This month John Pinching is in the big smoke with Crucell’s high-flying city slicker Kate Evans. She has an almost Dickensian ‘rags to riches’ tale to tell – forced to wash pots in order to make ends meet, Kate had a ‘road to Damascus’ moment, and now she’s one of the industry’s shining stars. What better way to kick off the festive season?

A frosty winter’s morn, Oxford Circus (exit 8, to be precise), I meet Kate Evans (right) – resplendent in an aquamarine cardigan – and we alight to a nearby hot beverage purveyor. This ain’t called ‘Coffee Break’ for nothing, dear reader. Realism is essential – we do actually go ‘for coffee’. Having said that, Kate orders a tea, shattering the illusion. I, true to my word, request a latte. The checkout girl seems a bit stroppy, but we proceed with the interview, we are professionals after all...

What do you think of the new mag? It was very eye-catching when it came through the post, which is a good thing, because usually it gets shoved on a pile. It looked different, therefore I read it. It was fun, more relaxed and sharp.

Thanks, the cheque’s in the post. So, Kate, what’s your story?  I was born and brought up in Middlesbrough and went to university in Durham. I got a 2:2 and was mortified; I cried for an entire day. I thought I’d never get a job, but I’ve realised that it’s actually your personality and drive that get you through, not what’s on your degree certificate.

Where are you based now? I arrived in London two years ago when I joined Crucell. My mum still thinks it’s another country, but I had to go and see what it was all about. I go into the office a couple of days a week in High Wycombe and the rest of the time I’m out meeting people. I prefer to be on the road, speaking to the NHS payers at the coal face: finding out about how the reforms are affecting them and how we can work together. I’m nationally based, so I go wherever people want to talk and engage in interesting projects!

How did you get into pharma? After uni I got a position as a peptide chemist, which after doing a Biomedical Science degree seemed the job of choice. It was based in the north east and we were making synthetic proteins for pharmaceutical research and development. After about a year of doing that I was ready to leave the North East and I got a job at Nottingham City hospital as a tumour immunologist researching how to create a blood kit which could detect breast cancer earlier than a mammogram.

What happened to make you change career direction? I used to chat with the reps who came in to sell pipettes and lab equipment to us. Talking to them was the highlight of my day and I used to think, ‘What am I doing every day, just staring down a microscope?’ What they were doing seemed much more ‘me’. You got to chat to people..  At the time I had to work in a pub during the evenings in order to pay my rent. That was when I became obsessed with becoming a pharmaceutical rep.

How did you get your big break? I started trying to find a rep job, but a couple of companies said you’ve got no sales experience, ‘go and work in a call centre.’ There was no way I was going to do that. Eventually I got into the industry through Innovex and worked with them for two and a half years selling MSD products. From there I went on to various positions at Sanofi Pasteur, MSD, and then on to Crucell in 2010.

How is the relationship between NHS and pharma changing? There is still a lot of mistrust stemming back to the era when everything was about a hard sell. Now you have to be able to sell a value proposition, focusing on the new NHS targets. It’s much more about ‘how we can help you with your care pathway, reduce health inequalities and improve patient outcomes’.

What is the best way to ensure relations continue to improve in the future? The key for pharma is deciding who you actually send to the Chief Executive of a CCG, because a Key Account Manager in one company may be very different to another, and some have only ever covered primary care. It is important to understand the whole local health economy and its needs. You need to have at least read the CCG strategy plan, and understood how your product can link to helping them meet their QIPP and QOF targets. I was very passionate about this at the recent Pf Local Insight Forum: many of the people in that room didn’t know what a Joint Strategic Needs Assessment (JSNA) was. In any other business you wouldn’t go and face a client if you knew nothing about what they do. Other feedback I get from customers is that they want someone who can make a quick decision, not someone who has to go back to head office and get agreement.

Have you established some good partnerships with public sector organisations? My own personal experience of working with PCTs has been very rewarding. The uptake of flu vaccines can be low due to various health inequalities, such as transient population, reduced access to clinics, and language barriers. Using local hospital data, you can start to build a business case about how a project may improve vaccination uptake and therefore potentially reduce hospitalisations. It is important to tailor any project to the needs of the local health economy as each has different requirements. I have worked with NHS, pharmacy and other private providers in these ventures. As well as improving patient care, the projects aim to improve uptake and therefore increase the overall market in the process. It shows you can be commercial and still be part of the NHS’s agenda.

You seem passionate about your work. Vaccines, whether they’re paediatric, flu or HPV, have saved millions of lives worldwide and that’s why I’m so passionate about this area. The highlight for me was being chosen by Crucell Global to visit Bangladesh in June this year to see their vaccination campaigns and how money is being put back into developing countries that don’t have a recognised health service. Since merging with Janssen this year it has been very interesting to widen my horizons and apply my skills to other disease areas. I also contribute to the NHS intranet blog for the company, keeping everyone up to date with the reforms.

What other changes excite you? It’ll be really interesting next year to see the emergence of companies like Circle Health, who have already started to fulfil contracts on behalf of the NHS, easing in the whole ‘competition element’ of reform. NHS hospitals are advertising for marketing and business development managers, perhaps because they won’t necessarily get all the referrals from primary care, given that there are some really impressive ‘Any Qualified Providers’ out there.

You’re clearly a bit of a mover and shaker, what does the future hold for Kate Evans? Everyone always wonders where they will be in five years, but I just take opportunities as they come along. As the NHS changes, so will the jobs within pharma. Companies will soon need specific people to handle joint working, for example, and I am sure more even more niched jobs will start to appear as the new NHS goes ‘live’ in April 2013.

Do you have a good work/life balance? In the days when I was winning Rep of the Year in consecutive years, the ratio was more work/work! I don’t stay on the computer until midnight any more; however, sometimes when deadlines are due, work can still start to eat into personal life. I have learnt over the years how to manage my time more effectively; it’s just part of the job. You’ve got to have relaxation time in order to function properly.

NHS engagement is about combining thorough market intelligence with a robust targeting plan.

The imminent authorisation of the first wave of Clinical Commissioning Groups (CCGs) promises to provide Key Account Managers with yet more information on which they can base their call strategies. By November, 35 CCGs will hope to have successfully navigated the comprehensive authorisation process and be approved to take on their new commissioning duties from April 2013. A further 177 prospective CCGs will be reviewed across the final three authorisation waves, with decisions on all the new local organisations expected by the end of January 2013. The dawn of a new era for commissioning is almost upon us. And as the reform rhetoric turns into reality, a new customer landscape for UK pharma will have emerged.

The four-wave authorisation process will place into the public domain a wide range of important documentation that was required not only to support individual CCG applications but, more importantly, to provide strategic blueprints for the long-term development of these embryonic local health organisations. Key documents include Joint Strategic Needs Assessments, Commissioning Intentions, Integrated Plans, Joint Health & Wellbeing Strategies, Organisational Structure Plans and draft Joint Commissioning Agreements. In some of the more proactive local organisations, such information is already available.

Elsewhere, it remains in late-stage development. Either way, the data and plans set out in these documents will undoubtedly provide crucial insights for KAMs targeting existing, new and emerging decision-makers and influencers at the local level.

And therein lies the problem. Identifying the most important and influential stakeholders in a changing NHS remains one of UK pharma’s biggest challenges. Earlier this year, the NHS Alliance’s Chief Officer, Mike Sobanja, said that the industry was about to embark on a game of ‘Spot the Commissioner’. He was not wrong. But to win, medical sales professionals tasked with the responsibility for identifying and developing key customer accounts must take the gaming metaphor a stage further and set about playing a conventional game of ‘Guess Who?’ Unfortunately, winning won’t be child’s play – it will require an insightful and educated approach.

But guess who, indeed. The current reorganisation of the NHS is bringing an increasing number of players to the table. Alongside CCGs, the Department of Health has recently published further details on the establishment of 27 Local Area Teams (LATs). Ten of these will be specialist commissioning hubs; the remainder will be afforded a variety of commissioning responsibilities. In addition, commissioning will be supported by 12 Clinical Senates, whose full remit is, as yet, unclear. Beyond this, the NHS Commissioning Board (NHS CB) – which itself will exert major influence over local commissioning plans – has more recently rebranded commissioning support services as Commissioning Support Units (CSUs). The NHS CB is currently conducting an authorisation process that will determine which organisations will provide ‘scale services’ to support CCGs – and has approved 23 to date. Critics claim the new CSUs look suspiciously like PCTs.

Regardless, it’s clear that in the very near future, pharma will find some of its key customers are housed in a CSU. They will also reside in fledgling Health & Wellbeing Boards. Undoubtedly, the new commissioning landscape will present a complex customer matrix for the industry.

Such is the speed and scale of the reforms that targeting customers in an environment that appears to be changing on a daily basis could easily be reduced to a guessing game. But pharma’s approach needs to be much more sophisticated than that. KAMs know that the old-school ‘noise-based’ approach to customer engagement will no longer work. Call plans must be targeted and efficient. But how?

Guess who?
The challenge really is like playing a giant NHS-themed game of Guess Who? Figuratively, every KAM has their own game board. The characters on it will differ, in terms of remit and influence, from one local health economy to another. And they will also be dependent upon disease area. A fully comprehensive board will comprise a mixture of clinicians and payers, as well as, potentially, influencers from social care and local authorities. Crucially, the game is as much about ruling out irrelevant customers as it is about identifying key targets. The former will determine the latter. The most adept sales professionals will be those who command sufficient market knowledge to be able to discern between an important stakeholder and a non-starter. They will then be able to use this information to form an efficient call strategy. Market data will clearly inform these targeting decisions. And there is a lot of it out there.

The imminent arrival of strategic documentation emanating from the CCG authorisation process will be just the latest in a deep mine of useful NHS data available to the industry. From QOF data to QIPP plans, HES data to CQUIN frameworks, the modern NHS is generating performance data, indicators and metrics at a rapid rate of knots. Used properly, it can be gold dust.

Local health organisations are being measured on their ability to eliminate variation in care, reduce hospital admissions and improve health outcomes. And they are increasingly required to report on how they are faring against these objectives. Proactive KAMs can use this data to develop messages that target commissioners of care and demonstrate how their drugs can impact service delivery in line with known priorities.

But data is only part of the answer. On its own, information is not enough. Success will only come from having an understanding of what it means, and establishing how it can be targeted in the right direction. A KAM can have all the data in the world, but if they are not able to translate it into an offering that demonstrates a meaningful gain for a customer, it is worthless.

The key account management game of Guess Who? will ultimately be led by the messaging you have developed, which, in turn, will have been driven by local circumstances and those customer needs identified within relevant market data. If you have a health economic message, certain clinical customers can be ruled out. If your value proposition can make a difference to a QOF target, once again, it will dictate a more precise customer group and eliminate others.

The rapidly expanding availability of NHS information promises great national and local insights for KAMs – and the Department of Health’s recently published Information Strategy indicates that a growing emphasis is being placed on the need to capitalise on the promise of data to drive improvements in patient care. But medical sales professionals must not lose sight of the fact that once they have reviewed all the available data and determined their product messaging, they still need to identify the key customers with whom those messages will most resonate. And they must then tackle the industry’s other long-standing challenge: gaining access to them. Having something to offer that can help customers meet their own objectives provides the best possible chance to achieve this.

So it’s clear that, faced with an evolving NHS bedeviled by rising demand, reduced resources and major reorganisation, productive industry engagement will only come through the development of a market access strategy that marries environmental intelligence with accurate customer targeting. This all links back to the need to establish a robust CRM strategy that integrates all aspects of customer data into a single platform, and communicates them effectively and efficiently across the commercial organisation. This approach will prevent KAMs going off in different directions and developing flawed strategies based on poorly-interpreted information.

In a dynamic, fast-changing market, only meaningful engagement that communicates the right message to the right customers will make any discernible difference. Anything else will be pure guesswork.

David Round is General Manager, UK at Cegedim Relationship Management.

JSNAs have suddenly been thrust into the limelight. But why are they so important?

Key account managers and other commercial team members in pharmaceutical companies should already be well aware of joint strategic needs assessments (JSNA). JSNAs were initially introduced in 2008. Since then local authorities and Primary Care Trusts have been under a statutory duty to produce assessments to outline operational plans for health services to meet the needs of the local population.

However, since the introduction of the Health and Social Care Act the importance of JSNAs has increased tenfold, with them being recognised as a key driver of improvement. JSNAs are now a fundamental part of the planning and commissioning cycle at a local level. Under the reformed health system there is a greater emphasis placed on the process and outputs of JSNAs than had previously been attributed – and there is a clear expectation regarding their influence on commissioning plans.

From April 2013 onwards, local authorities and clinical commissioning groups (CCGs) will have an equal and explicit obligation to devise the needs assessment document.

Local leaders and commissioners will be tasked with identifying the health needs and requirements of the local population and addressing these either through the services they commission, through the introduction of new initiatives, or through joint working and collective action with local providers. In doing so, local authorities and CCGs will be able to plan and commission services in an integrated fashion to allow health and care services to efficiently and effectively meet the needs of all members of the community.

In turn, JSNAs will be used by regional health and wellbeing boards to understand and take action to tackle local challenges. The assessments will also play a fundamental role and heavily shape the design of joint health and wellbeing strategies to set and measure outcomes; and also align these with local priorities established in the NHS Outcomes Framework – plus similar public health and adult social care frameworks.

‘Picture of a place’
Assessments must consider all of the current and future health and social care needs in relation to the area a local authority and CCG are responsible for. It must include requirements which report authors believe are achievable and which can be affected to a significant extent by the actions of the local authority, CCG or NHS Commissioning Board.

The Health Act has a clear expectation that JSNAs – and the strategies which are created as a result – will provide the basis for all local health and social care commissioning. JSNAs are a treasure map for pharmaceutical companies and their Key Account Managers. The documents, which must be published, provide a framework to examine factors that impact on the health and wellbeing of communities. Although these range from employment and education to housing and environmental factors, it is the overall impact of these on the physical and mental wellbeing of local residents that pharma should be targeting.

The DH says that JSNAs need to “articulate and address the unique ‘picture of a place’ in every region. In doing so, these valuable documents inform not only local commissioners, but their partners in delivering health services to provide a framework of objectives.

PCTs and local authorities have used JSNAs to establish the current and future health and social care needs of residents. Within the assessments there needs to be a focus over the short and medium term on taking into account anticipated changes in the demographic and infrastructure.

Captured data, information and intelligence underpin JSNAs. This evidence will also be published, giving pharma an insight into local priorities in areas where they can influence and target. But the assessments are far more than just a collection of evidence. They provide an analysis and narrative on the background of the region they cover. They process extracts while analysing evidence and allowing Health and Wellbeing Boards to develop a plan on the basis of these, using data to drive strategy and commissioning. They are a must read for a KAM to gain invaluable background information on local trends and targets.

JSNAs do not have to be completed on an annual basis. In fact, it is only in recent months that a number of PCTs have updated their initial JSNA. However, the DH states that assessments should build on and align with similar needs assessments in local areas to avoid duplication and to develop a “comprehensive local assessment” to inform integrated services. The aim for local authorities and commissioners is to create a single, consistent story on any given issue and to remove duplication whilst contributing across the local system.

‘Putting localism in action’
In the 2011 DH document Joint Strategic Needs Assessment and join health and wellbeing strategies explained – commissioning for populations Paul Burstow, then the Minister for Care Services, highlighted the importance of JSNAs and resulting strategies, saying they are “key to putting localism into action.”

In the foreword of the document he commented: “The strengthened role of JSNAs and joint health and wellbeing strategies will enable the local health and care system to go further than ever before. For the first time, decisions about health and care will be made on the basis of clinical expertise, evidence from the JSNA, and the valuable input of locally elected councillors and the public, via local HealthWatch and wider engagement with the community. This means decisions about action, investment and disinvestment can be genuinely local, rather than a reflection of national priorities.”

Burstow added that he was “clear” the assessments will not have a “galvanising effect on their own”. But when in combination with health and wellbeing strategies and aligned commissioning plans JSNAs have the “potential to be transformational in improving health, care, and wider services for people in our communities.”

The NHS Confederation agreed about the importance of JSNAs but warned about the quality of these assessments. It pointed out that a “good quality” assessment has the “potential to drive improvements, highlight health inequalities and closely inform commissioning.” But a “weak” JSNA is “disconnected from key decision-makers and commissioning and, therefore, removed from local communities.”

“Relatively few have been balanced by an assessment of the assets, strengths and capacities of local communities, which is clearly more desirable,” the Confederation said. “We believe that JSNAs have not yet reached their full potential for commissioning in local authority areas. The reform proposals provide a welcome opportunity to extend JSNAs to include health and voluntary partners.

“If the JSNA remains focused on health services, public health and social care alone, it may require fewer resources but will provide a limited analysis of the needs and assets of the community and may not engage or inform key partners, which is surely one of the key benefits.”

Exploiting JSNAs
JSNAs are and will be a valuable tool for pharmaceutical companies to identify the local health and wellbeing needs of specific regions across England. Although these documents contain important information on how pharma can drive improvements through system redesigns, pharma still needs to devise innovative care pathways to drive outcomes which will be financially attractive to commissioners.

A quick search of the internet reveals that no two JSNAs look the same – some are 14 pages long, others 114. The DH sees JSNAs as a means to outcomes “not just within single years, but over time.” Key Account Managers, using joint strategic needs assessments and the data available to them, must ensure they have an in-depth insight into the local challenges commissioners face and provide solutions now and in the future to create lasting relationships.

What does the Public Health Outcomes Framework reveal about the DH’s vision?

Public health is no longer the sole responsibility of one single organisation. Government reform through the Health and Social Care Act outlines how local authorities, the NHS, clinical commissioning groups (CCGs) and, more importantly, Public Health England (PHE) have now been tasked with improving the health of the nation. So how will it work?

PHE is the new, integrated and professional health system designed by the Government to be more effective and to give clear accountability for the improvement and protection of health within the community. The main function of PHE – along with its partners in the health service and in wider society – is to deliver support and enable improvements in health and wellbeing and to design and maintain systems to protect the population against existing and future threats to public health.  The new body brings together experts from a range of organisations, such as the Health Protection Agency, under one umbrella and gives local authorities and CCGs control over the public health budget – believed to be in the region of around £5.2bn – to improve regional requirements.

Public Health Outcomes Framework
For the first time public health will be measured against a devised framework allowing councils and the Government to track improvements and to take action where systems are failing.  From April next year, councils will be given access to a ring-fenced budget to tackle public health inequalities in the local population and meet Government targets. Councils who make the most improvements against desired outcomes will be rewarded with a cash incentive. 

Former Health Secretary Andrew Lansley said that the decision to move the public health budget away from Whitehall to local authorities was “absolutely right”.  He said: “We are giving local councils the money, the power, the right expertise and information to build healthier communities. Every area of the country is different so councils will be able to decide what the most important public health concern is for them and spend the money appropriately.”

A public health outcomes framework for England, 2013–2016 sets the context for the revised system from local to national level with one simple vision: “to improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest”.

It builds on the white paper Healthy Lives, Healthy People – published at the same time that PHE was established in December 2010 – and reveals that outcomes will be measured by a broad range of 66 indicators chosen by experts and grouped into four domains. The framework has two high-level targets: increasing healthy life expectancy, and reducing differences in life expectancy and healthy life expectancy between communities.

The Department of Health said the main outcomes “reflect the focus we wish to take, not only on how long we live – our life expectancy – but on how well we live – our healthy life expectancy, at all stages of the life course.”

Domains, objectives and indicators
The domains, which each have individual objectives, are:

• Domain 1: Improving the wider determinants of health
• Domain 2: Health improvement
• Domain 3: Health protection
• Domain 4: Healthcare public health and preventing premature mortality.

The framework makes it clear that although responsibilities have been moved away from central Government to local authorities, the NHS will still “remain critical to protecting and improving the population’s health” and “NHS clinical contribution is therefore central” to driving improvements.

In order to do this, the framework aligns with the Adult and Social Care Framework and the NHS Outcomes Framework through a series of shared or complementary indicators. The DH says that it intends to create an alignment with the outcomes framework through a series of set shared indicators that straddle domain 4 of its framework and the first domain in the NHS alternative. The shared indicators will be on premature mortality from specific areas of cancer, cardiovascular disease and liver disease.

The first domain in the public health framework has the objective to make “improvements against wider factors that affect health and wellbeing and health inequalities”. There are 19 indicators included, ranging from children in poverty to employment for those with long-term health conditions, including those with a learning difficulty/disability or mental illness and people with a mental illness or disability in settled accommodation.

Yet it is possibly in the other three domains where the pharmaceutical industry can exert greater influence and offer support. The objective of Domain 2 is to ensure “people are helped to live healthy lifestyles, make healthy choices and reduce health inequalities.” The 24 indicators here include a number that are relevant to pharma. These range from successful completion of drug treatment to cancer screening coverage and recorded diabetes- and alcohol-related admissions to hospital.

Improvements in these indicators will, in the main, be led locally by clinical commissioning groups through schemes devised or introduced to drive standards of public health.

Domain 3 has just seven indicators – although the framework says these are “critical” to protect the public’s health. Its target is to ensure “the population’s health is protected from major incidents and other threats, while reducing health inequalities.” Indicators that focus on Chlamydia diagnosis, vaccination coverage for the population, people presenting with HIV at a late stage of infection and treatment completion for tuberculosis are of clear significance for the pharmaceutical industry.

Domain 4 aims to reduce the “numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities.” Several indicators stand out as far as Key Account Managers should be concerned. Indicators including mortality from causes considered preventable, mortality from all cardiovascular diseases, and mortality from cancer, liver disease and respiratory disease call out for pharma’s expertise in creating innovative pathways of care, and of course its products.

The DH makes it clear in the framework that it is the responsibility of all healthcare providers to deliver improvements in indicators in this domain. 

Other uses
As well as driving standards of public health, the framework also supports health improvement and protection at all stages and across the life course of the population, especially in the early years. A further purpose is to provide a mechanism for transparency and accountability across the public health system. “As governance and accountability for Public Health England, local government and the NHS differ from each other, so will their relationship to demonstrating performance towards improving public health outcomes,” the document says.

Crucially, it will be for local authorities, in partnership with health and wellbeing boards, to demonstrate improvements in public health outcomes through progress against the indicators included in the framework that best reflect local needs, included in Joint Strategic Needs Assessments (JSNAs) and reflected in Joint Health and Wellbeing Strategies (JHWSs), to achieve cash incentives. Here, the DH expects specific progress against measures in the framework being “built into” JSNAs and JHWSs. These documents should be easily obtainable and accessible for KAMs, allowing an insight into local priorities which can then be targeted.

Although the framework has been planned for a three year period until 2016, the DH has confirmed that it will be refreshed annually “as data improves, technical capability across the public health system develops” and as it maintains an “aligned approach” across the NHS and local authorities.

Indicators will also be developed in order to create a complete set of baselines to support local service planning within the coming weeks by public health observatories, local authorities, the NHS and the Department of Health.

The DH accepts that “public health is such that the improvements in these outcomes will take years – sometimes even decades – to see marked changes”. But with budgets already in place to help tackle regional issues, pharma is perfectly placed to assist in driving public health outcomes in the short, medium and long term.   

How does the NHS Operating Framework influence pharma’s engagement with the NHS?

Economics continues to dominate the healthcare headlines. There has been much conjecture in recent weeks about NHS spending and how crucial promises of a ‘ring-fenced’ NHS budget appear to have been broken. Treasury statistics show that frontline spending on the NHS has increased by £3.4 billion since last year. But opponents claim the £1.6 billion surplus reported by PCTs and SHAs in 2011/12 has not been ploughed back into the health service – breaking David Nicholson’s 2010 vow that ‘every penny’ saved by the NHS would be reinvested in patient care. The DH says the surplus is being made available in the 2012/13 budget. With the NHS facing up to the realities of the ‘Nicholson Challenge’, the political debate over healthcare spending will run and run.

Operating Framework

The latest NHS Operating Framework clearly outlines the spending plans for 2012/13. It confirms that SHA/PCT surpluses will continue to be made available during 2012/13 and final year-end surpluses will be carried forward to the NHS Commissioning Board in 2013/14. PCT surpluses are expected to be made available to the relevant local health systems in future years. Conversely, PCTs carrying a legacy debt will be required to clear it during the year. Incoming CCGs will not be responsible for PCT legacy debt but they are expected to work closely together to ensure the situation does not arise.

PCT recurrent allocations will grow by at least 2.5% in 2012/13. PCTs are required to set aside 2% of their recurrent funding for non-recurrent expenditure. SHA clusters will hold these funds, with PCTs required to submit business cases to access them. The cost of organisational change during 2012/13 will need to be met from the 2%.

Tariffs and incentives

The framework outlines developments to the payment system in 2013, to incentivise the realisation of QIPP efficiencies and drive the quality and integration of services. Payment by Results has been expanded to encourage best clinical practice and better patient outcomes. Best practice tariffs are extended to:

• Incentivise more procedures being performed in a less acute setting
• Incentivise same-day emergency treatments where appropriate
• Increase the payment differential between standard and best practice care for fragility hip fracture and stroke
• Promote the use of interventional radiology procedures

Quality improvements are also incentivised in areas such as adult mental health, chemotherapy delivery, HIV services, podiatry, trauma, maternity care and paediatric diabetes. CQUIN is also being developed to provide a stronger incentive to deliver QIPP objectives. The amount providers will be able to earn for incremental quality increases above the standard contract will rise to 2.5% – across all standard contracts. Existing national goals for VTE risk assessment and responsiveness to the personal needs of patients will remain. In addition, two new national goals are introduced:

• Improving diagnosis of dementia in hospitals
• Incentivising the use of the NHS Safety Thermometer

Planning and accountability

The final chapter of the Operating Framework outlines the accountability arrangements for the final year of transition to the newly structured NHS. In 2012/13, the DH will continue to work through SHA clusters to hold PCT clusters to account – handing the baton for accountability over to the NHS Commissioning Board in April 2013. The framework warns that NHS organisations must improve the quality of services provided through the year, while delivering transformational change and maintaining financial stability – with under-performance likely to include ‘intervention from the centre.’
In 2012/13, the key accountability arrangements are:

• The current statutory framework – where SHAs and PCTs remain the statutory units of accountability
• The NHS Constitution – securing patient and staff rights
• Contracts between commissioners and providers
• CQC – regulating NHS providers
• Monitor – ensuring Foundation Trusts are meeting their terms of authorisation and delivering against priorities

Transition plans

The transition to the newly structured NHS is a dominant theme throughout the 2012/13 Operating Framework, and measures to plan for it within the current accountability arrangements are clearly articulated. In fact, given the ambitious nature and close proximity of the reorganisation, details around the planning arrangements for the final year of transition are surprisingly brief.

‘As the industry waits for clarification of individual CCG plans, broader strategies designed at PCT cluster level are already available.’

According to the framework, PCT clusters are each required to develop an integrated plan for the period 2012/13 to 2014/15. The plan should have a clear focus on quality and the national priorities outlined in the Operating Framework. The narrative should be supported by ‘data trajectories for each PCT’, and bring together elements around QIPP, finance, activity, workforce, informatics and transition to the new structure.

Shadow CCGs must support the plan, so they have a strong base on which they can develop their own planning for 2013/14. Likewise, the integrated plans need to reflect the outcomes of local Joint Strategic Needs Assessments. As with the NHS Outcomes Framework, emphasis is placed on integrating all care sectors – with PCT clusters urged to ensure that the public health transition elements of their plan are supported by local authorities.

Implications for pharma

The Framework stated that all PCT clusters’ integrated plans needed to be prepared – and approved by SHA clusters and the DH – by the end of March 2012. These plans are of major importance to pharma. They will contain vital information on the priorities, population needs and long-term ambitions of local health organisations. With the four-wave process to authorise 212 CCGs in England well under way, further data on the specific needs of individual local health organisations will emerge in the coming months. The requirement to publish Commissioning Intentions, updated JSNA and a whole variety of other forward-looking documentation as part of the authorisation phase promises to provide pharma with a comprehensive view of its market environment at the local level. But as the industry waits for detailed clarification of individual CCG plans, broader strategies designed at PCT cluster level are already available.

At a time when finances across the NHS are being squeezed yet the bar for quality and clinical outcomes is being raised, insight into the challenges facing key customers is a valuable commodity for medical sales professionals. The transition of the NHS to a new structure can be a catalyst for proactive medical sales professionals to improve their environmental monitoring, and significantly develop their understanding of customer need. The challenge for the industry is to ensure that key account managers speak in the same language – the same currency – as the customers with whom they seek to engage. The nature and scope of that currency is defined in national documentation such as the NHS Operating Framework and NHS Outcomes Framework, and within the vast local plans that are emerging as the NHS transition gathers pace. And well beyond it.

Success is about finding a common currency with your customers. The clues are out there.

Lancashire’s health and wellbeing board has identified four main priorities to improve the quality of care for local residents, board papers have revealed.

Improving the quality of services for mothers and young children, people with mental health issues, long-term conditions and for the elderly were all identified in its draft strategy.

The document said the purpose of the strategy was to “achieve shifts in the way that partners work”, which the board hopes will create a “greater impact on the health and wellbeing” in the region.

Priorities were identified by the board after analysing data and intelligence available through the Joint Strategic Needs Assessment.

The board aims to provide “accessible and effective support and services” to expectant mothers and their families and to “promote and safeguard” the health and wellbeing of children in pre-school.

Promoting emotional health and wellbeing in children and adults and supporting local residents who are affected by mental health problems to play a “full and active role in society” has also been identified.

The board hopes to reduce the incidence of, and mortality from, long-term conditions in the region, as well as improving the quality of life for people with long-term issues and their carers.

Finally, the board aims to increase life expectancy at 65, whilst supporting “older people and their carers” to play a role in local society.

A host of ‘early win interventions’ were also listed within the strategy. These include identifying people at risk of admission into hospital and providing intervention and support for carers of those with dementia.

Prospective CCGs are to be assessed on their commissioning intentions for 2013–14 as part of the CCG authorisation process, latest guidance from the NHS Commissioning Board Authority (NCBA) has revealed.

Applicants will need to submit key documentation such as Joint Strategic Needs Assessment plans and Health & Wellbeing Board strategies as part of a robust review process.

The shadow organisations will also need to provide a list of collaborative commissioning arrangements, joint commissioning agreements and any 2012–13 contracts approved via PCT clusters. An Integrated Plan for the current year will also be assessed.

The parameters for assessment are outlined in a new guide issued by the NCBA: Clinical commissioning group authorisation: draft guide for assessors undertaking desk top review, which is designed to support assessors participating in the CCG application process. The guide focuses on the first phase of NHSCB assessment, ‘desk top review’, the completion of which will lead to the production of a key reference document to support CCG authorisation.

The guide follows the April publication of a draft guide for applicants and aims to ensure that evidence submitted by CCGs is assessed ‘transparently, consistently and fairly’. It outlines assessors’ roles within the authorisation process, its overarching principles and methodology, and the criteria by which evidence submissions should be judged. This evidence, it says, should be a ‘by-product of core business’ for CCGs.

Full details of the authorisation process at the desk top review stage are available here.

A local information strategy is key to successful account management. The data is out there. Rhiannon Thomason explains how turning information into insight is all about context.

Despite reforms that appear to encourage decision-making and accountability at a local level, the UK health service remains a national one. The Health & Social Care Act actually strengthens the centralised power-base and, via the NHS Commissioning Board, issues a series of top-down directives that will cascade to a local level for implementation. Rumours of the death of the ‘N’ in our NHS are grossly exaggerated. But for Key Account Managers across the UK pharma industry, what happens at a local level is perhaps the prime focus. There is much talk of the need for ‘local health intelligence’. It is indeed a vital commodity. But it is important to draw the distinction between information and insight. The former is readily available. The latter is hard won and impossible to achieve in isolation. In the battle for local health intelligence, context is King.

The NHS is awash with data. Nowadays there is much more information available and the health service itself is increasingly placing useful data into the public domain. Examples such as QOF data, Joint Strategic Needs Assessments, HES (Hospital Episode Statistics) data, the Atlas of Variation and Public Health observatories provide a rich seam of information from which sales and marketing professionals can develop appropriate local messages. They combine to form a complex matrix of information. The challenge for KAMs is interpreting it and understanding what it means in their disease area and in their locality. There is variation right across the system.

In primary care, QOF data has become increasingly important. NHS customers are being tasked to reduce unnecessary hospital admissions, and the financial incentives from a local practice perspective are significant. But as the transition towards Clinical Commissioning Groups continues, practices know that they cannot work in isolation and that they must prove to the wider organisation that they are achieving their targets.

For the industry, QOF indicators have become a catalyst for improved customer engagement. Proactive sales professionals are no longer targeting GPs with messages based only on the clinical benefits of their products. They are instead identifying key local decision-makers and attempting to demonstrate how their product can impact a service, reduce hospital admissions, save a locality money and improve patient care.

Clearly, QOF data has become a strong lever for account managers to understand how their product can help customers meet their targets. In isolation however, the data can only take you so far.

When used in combination with other available information, a much more powerful package of metrics can emerge.

Sales professionals need to build the bigger picture of what is going on at a local level, to understand how their products can make a difference. This depends upon drawing together all the various strands of information, and developing value propositions based on the local context as a whole.

• How is each local health economy constructed? Which organizations are operating within each locality? What are the roles/responsibilities of each and how do they engage with one another? Who are the key stakeholders?
• What is the community profile? How many patients are there? What are the deprivation and ethnicity breakdowns?
• What is the patient pathway? What services are provided, by whom and how are patients managed?
• What is the cost of hospital activity? How much does each group of patients cost each locality?
• What are the outcomes? How much is each locality spending and how well are they managing each group of patients? How can the outcomes be measured?

The trick for pharma is to be able to use all of this information intelligently, in combination. Much of it is publically available, but without the knowledge and understanding of how it translates into what you are trying to achieve, it could, in a worse case scenario, send the sales professional in the wrong direction.

Variation in care
In a complex environment where context is everything, it is important not to lose sight of the bigger picture on a national scale. Many of the challenges being faced by local commissioners on the ground are around the treatment of diseases identified as national priorities. The implementation of commissioning plans at a local level largely cascades down from the key domains laid out in the NHS Outcomes Framework. The challenges manifest themselves in the local variations in care that are widely highlighted as being in need of redress. Once again, these local variations – if intelligently assessed – provide pharmaceutical companies with a powerful market access opportunity. Companies that can demonstrate that their products, not just their messaging, are aligned with local need will significantly increase their chances of uptake.
A good example of how the national agenda is driven by addressing variation in care at local level, is the treatment of diabetes.

Diabetes – a mini case study
The national picture
An estimated 3.8 million people in England have diabetes, with 2.45 million QOF registered patients. This is forecast to rise to 4.6 million by 2030. Diabetes and its complications costs the NHS around 10% of its annual spend. £725 million a year is spent on diabetes medication (8.4% of NHS drugs spend), and an additional £600 million is spent on diabetes-related hospital activity. An estimated 80% of the NHS’s £9.8 billion UK diabetes bill is spent on treating diabetes complications. It is predicted that diabetes will cost the NHS £16.8 billion by 2035.

National and local initiatives
As part of QOF, practices are to be encouraged to provide lifestyle advice and annual glucose checks to everyone judged as high risk from the age of 25 – even those with normal HbA1c levels. NICE is piloting new QOF indicators that promote tight cholesterol control in diabetes.
The introduction of insulin pumps instead of injections, as well as educational programmes such as the DAFNE (Dose Adjustment For Normal Eating) course are good examples of local initiatives to combat diabetes.

Local variation
NHS Hampshire has the highest number of diabetes patients on the QOF register (54, 761). Hospital admissions (inpatient, outpatient and emergency attendances) are costing NHS Hampshire £3.7 million each year – one of the highest of all PCTs. However, its cost per thousand patients is low – ranking 113 of all PCTs. It also has the lowest death rates from diabetes. Therefore, although it has the highest number of diabetes patients, NHS Hampshire appears to be managing its patients well.

NHS Kingston has one of the highest diabetes spend per thousand patients in England. Compared to other PCTs in its SHA, it also has a higher number of Finished Consultant Episodes, longer lengths of stay, higher emergency admissions and the lowest elective admissions. Compared to NHS Hampshire, this suggests  that NHS Kingston could be managing its diabetes patients more optimally.

Lessons for pharma
The diabetes example outlined above provides a clear indication that a one-size-fits-all approach to pharmaceutical sales and marketing will no longer work. The apparent variation in care between two diverse PCTs highlights that every local health economy has different needs. A diabetes KAM working in Hampshire could not relocate to Kingston and challenge stakeholders there in the same way, with the same proposition. The situation, and the opportunity, in each PCT/CCG is totally different. The ensuing approach must be similarly distinct.

A local information strategy is critical for Key Account Managers engaging with today’s NHS. Understanding local dynamics is critical, and the information to facilitate this is increasingly within reach. The key is joining it all together and placing everything in context. It’s a mixture of local and national. Top-down directives issued at national level are providing important indicators by which local commissioners are measured, and are in turn are becoming powerful levers to help pharma develop value propositions that align with local need.

The data is out there. But success is in understanding the difference between information and insight. After all, context is King.

Rhiannon Thomason is Business Development Manager, Cegedim Relationship Management.