So why is pharma keeping so quiet about joint working?
Rumour has it that joint working is happening out there. The NHS and industry are, tentatively, beginning to grasp the benefits of partnership working. So why are most drug companies determined to keep details of their joint working projects a secret? Chris Ross reports.
Last week I received an email from a consultant pharmacist wishing to raise awareness of a partnership initiative that his Trust had undertaken with a pharmaceutical company. It was the third similar enquiry from a healthcare professional (HCP) in as many weeks. And it was an indication of just how far NHS-industry relations have come in the past decade.
Thirteen years ago I interviewed a handful of GPs to write an article on HCP attitudes towards pharma and, in particular, their willingness to work in partnership with drug companies. The subsequent piece was called “Sleeping with the Enemy” and it presented a rather cautionary tale of why NHS professionals were wary of “getting into bed” with pharma. Fast forward to 2011 and it’s clear that while both parties are still very much sleeping in separate beds, they have, metaphorically at least, begun to “co-habit” through a growing number of joint working projects designed to improve patient care.
Back in 1998, pharmaceutical companies were queuing up to position themselves as ‘partners to the NHS’. In turn, HCPs appeared keen to maintain their traditional, transactional relationships with the industry and to keep the suggestion of partnership at arm’s length. And as an increasing number of GPs installed “No Reps” signs in their surgery windows, the more proactive and visionary doctors that recognised the potential of partnering with industry preferred to keep a relatively low profile rather than risk developing a reputation for ‘sleeping with the enemy.’
Times have, of course, changed. The intervening years have not only seen exponential growth in the size, shape and identity of the industry’s customer-base, but the pressures of a failing economy have meant that NHS attitudes towards joint working have relaxed as demand on the service increases. But the biggest change, and indeed perhaps the biggest surprise, is that it now appears to be the NHS that seeks to promote its joint working initiatives.
The Government’s recent modification of its plans to establish GP Commissioning Consortia will see the emergence of ‘Clinical Commissioning Groups’, with support and cross-speciality advice provided by ‘Clinical Senates’. The apparent aim is to secure the involvement of the full range of clinical expertise in the commissioning of NHS services. The redrawing of the commissioning map will undoubtedly have major implications for the pharmaceutical industry’s sales and marketing strategies, but in truth, companies have been building relationships with a broader range of clinical decision-makers and influencers for many years. In fact, even in terms of fledgling partnership agreements, practitioners from right across the clinical team are increasingly getting involved in the implementation of joint working projects. What’s more, as they battle to demonstrate progress in line with their QIPP objectives, they are ever keen to raise awareness of the outcomes such initiatives have delivered. Since the turn of the year, Pharmaceutical Field has been approached by HCPs ranging from GPs and consultants to clinical pharmacists and specialist nurses, each seeking the oxygen of publicity for their joint working projects. It’s a far cry from inferences of Sleeping with the Enemy in 1998.
In the coming months, as the principle of partnering becomes more established, Pf will explore individual examples of joint working in more detail. But to do so, it needs the pharma industry to wriggle free from its self-imposed straitjacket of silence. At present, while their customers endeavour to raise wider awareness of their efforts, many pharmaceutical companies appear keen to keep their partnership cards close to their chests – preferring instead to preserve apparent competitive advantage by maintaining stereotypical corporate secrecy over their joint working strategies.
This is surely counter-productive. At such an early phase in the establishment of a partnership agenda, the most nagging question uninformed NHS professionals continue to ask are around definition. “What is joint working?” they implore. “What are the parameters of what we can do, and how do we go about doing it?”
Other than face-to-face human interaction, there are few better means of increasing understanding than practical demonstration. But too many examples of joint working remain locked in the basement of corporate HQ, in the process depriving potential stakeholders – from both the NHS and the industry – of insights into best practice that can help accelerate the collective progress of joint working and, more importantly, significantly benefit patient care.
Despite welcome signs that stakeholders within the NHS are becoming more open to the principle of joint working – and in some cases are willing to promote their involvement in it – progress to date has been limited. The early adopters are considerably outnumbered by the laggards. But the many in between offer great hope for pharma if it can look at the bigger picture and recognise the value of sharing best practice.
The industry still needs to drive the partnership agenda. According to the former Director-General of the ABPI, Dr Richard Barker, the industry is merely at base camp in the evolution of joint working. Progress, says Dr Barker, is all about attitude and will rely on a change of mindset. “The industry is changing. It knows it needs to prove the value of its products, not just their uniqueness. That value has to be in terms of improving the pathway of care and the outcomes for patients. If the new clinical consortia are going to be measured by outcomes and the industry’s products are going to be valued according to their outcomes, there’s an obvious marriage. We should be sitting down and talking about how we can improve the overall outcomes by creating value pathways, not just value products. That should be a natural conversation.”
Equally naturally, the conversation between pharma and NHS will most likely be delivered, from an industry perspective, by medical sales professionals. Once again this is an area where perceptions have needed to change. Mike Farrar CBE, Chief Executive of the NHS Confederation, says the relationship between NHS and industry has traditionally been perceived as an adversarial one best characterised by the image of the ‘pushy drug rep’. “Attitudes on both sides have begun to change,” he says. “There is now a much broader understanding that prescribing plays a massive part in care pathways and that without effective prescribing as part of an overall care package, some of the interventions being made can be undermined. As people have begun to understand care pathways, an increasing number of examples demonstrating the value of a good relationship have emerged.”
But those examples need to be shared, explored and, where possible, improved. And this is a collective responsibility. As Mike Farrar says, both parties must continue to demonstrate the benefits of what can be achieved by working together, to provide “almost a moral obligation that everyone should be exploring it.”
Mark Wilkinson, Director for Life Sciences Innovation and a key member of the NHS Life Sciences Innovation Delivery Board, says that partnership is a contact sport. “It’s all about building relationships,” he says. “The best joint working schemes have been where people have developed a mutual trust and, as a consequence, started to identify areas of common interest. Collaborative goals are important. NHS and pharma need to find those out.”
And so, almost 15 years since a BT ad campaign coined a national catchphrase, the pharma industry and the NHS are finally waking up to Bob Hoskins’ advice. It’s good to talk. Critics will argue that when it comes to partnership working, there’s been a lot of talk and not much action. This is largely true – people have been talking about the opportunity for over a decade and the rhetoric is still running ahead of the reality. This is underlined by the fact that conference presentations dedicated to joint working are, as Mike Farrar concedes, frequently delivered by the same voices imploring others to seize the opportunity.
But the debate does need to move beyond theory and rhetoric. Evidence that joint working works is growing all the time. It just needs to be shared with a wider audience. According to the experts, partnership working is built around the twin principles of transparency and disclosure. Ironic then that pharma seems to want to keep its activities such a secret. Advocates of partnership within the NHS appear more willing than ever to raise awareness of their joint working initiatives. Isn’t it about time that pharma did the same? It’s good to talk.
Parts of this article are taken from Partnership in Practice, HSP’s new publication for pharmaceutical sales professionals and NHS management. To download a digital copy of the first issue, please visit www.pharmafield.co.uk