The UK medical device market is one of the biggest in the world, with growth relying predominantly on imports. But it is also a significant exporter of medical technologies. In the second of two articles looking at the domestic market, Medtech Business in association with Espicom takes a look at the UK medtech export market.

The UK is a significant global exporter of medical devices (including medical equipment and medical supplies) and remains among the world’s top 10. But the sector has faltered in recent years. Exports peaked in 2006 at US$7,238.5 million, but have fallen every year since then. In 2009, exports dropped to US$5,394.4 million – roughly the same level seen in 2005. The orthopaedic sector was hit especially hard in 2009. (For more details, see Figures 1–3.)

Consumables

Medical consumables were the largest individual export area in 2009, valued at $1,140.0 million,* or 21.1% of total exports. This was a fall of 3.8% compared with 2008, with a 2005–09 Compound Annual Growth Rate (CAGR) of –1.8%.

Consumables are defined as wound care products (medical dressings, sutures, sterile, surgical and dental goods), syringes, needles and catheters. Within this category, catheters and cannulae amounted to $279.7 million, virtually unchanged from 2008, but significantly lower than the 2005 level of $410.6 million. Exports of medical dressings amounted to $503.7 million, a fall of 8.3% compared with 2008.

Diagnostic imaging

Diagnostic imaging is not historically one of the UK’s stronger sectors. In 2009, UK exports of diagnostic imaging apparatus amounted to $1,131.3 million – 21.0% of the country’s total export market. In recent years, the electrodiagnostic sector has been its biggest source of growth. The 2009 total showed a fall of 0.1% compared with 2008, with a CAGR for 2005–09 of 5.4%.

Electrodiagnostic imaging exports amounted to $575.1 million, a rise of 23.4% over 2008 due largely to a big rise in MRI exports. Radiation apparatus exports were far lower at $83.4 million, although this too represented a strong increase of 28.2% on 2008 figures. Exports of imaging parts and accessories fell sharply in 2009, by 21.4% to $472.9 million.

Orthopaedic products

Exports of orthopaedic and prosthetic products saw a sharp fall in 2009. Exports totaled $1,231.5 million in 2008, but fell by 46.7% the following year to reach $656.2 million. Artificial joints fell by 67.1% to $71.5 million, while other orthopaedic/fracture appliances fell by 49.8% to $445.2 million.

As outlined in Medtech Business’s first UK market article (July 2011), imports in this sector also saw a sharp fall in 2009. Espicom suspects that much of the reduction is due to a change or relocation of multinational manufacturing and repackaging activities.

Patient aids

Exports of patient aids amounted to $1,054.5 million in 2009, a fall of 5.2% compared with 2008.

Portable aids fell by 8.0% to $762.1 million, while therapeutic appliances rose by 2.9% to $292.4 million.

Dental products

Exports of dental products reached US$148.2 million in 2009 – 2.7% of the total. This is an increase of 4.1% over 2008; the total fell sharply in 2007, but has since recovered a little.

Dental cements amounted to US$70.2 million in 2009, a rise of 17.7% over 2008.

Leading destinations

In 2009, the single leading destination for UK exports was the US, with $768.1 million (4.2%) of total exports. The largest shipments to the US were diagnostic imaging products, which amounted to $188.8 million, 16.7% of exports in this sector. This was followed by consumables, which amounted to $136.5 million, 12.0% of exports in this product area. The US also received 31.7% of dental product exports, valued at $47.0 million. (See Figures 4 and 5 for more details.)

More than half of UK exports went to the EU-27 countries. Shipments totaling $3,016.7 million (55.9% of total exports) left the UK for the EU-27. The principal recipient within the EU was Germany, accounting for 13.4% of exports, valued at $720.6 million. Almost a quarter (22.3%) of diagnostic imaging apparatus exports went to Germany. Belgium was the single biggest importer of UK consumables (18.6%) and UK orthopaedic and prosthetic products (17.2%) – in both cases outstripping the US. Other leading destinations within the EU were France, Ireland and the Netherlands.

Next month, Medtech Business will look at the medical technologies market in France.

This article is based on information from Medical Market Outlook reports published quarterly by Espicom Business Intelligence.
*All figures are in US $. For further details of the 63 markets covered, please visit www.espicom.com/outlookm1

GSK and the McLaren Group have entered into a long term strategic partnership until at least 2016.

The McLaren Group will share its knowledge in engineering, technology, analytics, and strategic modelling to help improve performance across GSK’s global divisions.

Ron Dennis, Executive Chairman, McLaren Group and McLaren Automotive, says the partnership “engages two great British companies” in a “multi-faceted and ground-breaking way”.

A new state-of-the-art learning facility will also be built as part of the agreement at McLaren’s Headquarters in Woking by 2013.

The partnership will initially focus on GSK’s manufacturing, research and development and consumer healthcare divisions.

Glaxo will evaluate whether it can use McLaren’s engineering and technical expertise to its own manufacturing processes. It’s believed that McLaren’s approach, technology and processes it applies to its Formula 1 team could lead to improvement in GSK’s production line performance and improve cost and customer service.

The pharma company’s R&D organisation is also examining whether McLaren’s expertise and technology could improve their own clinical research processes by increasing the speed of trial design, and allowing for real time patient monitoring and treatment adjustment.

Also its Consumer Healthcare business will work alongside McLaren’s Formula 1 unit which analyses team performance during a Grand Prix to enable GSK to respond quicker to competitor activity and customer needs, and inform decision making on various issues. Analytical and performance management tools developed and used by the Group will also be utilised to improve GSK’s ability to come to faster decisions around longer term investments.

Andrew Witty, GSK, CEO, says the partnership highlights the company’s innovative thinking which continues to look for “inspiration and fresh perspective” from outside the sector on how to achieve its strategic goals.

“I am delighted to announce this partnership with McLaren which brings together two British companies whose continued success hinges on the ability to innovate and rapidly respond to change and competitor activity,” said Mr Witty. “McLaren has an unparalleled reputation for innovation built on rigorous analytics and fast decision making.”

McLaren boss Ron Dennis says the agreement is the first between the Group and a major pharmaceutical corporation. “Specifically, our intention is that GSK will harness McLaren’s world-beating Formula 1-bred technology, processes and operational dynamism, in order to enhance its performance across a wide variety of its divisions in a way that none of its competitors can match,” he added.

Keeping hold of key members of staff has always been an issue for successful organisations. To avoid head-hunters, Anton Franckeiss explains valuable measures to increase employee retention and satisfaction.

Although the pharmaceutical industry is one that consumers tend to depend on to provide instant cures or magical remedies to our all too human frailties, it actually operates to a longer timeframe. Any new treatment for our remedies may take only seconds to swallow, but will have been in development for many years, and possibly even decades. But despite its foundation in long-term projects, the industry also experiences higher than average staff turnover rates – a circumstance that the industry shares with IT and financial services. While the requirement for specialist knowledge and professional skills is a common factor across all three of these sectors that should not be ignored, human resource (HR) professionals within the industry should resist the temptation to believe that there is a single cure that can be prescribed and administered.

Although the analogy may be a simplistic one, especially in the industry context, adopting a holistic view that sees retention rates as one of the vital signs of the ‘patient’ (ie the workforce of each pharmaceutical company) may be helpful. Recent surveys, both by Pharmaceutical Field and by the Chartered Institute of Personnel and Development, have shown a slowing of staff turnover rates in the industry. Yet the reasons may be at least partly a reflection of the broader labour market and economy.

In an era of slow economic growth after a sharp recession, employees are seeing redundancies elsewhere – or even closer to home – and may have drawn the conclusion that the metaphorical frying pan might be a happier place to be for the medium-term than the unknown quantity of the metaphorical fire. There is, however, no room for complacency here. If the factors at play are limiting turnover rather than actively encouraging retention, the ‘condition’ could flare up again at short notice depending on movements in the broader economy: a chronic condition, after all, requires monitoring and management to ensure that any chances of it becoming acute are minimised.

Road to recovery

The analogy of a chronic condition, however, should be challenged. A continuing situation of poor retention does not imply that this either must simply be lived with or will inevitably get worse. There is no reason that the prognosis should be gloomy, although a combination therapy approach will be required and the regime will need to be maintained for some time before improvements in the underlying condition are secured. The key to success lies in the depth of understanding that the doctor – in this case the HR functions of companies in the industries – can acquire about their patient.

Without research, dialogue and communication, companies can too easily assume that they understand the retention factor priorities of their workforce, while the employees actually see the outlook rather differently. A 2006 survey by Talent Drain, for example, showed that employees rank ‘cooperation’ as the second most important factor, while employers listed this in ninth place.

Employers also typically overstate the impact of pay and financial rewards, while underestimating the importance to employees of opportunities for personal growth. What appears as a mission critical role contribution through one end of the telescope looks more like one component of an on-going personal biography from the other. In an industry that embraces great diversity of roles – from sales to scientific specialists – there is likely to be a similar diversity of outlook – the intelligent response is to seek understanding rather than to assume that a single remedy can be applied in all cases. Feedback to HR from line management in different operational areas could be helpful here, so keep lines of dialogue open.

The right prescription

Employee motivation and engagement requires similar treatment; although recent surveys say suggest turnover is reduced, they also suggest what an earlier Pharmaceutical Field article, called The Fear Factor, highlighted. Pro-actively seeking to increase engagement will enhance the chances of turning a cure into a preventative approach. The highly engaged will be less easily tempted away when external economic factors change. Again, an appreciation of potential complexity will be helpful. Scientific staff may be balancing a need to supervise and manage others and commercial encouragement from the organisation to develop their leadership skills with their personal commitment to their professional discipline. Acknowledging such a potential conflict of factors will be a far more productive way of identifying motivational approaches than failing to address it.

There are also industry-specific challenges to address, one of which was highlighted in an interview between the BBC’s Evan Davis and GSK Chief Executive Andrew Witty in the former’s recent book, Made in Britain: “One of the things we say to our scientists is that you have to be comfortable with failure. [There are] great scientists in this company who will never succeed in their entire career … Of 10,000 new molecules that we might synthesise, so that we might create 10,000 possible new drugs, probably one will be a drug.”

Strategies that promote innovation – the use of multi-disciplinary project teams where each can make their own distinct contribution and gain inspiration from other – can help here in other ways. But also allow staff with specialist skills to receive peer, as well as line management, feedback on the value of their contribution. It was a point by Alistair Flaister in a People Management article, Organisational learning: The social network, when he made the important point that: “The real engine of creativity and organisational success is to be found in internal networks of friendship and collaboration.”

Line managers have other contributions to make, not least in listening acutely and in building a supportive and encouraging team culture. It’s a point underlined in the 2010 Work Foundation report, Exceeding Expectations: the principles of outstanding leadership, which identified two elements common to the approaches of outstanding leaders in creating a working environment:

The first is the need to develop an open and supportive atmosphere to create the conditions for trust and respect, and the second is to ensure the workplace enabled success and satisfaction.

Part of the latter element may require support from HR in terms of fresh thinking. Depending on the severity of the case, HR might also ponder the benefits of making a referral to a specialist consultant. Helping specialist staff to make the transition to a leadership role is not simply a progression or promotion through a series of levels of leadership. It requires them to make a fundamental transition from development of a professional discipline to that of a broader organisational and commercial role. It also requires the transfer and application of new behaviours that challenge and enhance their performance and contribution. Two other factors that The Work Foundation found as common to outstanding leaders is a willingness to be flexible in their approach to process, and a willingness to adapt roles to give individuals the maximum opportunity to achieve personal growth and job satisfaction. An organisational willingness to be similarly flexible in role definition and organisational design can support good leaders within the company to deploy this approach successfully.

Never say no

Think of a talented individual that the company should seek to retain, and then imagine how they might feel if they heard the words “I’d love to be more flexible, but I’ve spoken to HR and they said …” It’s also helpful to remain mindful that disengagement is unlikely to be a proactive personal choice – employees are more likely to become disengaged as a reaction.

Ultimately, employee retention is not so much a condition as a symptom. An indicator that employee engagement is low, that opportunities to satisfy personal motivations are too limited, that opportunities for progression are overly limited or unclear, or that employees are not receiving positive feedback on their performance and/or contribution when praise is due. The answer is not to treat the isolated symptom, but to investigate the underlying condition and develop a comprehensive talent management strategy that will systematically improve organisational health. Even in an industry where specialist skills are a key requirement in many roles, an employee value proposition and a recruitment strategy that identifies employees with a strong cultural fit are still important requirements. Any industry dependent on innovation and intellectual property should appreciate that human resources are its critical input. And most employees – who will, after all, have chosen to make an application to join the organisation and done so in good faith – are ultimately looking for something relatively straightforward: regular reminders of several good reasons to stay. That, of course, is easy to say, but there’s something positive to be said for making it easy to do.

Anton Franckeiss is the Managing Director of ASK Europe.

Finding the best employer is like playing the dating game. No-one wants to be married to their job, but tying the knot with an employer is an important commitment. The strongest relationships can last a lifetime, while playing the field may not look quite so good on your CV. So what is it that attracts us to our employers? Do we marry for money, or is long-term fulfillment enough? And is a good sense of humour essential? Pf’s Emma Campbell-Kelly outlines some of the key criteria in identifying ‘The One’.

The summer months, particularly the holiday season, are often the time when most of us pause and reflect on where we are in life. That two-week break in the Maldives, or even just the back garden, can invariably provide the catalyst for some killer questions: Am I in the right job? Does my employer appreciate me? Do I appreciate my employer? Is it time for me to move on? For many, this period of reflection provides little more than confirmation that they are happy where they are. In the current climate, where job security is king and fear of moving jobs has bred a ‘better the devil you know’ approach, many workers are staying put rather than risking change. But for some, a ‘grass is always greener’ philosophy drives them towards the pursuit of new employment. But what do you look for in a new employer? What defines the perfect job and, indeed, an employer of choice? Where do you begin in the pursuit of professional happiness?

Searching for a new job can be a daunting endeavour. Whether it’s your decision to enter the vacancy abyss or not, the task can be arduous and time-consuming. Slim pickings are expected in such a precarious economic climate, but there’s still a world of decisions to make: location, role, salary and even whether you are looking in the right industry are all key considerations.

The experience is similar to becoming newly single, in the market for a new partner. Job sites and recruitment companies could be metaphors for dating agencies in this case, or a friend who’s trying to set you up, or a speed dating session.

And you must select employers from this pool of availability in a similar way to how you would approach someone to ask them out. Like a relationship, a job is an investment, and will define you for the period you choose to stay committed to it. You want the whole package: ‘The One’. It will stay on your record, your personal history, or rather your CV. No pressure then.

What do you look for? Materialistic features (financial details) are number one priority for most. Your interest in a job or person is sparked by judging at face value. It’s not necessarily shallow, because what else can you base your judgement on in the first instance? Being objective with your search is key to obtaining a job that will tick all the boxes for you.

So once you’ve landed your first ‘date’ with the desired employer, aka job interview, first impressions are too important to disregard. You dress to impress, revise your CV, and prepare answers to every question under the sun. Both parties want to impress, without coming across as too keen. But at the end of the day, you want this job, you wouldn’t have applied otherwise. And the employer wants the best they can get (which is you, obviously). After all, as Ray Kroc, founder of McDonald’s, said: “You’re only as good as the people you hire.” So it’s potentially a win-win situation, as long as you both get what you want.

Job satisfaction has always come top of surveys questioning motivation at work. Until now. It seems that such an insecure and volatile economy is making us tighten our belts (as if they weren’t tight enough already). Living costs are continuing to rise, a unanimous, desperate ‘Yes please’ is given in response to money. The prospect of a double-dip recession has hit us while we’re down, just as we were getting our hopes up.

With this in mind, it’s no surprise when perusing the Chartered Institute of Personnel and Development’s (CIPD) recent quarterly Employee Outlook survey. The review showed that increased salary and benefit packages have overtaken job satisfaction as the number one reason why employees are looking to change jobs.

Out of 2,000 questioned employees, 54% rated higher salary and benefits as their top reason for wanting to change jobs, while 42% said that job satisfaction drove their career move choices. This is a sharp reversal compared to last year’s 61% voting job satisfaction over 48% monetary reasons to look for alternative employment. A shocking revelation from the survey showed that almost a fifth (18%) of employees completely run out of money before they’re paid, either always or most of the time. So the financial pressure is on, it seems.

But are finances what get us out of bed in the morning? We recall how the carrot beat the stick regarding the donkey’s motivation. But what does the carrot mean to you?

Is it salary, benefits, a fancy company car? For some people, especially those who are struggling financially at the moment, the answer would be a giant nod of the head. But what about the 42% who voted job satisfaction as their motivation to work hard?

For this group, an employer’s treatment of its workers and management skills really makes a difference. It’s the little things that contribute to their career happiness. A friend you can confide in, belief in your product, respect for your manager; the buzz of adrenaline when you know you’ve done a good job.

Company culture has always been a vital aspect of work life. Your co-workers are with you for a significant portion of the day, so team dynamics are important. Henry Ford of Ford Motor Company had the right thinking: “Our employees are like extended members of our family.” The company should run like a well-oiled machine at all levels, complementing and developing each other’s roles and responsibilities. Confidence and trust glue the team together and make everyday errands pass by effortlessly.

There’s no doubt about it, your happiness at a company is largely directed by what you do for at least 40 hours a week. And let’s face it – your working life is a long one, so it’s best to do something you enjoy. It’s been proven time after time that you’re more likely to work harder if you’re passionate about your job. Happy people are more energetic, proactive, creative and optimistic, and quicker to learn. In which case it’s in your employer’s interest to make you happy.

This is largely down to how you’re managed. Management and guidance at work largely affect your work ethic and the company’s dynamics. “Management is nothing more than motivating other people,” stated Lee Iacocca, Chairman for Chrysler Motors. Management is a crucial role to play, because your workforce implicitly relies on your motivation to work. Donald Trump once said, “Good people = good management and good management = good people.”

Money can only promise a limited amount of will-power from an individual; pride in their work will give them the edge and a hunger for success. Belief in your product, trust, loyalty and commitment to the employer are also invaluable attributes for an employee to embody, and are recognised by good employers. As Mary Kay Ash, Head of Mary Kay cosmetics, stated: “People are definitely a company’s greatest asset. A company is only as good as the people it keeps.”

So perhaps, most of all, we just need to feel loved. Being treated well, as in a committed relationship, ensures that we’re in it for the long haul.

In July, the Office for National Statistics (ONS) published a report on what makes Brits happy. Not money, as it turns out. Health, family and friends topped the list when around 34,000 people were asked “What is wellbeing?” and “What in life matters to you?”

The survey was commissioned by David Cameron to help him develop future policies, but ironically critics have since complained that the £2 million to conduct the survey was a waste of money as the results are quite obvious. We’re never happy, are we?

But at the end of the day, as much as money is a necessity to live, happiness in yourself and at work increases quality of life, and helps boost your company at the same time. A happy workforce is a productive workforce after all.

From an employer, you want to be pushed to your full potential, appreciated for your effort, made responsible for important decisions, making you believe in your product and employer.

Working life is most enjoyable if you’re lucky enough to be in the position of not worrying about money. To have an enthralling occupation puts a spring in your step.

And as much as looking for a new job can be tiresome and sometimes feels like a dead end, just remember, it’s all in aid of finding ‘The One’, your soulmate that offers the whole package: an invigorating role with great prospects. And if the money’s good at the same time, all the better. So make it a good one with good people.

Pharma’s Account Management model is built on the principle that frontline professionals develop and deliver brand value propositions that align with the key priorities of key customers. But in a changing market where new customers are emerging, how well do you understand those priorities? Omar Ali pens Part I of a typical day in the life of a Formulary Pharmacist.

Despite consumers’ apparent lust for TV medical dramas and gruesome surgical documentaries, it’s unlikely that the viewing public would find a biopic centring on the work of a Formulary Pharmacist particularly enticing. But, for an audience of pharmaceutical sales professionals charged with understanding its customer-base, gaining an insight into the breadth and depth – and far-reaching implications – of a typical week in the life of NHS prescribing advisers, medicines management and formulary pharmacists should provide much food for thought.

Pharma appears desperate to establish the ‘key priorities’ of its many customers. This article, based on typical encounters with medical sales professionals, is a genuine attempt to outline mine.

A MONDAY MORNING, SOMEWHERE IN SURREY
8.10am: GI CONSULTANT / IBD.
(Discussion in the corridor)
Arrived at my NHS base camp. Stopped in the corridor by one of the GI Consultants who wants to set up a GPC/CCG commissioning group on GI Inflammatory Disease with one of the local Consortia - we ran one with Rheumatology framed around an osteoporosis brand. We put a date in the diary to discuss. I will be coordinating an IBD lunch event to facilitate joined-up working. Bringing in the GPCs is easy - I can text most of the GPs on the Commissioning Board of our local clusters, such is the relationship required for joined-up thinking. He’s very committed to his cause – and has very recently impressed significant knowledge and application of commissioning processes involved. Needless to say, many of his choice agents are either off-license or difficult to source from community pharmacies. He also has a whole stack of biologics he’s keen to use – but without some PCT discussions (and now outreaching to GPCs) he won’t get very far.

Thoughts for pharma

GI/IBD has become very noisy and in certain areas very controversial. Biologics are testing the very essence of ‘affordability’ in the NHS. We also know that by using them correctly, we can prevent signi­cant morbidity – surgery/admissions/etc. However, joined-up thinking doesn’t occur by magic – and you have a signifi­cant role in making this happen. When we coordinate this GPC/Hospital IBD lunch event, I am certain I will be discussing with various stakeholders, including pharma. NICE in principle supports a number of products but there are complexities. For example, bringing patients in for an IV infusion will generate income for the Trust – which funds a nurse who provides additional services. Patients treated at home may be a preferred option – there is no VAT. Home healthcare is not without its headaches around delivery, months’ supply ordered and administrative burden.

I am still disappointed at the level of pharma support I have seen here. There is far more that can be done to bring a clinical context into a financial framework. I call this the ‘Mortgage Principle’ – translating falling in love with a house into a financial framework with a defined loan: value and %APR with monthly repayments – see previous Matrix Revolutions. There seems to be a vast gap in understanding NHS processes – not just from pharma, but also from consultants – so improved process mapping from chronic disease to A&E through to post-discharge is essential. It also brings out the ‘true-cost’ of the disease in IBD – not just the ‘drug’s cost’. If our consultant doesn’t move ahead and advance his prescribing base, he will end up referring more patients to tertiary centres (which will only increase PCT costs) – so it’s important to put things into context here. Process Map the patient and the money will follow. If this is not tackled by pharma, I foresee the future of managed care entering here very neatly. Looking after the whole pathway and pushing pharma out to bystanders – look at companies like IHP, United Healthcare & Medco, it’s happening.

8.40am: Pharmacy Base.
(Discussion with the boss)
Arrived to my desk – finally. This time it’s the Chief waiting with an IFR/one-off-request that needs sorting. It’s the usual story: this time it’s a urology product that a GP is refusing to prescribe. We are having to push through the IFR/one-off-request – and also liaise with the GP for a medium-term solution (the patient is travelling significant distances to obtain this). This means some research, PCT discussions, GP emails and a phone call to the patient. I will also try and perch on the urology consultant’s shoulders (he runs a clinic this afternoon) and coordinate future D&T processes. Most of all, we need to ensure that the patient is central to this whole system – which is easier said than done. It’s good timing though – I have been in discussions with urology, working through the top-ten spend on the drug list to see where we have efficiency savings (something which is occurring across the whole trust in conjunction with PCTs & GPCs). This product initially came up as ‘not-on-the-radar’ but clearly needs some attention. I have our medicines information pharmacist conducting background research – I have emailed the specialist commissioning pharmacist at the PCT and CCd the prescribing adviser who has just evaluated a recent APC paper on overactive bladder prescribing (which we are discussing at our next D&T).

Thoughts for pharma

Urology is big on the radar. Many prescribing items are specialist, while there are significant prescribing efficiency savings aimed at ‘overactive bladder’ and linked into a more encompassing discussion with endocrinologists, and the ongoing story behind testosterone. I am sure I am sitting on a business card of a testosterone brand, but which company it was I cannot recall. Thumbing through my cards – the stack waiting for a call back is big – I can’t really see through the thick fog of various companies/pharma/sub-companies/take-overs. Note to self: request all staff to ensure reps write their brands on their business cards when they call at the pharmacy. Key priorities around urology that are high on the radar across primary/secondary care are as follows:

• Urinary retention/BPH
  Is it just me or has Combodart lost its way? I remember some very exciting joined up thinking on preventing unnecessary referrals and bringing consultants out to primary care. Given urology consultants admit themselves that DREs to exclude prostate Ca is not easy, liability and governance for getting GPs to this was always heading into a cul-de-sac. I think there is a ‘new campaign’, though I’m not sure what it is. We have both finasteride and dutasteride on our joint formulary – but I’m not seeing the right financial framework on the ground. I can see NHS PCOs moving backwards, lifting finasteride back on the pedestal and not even considering the Combodart story. If there is a value proposition around this brand someone better get this moving within commissioning circles fast. To add to this, tamsulosin’s patent expiry further hastens the need for the value story here. If the last D&T rejection we had is anything to go by this is either off the radar or must be a third drop-down detail on someone’s bonus scheme.
• Urinary incontinence
  We have NICE, LUTS and SMC. HTA is all important. Most of pharma focuses on product differentiation. They need to, NICE is an open forum for prescribing. But I don’t see a commissioning story or a decent value proposition for payers. Please don’t state you want to run me through a cost model – that is not a ‘value proposition’. I have yet to see a company come to me and talk about QIPP. Where are you guys? Please don’t moan at the NHS for using generic oxybuytnin first-line – we get the opposition, what we don’t get is a Payer ‘QIPP Value Proposition’ around your brand. Too much n=1 for my liking. The only brand working the NHS has to some extent are the solifenacin crowd – they certainly have significant clinician/KOL buy-in if the Payers are left somewhat ‘wanting’. I’m unsure where exactly duloxetine & fesoteradine are heading, or what their value story is – despite SMC approval. Maybe it’s just me.
• Bladder instillation
  This is hotting up big time. Why? Because there are costs to both primary and secondary care – and furthermore, despite numerous products – some without a license – for conditions such as interstitial cystitis there is significant unmet need on cure rates, relapse rates and hospitalisations. Someone, somewhere will win big when they map out to us what already suspect – hospitalisation costs here are huge, and process mapping will show how these are sectored into various health economies. At the moment, everyone is walking and talking product – bag of saline/infuse like this/lovely twisty connector/etc. Just waiting for someone like United or Medco to come and show us the path to the land of milk and honey. It appears no-one else will.
• Testosterone
  It’s back! The story has become interesting all over again, and all credit to pharma. The link with diabetes is moving this higher and higher up the agenda. It is fraught with issues. Everything from best mode of delivery to patient/compliance and desired effect, through to overlap with specialties – is this endocrine or urology or both, same pathway or different pathway? The pharmaceutical arguments in testosterone are worthy but having no coat hanger to hang your outcomes on makes for difficulty in pulling out the cheque book. There is a ‘gap-effect’ in situ – from academic niceties to clinical practice. I’m not sure the pull is there yet – and again, I return to my translation into a financial argument. Furthermore, there are cost savings and efficiencies to be had and this is where a product-matrix weighted with Payer Related Priorities would assist a brand in its Payer Value Proposition – if it indeed cares to invest in one.

It goes a bit like this:

1. What’s important to payers with a view to testosterone replacement?
2. Rank this list in a weighted manner so that they all add up to 100% (ie they may say evidence w%, compliance x%, safety y%, cost z% – w+x+y+z must all add up to 100%
3. Now you have your weighting, get the payers to allocate the numbers for each of the testosterone brands
4. Now you have not just who is the winner, but also how and why
5. So if, for instance, compliance is 25% weighting of the whole game, then if you spend 80% of your time talking about compliance, this may not be effecting your exposure time with payers to maximum benefit –remember the clinicians will have a different matrix. You may have the best compliance story – well done, that’s 25/25 but you will never score higher than this. There is another 75 points in this exam that you haven’t answered yet. You need to find out ‘what is the % weight that formulary/prescribing advisers give to the ‘testosterone story’ – once you have this value, you know how important it is.

9.30am: Meeting with Obs & Gynae Consultant / re: Formulary Application
This should be quick. We’ve recently put on some pessaries to our formulary. Obs and gynae want to use them in difficult/pre-specified labour/delivery situations. Now the company has whipped over a freezer to their unit. Yes, they are stored in the freezer, and no, before you ask, I don’t know whether we defrost before use or just pop them into our patients freezing cold. Have had a discussion about this with my wife over dinner, she is also a pharmacist – not a good move. Anyway, I’ve been firm but clear. The pharmacy doesn’t have a freezer, we need to discuss with the company about a freezer. There will be no prescribing of this new product within the Trust until we resolve the ‘freezer’ issue. All credit to the company, supportive they are, quick to respond they have been and, as I write, and you read, one of my staff is coordinating logistics around this. This is a classic example of simple supportive strategy. I looked back at the minutes of our D&T Form and smiled to myself… “accepted onto formulary, pending freezer.”

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

London & Essex Medicines Management
Cardiology Discussion Forum Hosted by iRx Solutions, July 2011

Pharmacists have the appetite for medicines commissioning

The NHS landscape is changing, the shape of medicines commissioning especially. At a time when the NHS – like other parts of the public sector – is in financial dire straits, the Government is driving a radical overhaul of the structure of health and social care services, in England at least. But incoming CGCs will be crying out of support around medicines management and commissioning. It’s time for pharmacy to step forward.

According to Stuart Saw, Director of Finance at NHS East London and the City Alliance, the recent listening exercise and “pause” of the Health and Social Care Bill’s journey through Parliament has not resulted in substantial changes to the direction of travel. “Irrespective of what people thought the pause might bring, the momentum was already there before the pause was called and it’s impossible to turn around,” he told guests at a cardiology discussion forum, held by iRx Solutions in London last month.

It is this momentum that will, in all probability, see the formation of some 500 Clinical Commissioning Groups, formerly known as GP Consortia, replacing around 150 Primary Care Trusts, which are to be abolished.

Omar Ali (pictured above right, with Jayesh Shah and Victoria Overland), a formulary pharmacist in the NHS, and one of three directors at iRx Solutions, suggests that these commissioning groups will be crying out for support around medicines management and commissioning, and believes that pharmacists have the necessary talent to fill the gap. “We have experienced firsthand how much sway pharmacists have as decision-makers within the NHS. This cultural change has happened over a number of years but has resulted in our profession being in a prime position to help deliver a new outcomes-focused healthcare system, which needs our expertise – and needs it urgently,” he said.

Mr Ali and fellow iRx Solutions directors, Victoria Overland and Jayesh Shah, also NHS pharmacists, came together in 2010 to consider how they could facilitate sharing of ideas and good practice among such influential pharmacists. Their vision: a suite of medicines-related solutions, including specialist education and medicines commissioning support, delivered by expert pharmacists to colleagues in ‘payer’ roles. Their recent cardiology discussion forum was a refreshing mix of good food, sponsored and non-sponsored presentations, and debate – attended by prescribing advisers, heads of medicines management and other pharmacy leaders.

Victoria Overland, who comes from a background as a commissioning pharmacist in primary care, says that pharmacists are now among the key decision-makers and are well placed to influence both prescribing and commissioning in the new NHS. “Therapy choices made by GPs,” she explains, “are currently supported by PCTs, which have a wealth of commissioning experience – balancing effectiveness and outcomes with the costs to the health economy. When the PCTs disband, this requirement for high-quality medicines commissioning support will still exist. What will be different about it is that Clinical Commissioning Groups will be making decisions that they feel best suit the needs of highly localised populations. We know that pharmacists have a great deal of experience in reviewing the efficacy and safety of medicines, and, crucially, their impact on healthcare budgets.”

So what did participants hear about at the discussion forum? Cardiology content was served up alongside presentations from Stuart Saw, who described the challenges being faced with the NHS reconfiguration, and Omar Ali, who gave an express tour of how value-based pricing of medicines might work in the future.

Helen Williams, Consultant Pharmacist for cardiovascular disease in south London, outlined how appropriate changes in drug therapy could support the Government’s QIPP – quality, innovation, productivity and prevention – agenda. Conversely, she questioned the wisdom of switching patients from certain branded angiotensin-receptor blockers (ARBs) to generic losartan. Ms Williams argued that some of the branded ARBs are due to come off patent in the near future and that the healthcare costs associated with switching therapies – not to mention the potential disruption for patients – might not be justified.

“We had nine years between simvastatin patent expiry and atorvastatin patent expiry and, as a result, we’ve saved millions,” she told attendees. She pointed out that the losartan patent expired in March 2010, adding: “We’ve got valsartan [expiring] this year and we’ve got candesartan and irbesartan next year. So I think we’ve missed the boat. If we wanted to make savings . . . from generic losartan, specifically, we needed to plan for it in 2008–09.”

Stable angina was also on the menu, with the profile of the condition set to be lifted following the publication of a new clinical guideline by the National Institute for Health and Clinical Excellence. Making clear that the NICE guideline was only in its draft form (when the discussion forum took place), Sotiris Antoniou, Consultant Pharmacist CV Medicine NE London CV & Stroke Network Barts & London NHS Trust, described the place in therapy of the range of medicines available for treating stable angina patients in the UK. He emphasised the need for clinicians, when interpreting NICE guidance, to “think about the whole patient” and his or her quality of life.

This is something that Jayesh Shah understands all too well from working as a medicines management pharmacist, supporting GP consortia. “With so many changes since the White Paper was published last year, there is a lot of confusion among both clinicians and managers,” he says. “But something we are certain about is that healthcare professionals care a great deal about their patients and want the best outcomes for them. So that’s our passion and driver, and meeting the ambitious goals of the QIPP agenda is also an imperative.”

According to Mr Shah, a healthy dialogue between pharmaceutical companies and pharmacists – “we need to think creatively about this relationship” – will help the industry to align its priorities with those of the evolving NHS. Omar Ali adds: “We are committed to working with the pharmaceutical industry to ensure all aspects of our educational events meet regulatory requirements. Moreover, iRx Solutions is committed to ensuring the quality of the content and speakers is exceptional. But we know that this kind of meeting is about more than the educational programme: both pharma and medicines management attendees see the value in time put aside for networking.”

Progress of the NHS reforms may have slowed, but it appears that momentum is building in at least one profession to tackle whatever the Government manages to push through Parliament. If the opinions of the team at iRx Solutions are anything to go by, pharmacists certainly have a bright future as decision-makers around medicines.

The directors are speaking on behalf of iRx Solutions not the NHS organisations by which they are currently employed. For more information on iRx Solutions, visit www.irxsolutions.co.uk.

It’s long been said that men are from Mars and women from Venus. Iain Bate explores the findings from the latest Pf survey to establish if, in pharma at least, the sexes really are worlds apart.

For decades studies have been evaluating whether men or women make the better boss or employee. Questions have also been asked time and again about who works harder or more efficiently with the resulting arguments commonplace in boardrooms, bedrooms and everywhere else in between. And, like every other industry, the world of pharma has not been immune from the debate. Now in its tenth year, Pf’s annual Company Perception, Motivation and Satisfaction Survey provides a confidential way for medical sales professionals to express what they really think of working within the UK pharmaceutical industry, and provides a useful benchmark of field-force remuneration. Once again, this year’s survey shows that the difference between men and women is not as clear as the X and Y chromosomes that separate us.

In 2007, Total Work, Gender and Social Norms, a study from the US National Bureau of economic Research, by Michael Burda, Dan Hamermesh and Philippe Weil, aimed to put an end to the age-old argument of who actually works harder. Although on the surface the majority of respondents claimed that women work harder than men, the survey found that across northern Europe and America the total workload – combining activity at work and at home – is now shared almost equally.

There are reportedly just 78 genes that separate men from women. But the feedback from the Pf survey would suggest masculine and feminine thinking is far closer together. Women slightly outnumber men in the survey accounting for 53% of respondents. They also outnumber male counterparts in almost every age group as well – a surprising statistic considering it’s usually females who sacrifice, or at least put their careers on hold, when starting a family. This social norm is reflected with the only age category in the survey where men outnumber female counterparts by almost 2:1 is those aged 55 or over.

The pay gap

Pay discrimination has always been a major issue and one which campaigners have tried to balance for decades. On the 1st October 2010, the Equality Act 2010 came into force. The brainchild of Harriet Harman and one of the Labour Party’s 2005 manifesto commitments it was supposed to finally bridge the gap in salaries between men and women. Forging together nine different laws, including the Equal Pay Act, the legislation gives the Government the power to require large private sector companies with more than 250 staff to establish whether there is a pay gap and to publish their findings.

But so-called ‘gagging clauses’, which stopped people from discussing their salary with colleagues, remained and several other provisions were left out of the Act, including the gender pay audit.

The Act was supposed to finally end the years of discrimination women have faced – particularly in respect to pay. However, if anything, the survey reveals the pay gap is actually increasing. In last year’s survey, the pay difference between the combined median salaries of medical representatives, hospital specialists, NHS liaison officers and first-line managers was £1,539. But that figure has now leaped to £4,000 in the space of 12 months See figure 1).

Despite the pay gap increasing, women are again more satisfied with their salary than men with more than half (51%) of female respondents admitting to being happy with their remuneration. Needless to say the amount of men who said they were satisfied with their annual remuneration increased from 46% to 49%. But more surprisingly is that 61% of women believe they are on an appropriate salary, compared with 57% of men – maybe the Government’s ‘gagging’ clauses remained for a reason…

Experience and expectations

Although there are more men within the medical sales industry aged 55 and over than women, it is the fairer sex that has more experience within the industry in the early stages of their careers (see figure 2). More than double the amount of women (14%) have up to four years experience in the trade. Women who have worked within the sector for between four and eight years also marginally outnumber men. But more than three-quarters of male respondents said they have eight years of more total experience, compared with 67% of women.

When analysing the amount of time in a person’s current role, it would suggest that the Equality Act is bridging any divide or favouritism towards a certain sex. Exactly a quarter of men have been with their current employer for less than a year with women only one per cent behind. Results also found that employers would now seem to favour an evenly balanced workforce of men and women. In fact, more than a third of both men and women (37%;35%) have been in their current role for between two and eight years. Over that, 17% of men and 14% of women say they have been employed for nearly a decade by the same company.

Often accused by women as having commitment issues, it would seem men do have itchy feet after all with 40% admitting to wanting to move company or position within the next 12 months (see figure 3). More than a third (35%) of women also admit to considering a change of employer or role by this time next year. But a higher number of women (59%)compared to men (53%) said they were happy to stay with their employer and within their existing role.

What really matters

In the current economic state it’s no surprise that both men and women claimed that their salary was the main motivational factor whilst at work (see figure 4). With pharma companies still content on cutting budgets and wielding the axe on sales teams it’s also of little shock that job security is now the second most important factor for employees within the industry. Interesting when you consider in the 2009 survey job security just managed to make the top-twenty motivational factors. The number of redundancies has obviously taken its toll on all respondents within the last twelve months with more people than ever keen to hold on to their job.

Women put a greater emphasis on work-life balance than men who said the relationship with their immediate manager was of more importance. This opinion again may reflect a more maternal instinct and a willingness to find the right balance between time spent with the family at home and at work. Men also said that company culture was of more importance than women with females having a greater belief in products than male counterparts.

Where satisfaction within the workplace is concerned there is no separating men and women. Both sexes said that a belief in products, relationship with manager, accountability, autonomy and pension scheme were the top-five satisfying factors. As the survey suggests, men and women have never been more similar…

In his latest article exploring the dynamics of high performance in the workplace, Apodi’s Tony Swift examines how line-managers have the power to determine whether teams are successful or not. Drawing on his own experiences, he discusses what makes a great manager and leader, and why measurements of success are so important.

According to Tom Peters, the renowned business guru, the number one source of dissatisfaction amongst employees is the quality, or lack of it, of the first-line management in companies, sports teams or organisations. For many employees not even the best pay and conditions in the world will make it tolerable to work for a bad manager.

The varying quality of management is a little surprising given the fact that most employees will quickly make their own assessment of the quality of management in the team they work for and, if asked, will readily give their opinion.

It is seemingly more difficult for senior management to make this assessment because there are considerable variations in the quality of first-line management and organisational structures may make it difficult to see where problems may lie. Yet it might be that assessing quality by senior management is not the problem per se. It could be that inertia and an underestimation of the important role that first-line management plays which enables poor management to exist in some companies in the first instance.

Throughout my own sporting and business career I have been fortunate to be managed by superb coaches and captains at various times. Conversely, I have seen some very poor attempts at leadership – even at the most senior levels. Superb coaches and captains have a habit of getting the very best out of the talent at their disposal. The first England international rugby captain I played with was Bill Beaumont. Bill had a number of attributes that made him ideal for leadership, including fearlessness, humility, amiableness and empathy. Even the most senior players within the team listened to him and respected him. When he retired England missed his leadership and for a number of years went through a very unproductive and unsuccessful time.

Therefore one of the most significant strategic business decisions any company makes is who to promote or recruit into management. For an organisation to make the most appropriate hiring decisions for management, a good starting point is to first of all identify what good managers actually do.

What great managers do

Here are just some of the practices implemented, and excelled at, by great managers:
1. Recruiting the right team – this is key to ongoing success. I have discussed recruitment in previous articles in Pharmaceutical Field, so please take a look at these for more ideas on this subject.

2. Setting the direction – simply put, people need to understand specifically what is expected of them and how they will be measured. Research undertaken by Apodi shows that this is not always the case. Many pharmaceutical companies are establishing Market
Access teams and Key Account Management teams to address the new healthcare economy. However, those that are being successful have very clearly identified the role of these teams, how they should operate, be measured, and constantly communicate the benefits internally to the rest of the organisation.

3. Enforce results, manage activities – successful sales people within the same teams often deliver required results through different types of behaviour and activities. If a manager attempts to standardise these approaches it may result in blunting much of the talent within the team. Good managers need to understand when to stand back and let the sales people deliver in the way which best works for them.

4. Making tough decisions – all managers at some stage in their career find that one of their reports is not going to make it. Good managers find this out quickly and act immediately. Poor managers let the problem fester – the effect of this is to undermine performance in the business and also undermine the manager’s standing within the team. Good employees tend to know when poor performing employees are being tolerated,
which can be incredibly damaging. That is because high performing employees tend to share a sense of mutual accountability which gives employees and teams the confidence they need to take on more challenging tasks. This is just not possible with poor performing
people. At its extreme, I have seen certain teams almost take it out of the manager’s hands and rid the team of poor performers when and if a manager prevaricates.

5. Work on strengths, not weaknesses – whilst it is possible to improve people’s weaknesses through coaching and mentoring, the improvements are often minimal. Many organisations waste considerable resources in this area and better returns can be realised
by:

• focussing on people’s strengths

• designing the organisation in such a way that the strengths of an individual are maximised and the weaknesses minimised.

Figure 1 (see below) highlights some top-line research on the effectiveness of individual business development executives within a team. Each executive was marked out of five (1=poor-5=very effective) for different but relevant talents.

The research highlighted a number of factors. Each individual had particular strengths and weaknesses apart from Executive 1 who was a strong all-rounder. Rather than working on individual weaknesses it was decided that it would be more effective if the executives worked in a team environment – rather than as individuals – where their strengths could be maximised and weaknesses eliminated. The research also showed a general weakness in
the prospecting area and, rather than attempting to train people to be more effective in this area, it was agreed to recruit a new executive with specific prospecting skills.

6. It’s always ‘show time’– a number of the above practices are viewed as ‘hard edged’. Great managers complement these practices with the softer skills necessary to motivate team members. For example, making tough decisions is only respected by team members
when these decisions are fair and in the interest of the team as a whole – being tough for the sake of it wins no support or respect from fair minded people.

Great managers also know there is no let up – they are on ‘show’ all of the time as far as team members are concerned. This means displaying all of the traits they want displayed by their team members – hypocrisy just does not work in management.

Why measurement matters

If the key practices above are put in place and actively pursued, then high performance is the likely outcome. There are examples of this in every walk of life. Sir Alex Ferguson, the manager of Manchester United Football Club, implements these practices and displays
these attributes, which has resulted in a hugely successful career. From my own point of view, I have found it difficult to identify any high performing team where managers do
not display these practices, whether in commerce, sport or the charity sector. However, not all managers are in such high profile roles that their performance is there for all to
see. This is why it is so important for managerial qualities and competencies to be valuated against measurable criteria.

Measuring manager performance

When I review how managers are measured, it is rare to see all of these practices being part of the assessment process. I believe organisations would be well served by incorporating ways of measuring managers’ performance in their existing assessment processes in the following areas:

• The ability to recruit effectively
• Establishing the right direction for the team
• Enforcing results and managing activities – only when necessary
• Making tough decisions if required
• Coaching ability – focusing on strengths
• Having the ability to carry the team with you.

Measuring team performance

A common scenario we are seeing in pharmaceutical companies is where they establish a Key Account Management team and Market Access team but are then unsure as to how
well these teams are performing and whether or not the investment has been worth it. It is critical that they know the answers to these questions.

The primary reason companies are unable to answer is because they have not developed a measurement system the organisation trusts sufficiently in order to base decisions on. Market Access teams are typically established in pharmaceutical companies some 6-12 months prior to a launch of a product. Normally the role of this team is to create a favourable environment with the NHS to ensure maximum sales when the product is launched. Clearly in the first 6-12 months prior to launch there is no sales data and therefore the ultimate measure of success does not exist.

The company’s strategy has to be clearly defined and the team’s performance needs to be measured against this. It will usually be a mixture of quantitative inputs and qualitative
outputs. The reliance on qualitative outputs with its heavy reliance on subjectivity means that a company can only entrust the management of this to extremely competent, talented and experienced managers.

Getting it right

Pharmaceutical companies routinely make multi-million pound investments in the deployment of teams. As the guardians of such investments, the team management has to embrace, and be adept at implementing, the practices we have looked at. Therefore, not only is selecting the right management vital to success, but so is putting in place ongoing assessment of key practices.

An effective, results-based management process demands both superb management and effective monitoring in equal measure. It is likely that only when these particular conditions are in place, will true high team performance be achieved.

 

  Tony Swift is the Managing Director of Apodi.