The most successful marketers will be those that understand local needs and tailor their services that help meet them, delivering relevant outcomes in the process. Whatever the fate of the Health and Social Care Bill, the terms of engagement between pharma and NHS are unlikely to change and the key ingredient for success will continue to be the ability to be customer-centric.

The Government’s NHS reforms may yet prove to be the car crash that has already happened, but don’t allow your sales and marketing approach to become exposed to the same accusation. The industry can help all of its NHS customers drive improvements to patient care – it’s all about finding the right vehicle. Now belt up!

Snapshot review of an emerging CCG

In October 2010, I was seconded into the NHS to provide additional resource to a Transformation Team charged with managing the transition of a PCT into the new CCG model. The project covered a large geography and involved three established PBC teams, each with different responsibilities, structures and cultures. The Transformation Team was multi-disciplinary, but included clinicians who were strong advocates of clinical commissioning. The group would eventually emerge as one of the first wave Pathfinders.

The transition project required the team to evaluate every function of the existing PCT, and to establish which of these should form part of the CCG function and which could be outsourced. The scale of functionality of a standard PCT is broad and vast. It includes aspects such as medicines management, information/data management technology, decision support systems, HR support, contracts/procurement, legal finance and communications.

The challenges and considerations were huge; which services are critical to running a commissioning organisation with a budget of around £700 million, and therefore should remain in-house? Which could be outsourced to CSSs, who may be able to provide them more cost-effectively? Should the CSS be brought in-house, to ensure control over key aspects such as IT and other back-office functions? Should medicines management be included on headcount?

The CCGs established a Clinical Commissioning Board, comprising a multidisciplinary panel of CCG and PCT representatives, to drive decision-making and ensure it was clinically-led. The CCGs were divided into seven localities, each with a Locality Lead that had previously sat within the PBC groups. As part of the transformation process, the GPs who have declared an interested in assuming commissioning responsibilities are being taken through a training programme to upskill them for the future model. This process is ongoing. The scale of the challenge for GPs is recognised to be huge.

The Board created a blueprint for  Commissioning Support Services and agreed the outcomes that they wanted to achieve from it, its functions and objectives. This was done in collaboration with over 100 GPs, who worked through a long clinical commissioning transformation process to jointly agree how existing PCT functions would be transformed and where they should sit within the CCG.

The NHS is currently firefighting with uncertainty, but alongside all this transformation work there is still the undercurrent of ‘business as usual’ to ensure the wheels are kept on the organisation. Commissioners are continuing to carry out their day jobs amongst all this uncertainty, and need support to make their mark in what will be a competitive jobs market as commissioning roles reduce to accommodate the £25 a head budget which has been granted to CCGs.

Jessica Henderson is a Research Associate at WG Consulting Healthcare Ltd.

Pf Editor, Chris Ross, asks who pharma’s customers really are as the NHS reforms continue to progress.

The journey towards NHS reform was always likely to be a long and painful one for the coalition government – but, as opposition to the Health & Social Care Bill grows stronger by the day, it’s becoming increasingly difficult to predict where the journey will end. At present, Royal Assent seems many miles away.

But despite the fierce political and ideological objections to the proposals, in many parts of the country the NHS has already ventured some way along the roadmap to reorganisation. Embryonic Clinical Commissioning Groups are steadily establishing themselves across England, and the transfer of powers from PCTs to the new commissioning organisations is well underway. It is likely to prove costly for NHS productivity and patient care if the journey to reform finds itself at a dead end and the Kill the Bill movement finally succeeds.

Whatever happens in the coming weeks and months, the ramifications for the pharmaceutical industry have already been significant. Since the introduction of PCOs, PCGs, PCTs and, of course, NICE in the early 2000s, UK pharma companies have spent the best part of a decade trying to establish exactly who their customers are and realigning their sales and marketing efforts accordingly. During that time, it’s become increasingly clear that a one-size-fits-all solution to customer segmentation will not work, and that the identity of so-called ‘key accounts’ will vary from region to region, and disease area to disease area. In such a dynamic and fast-moving environment, the work of field-based medical sales professionals becomes ever more important. The role of the rep may have been redefined in the past ten years, but while numbers on the ground have dropped significantly, their value to UK pharma in a changing marketplace has only increased.

Chris Ross, Editor.