Much has been written on the critical skills, technologies, systems and methodologies associated with successful pharmaceutical selling. Bryan McCrae explains why consistent sales success involves much more.

At my company Sales-Motivations we’ve just completed research into the most critical factors for sales success.  There’s been some very illuminating initial results. The two factors which we’ve found to be most important for high sales performance are resilience and intrinsic motivation. Strangely, given their importance, these factors rarely receive attention or development. It’s a sad fact that medical professionals often see little value in technological communications. Representatives now have only a few minutes or perhaps seconds to communicate and, in some countries, are prevented from seeing medical professionals altogether. Where contact is maintained, this is often driven more by sampling than the exchange of information. If current trends continue, then direct access to medical professionals may fade away altogether.

Resilience is the ability to recover quickly from setbacks and to keep going in the face of challenges. There are two main aspects to resilience.

The first is how badly a setback affects performance. It’s normal to feel down or demoralised if a major opportunity is missed. But does this result in just a small drop in activity levels for a short period or a major and long lasting drop in activity and performance? How long does this drop in activity and performance last for? It can vary from a few minutes to days, weeks or even longer. In some instances performance levels never fully recover. It is easy to see that the deeper the dip and the longer it lasts the more it will reduce performance. Resilience is vitally important to sales success.

The second factor is intrinsic motivation, which is the degree to which people want to work well in their jobs in order to achieve personal satisfaction and success. External motivators do work, but the effect is often short lived and not as strong for complex, technical or solution selling, compared to transactional selling.  This link between intrinsic motivation and effort, persistence, productivity and staff turnover has been repeatedly and reliably demonstrated in many studies.

‘Will-do’ or ‘Can-do’

Together, these factors also explain the difference between ‘can-do’ representatives and ‘will-do’ representatives. This is often most obvious when there are major changes in the market or changes in the role of the representative – as is certainly the case presently within pharma.

Selling doesn’t come naturally to everyone. But by harnessing the latest psychology techniques every employee can become part of the wider sales team. The outcome? A boost to employee motivation, the ability to engage in selling and a boost to your bottom line.

A new approach

The playing field has changed with the recent changes in the NHS and budget pressures resulting in the market becoming a lot more competitive. Sales professionals now need to be able to sell themselves and their products more than ever, show what differentiates them from their competitors and use sophisticated sales and account management techniques to win and retain clients.

But even the words ‘sales or selling’ fill many representatives with feelings of dread as it conjures up images of pushy double glazing and dodgy used car salesmen with questionable ethics. However, this selflimiting belief can be addressed by using powerful proven psychological techniques.

Fundamentally there is an issue around the thoughts, feelings and beliefs conjured up by the words ‘sales or selling’. This is where a change of mind-set can be very helpful. Rather than think of it as selling, think of it as of the process of finding healthcare professionals who need your products to help their patients stay healthy. In return, they will want to stay aligned with your brand, rather than competitors.

By challenging one’s mind-set the lack of motivation commonly associated with doing something we don’t feel comfortable with can be addressed. In fact, there is no need for any pharma sales professional to feel uncomfortable selling. The skill sets used for sales share many of the skills found in many scientific professionals. With a bit of flexibility and creativity these skills can be transferred from use in sciences to utilisation in sales to great effect.

Breaking barriers

One approach that has been proven to be very effective is ‘structured self-coaching’. Just like face-to-face coaching sessions, this involves clarifying what a person wants to change then identifying, exploring and overcoming the psychological barriers to achieving these goals, followed by creating an action plan to implement it.

Taking the example of ‘I want to feel more confident when trying to get a client to sign up for a new brand’, a common barrier might be the belief that if you can’t get them to sign up quickly then you don’t know how to negotiate sales and you’ll inevitably lose the client as a result. This sort of thinking is obviously unhelpful and, if left unchecked, results in reduced motivation, the ability to recover quickly from setbacks and lower sales as a consequence.

But an approach called ‘thought challenging’ is very effective in breaking this sort of thinking pattern. It involves four specific questions:

Question 1: Am I making any ‘thinking errors’?

There are a common set of unhelpful thinking patters that we all fall into from time to time, such as emotional labelling, magnification and should statements. The word ‘stupid’ is an emotional label. Individuals magnify the consequences of not being able to answer a question immediately and the ‘I should be able to’ belief implies that there is some sort golden rule that is broken.

Question 2: What is the evidence for and against this thought or belief?

Do all effective sales professionals really know the answer to every question that a client might ask of them? How do I really know this? What proof do I have? Have I asked any accomplished reps if it is true?

Question 3: What are other ways of looking at this situation?

What would happen if you said: “I’m not certain of the answer, but I’ll get back to you within 24 hours?” Creatively generating several options at this stage is always useful. Pick one and give it a try.

Question 4: What am I going to do to generate a different result?

If you do nothing different then you’re very likely to get the same results. Sales professionals need to work out how to think, feel and behave differently next time to bring about improved results.

This structured approach, together with on-going reinforcement and practice, really does help people fine-tune their thinking and behaviour to be more successful. In fact, using these techniques has been shown to result in 20% more people reaching or exceeding their sales targets.

Testing resilience

Do you know how resilient you, or you sales team, really are? One approach would be to take a resilience online questionnaire – there’s one at the Sales- Motivation website. Once you have completed our questionnaire, respondents receive a personalised six-page report describing individual motivation and resilience profiles and what can be done to maintain or improve them to boost performance.

Research from a recent study with more than 1,000 participants found that anyone in sales can increase their performance by developing their intrinsic motivation and resilience by a structured self-coaching approach.

It works with poor performers as well as helping others move from ‘good’ to ‘great’ and helping the ‘great’ to become consistent ‘superstars’. These really are the secret ingredients of sales success!

Bryan McCrae is a Sales Psychologist, Sales Coach and the founder of Sales-Motivations. He is a Fellow of the Institute of Sales and Marketing Management, a Founding Fellow of the Sales Leadership Alliance and a member of the British Psychological Society. For more information visit www.sales-motivations.com.

Biotechnology company Celgene UK and Ireland has appointed experienced HR professional Sarah Bater as Director of Human Resources.

Bater has held senior HR roles in several companies including AstraZeneca, BAA Ltd and Vodafone.

At AstraZeneca, where she was Head of HR Shared Services, Bater focused on developing the company’s key account management capability.

Her areas of expertise include strengthening diversity and inclusion within a company, helping it to broaden the range of its performance.

A global biotechnology leader, Celgene recently announced positive phase 3 clinical trial results for drugs to treat pancreatic cancer and psoriatic arthritis.

“Celgene is a company which has successfully established a dynamic and prosperous environment,” Bater said. “I hope to bring my experience to the HR team to help reinforce the great values Celgene already holds and ensure a culture where existing and future employees will thrive.”

Samantha Pearce, General Manager of Celgene UK and Ireland, commented: “Celgene has gone through a period of fast-paced growth over the last few years, so we are delighted that Sarah, with her expertise in HR, will be joining our team.

“Her role reinforces our commitment to our employees, current and future, to help them grow professionally whilst ensuring the Celgene culture is maintained.”

Research suggests that the best work-life balance involves strong commitment to both areas.
Does that happen in pharma – or only in Narnia?

Medical sales professionals are likely to be wary of work-life balance (WLB). The traditional sales model has been associated with a workaholic mindset – the more you work, the more commission you earn – and an attraction to the freedom of the road. But these days, travelling light is likely to mean you have nothing to come back to. As medical sales has developed towards long-term selling and key account management, so its professionals have come to rely more on domestic stability as a support.

A perfect circle
A recent study by Working Families challenges the idea that home life and work are competing priorities. They surveyed over 2,000 high-achieving professionals, mostly female, working in the private sector in South-East England – supposedly the yuppie heartland. What they found was a strong, bidirectional correlation between ‘work engagement’ and ‘relationship quality’. As either factor improved it strengthened the other factor instead of detracting from it.

They also found that problems at work affected home life and vice versa – but whereas many professionals could escape from domestic stress at work, few could leave work issues behind when going home. Where a vicious circle existed between the two, the driving force was usually trouble at work. Where steps were taken to reduce stress at work, the domestic picture normally improved.

Working Families concluded: “Work-life balance is not the bringing together of two separate and competing domains, but rather the two need to be understood as two aspects of the same dynamic. Those who are more fulfilled at work may also be more fulfilled at home.”

These important findings suggest that work-life balance does not have to be seen in terms of managing a conflict. Far more importantly, it can be seen in terms of creating a mutual reinforcement to the benefit of the individual and the company.

Bending the rules
The big question for employers is how they can achieve this perfect circle for the dysfunctional individuals who make up their sales teams. Giving staff more flexibility – in terms of when and where they work – is the most popular solution among companies and staff alike.

However, Working Families notes, flexible working is no bed of roses. For women in particular, flexible working is likely to impact negatively on home life by allowing a conflict to develop. Conversely, men tend to take up flexible working “far less often” than women, perhaps due to fear of such a conflict. Employers should therefore ensure that there is an “embedded culture of flexibility” in which such conflicts and anxieties can be resolved.

The Work Foundation even makes flexible working definitive of WLB: “Work-life balance is about people having a measure of control over when, where and how they work.” But the truth is that WLB cannot be wholly separated from other issues such as accountability and autonomy.

The CIPD’s Employee Outlook for summer 2012 notes that 60% of employees report satisfaction with their WLB. Women are more likely to feel that they have the right WLB (65%) than men (55%). The CIPD reports a strong positive correlation between employee engagement and satisfaction with WLB.

A delicate balance
The Pf Company Perception, Motivation and Satisfaction Survey 2012 shows that for medical sales professionals, work-life balance ranks fourth in a list of 18 priorities (after salary, relationship with direct manager and job security). Overall, 42% of survey respondents are ‘satisfied’ with their WLB and 28% are ‘dissatisfied’.

These figures suggest that WLB is neither a major problem nor a big success for the pharma industry. Given that WLB is a predictor of work engagement, they do not encourage complacency.

Women surveyed are happier with their WLB (44%) than men (39%), which may reflect greater skill in balancing the relevant factors. Employees working part-time are happier (49%) than those working full-time (41%), which may reflect a trade-off between income and WLB.

Industry satisfaction with WLB is fairly consistent across regions in England, but is much lower in Wales (31%) and Scotland (30%). In Scotland, the proportion actively dissatisfied with WLB is 35%, making the issue a negative one for the nation’s pharma companies.

The age-related figures show highest satisfaction with WLB (68%) among employees aged below 25, with lowest satisfaction (35%) among those over 55. That does not suggest that starting a family is a trigger for major WLB concerns – and indeed, Working Families states that such a view is a myth. Rather, WLB becomes steadily more important with age.

Employees whose sales are above average are more likely to feel they have the right WLB (45%) than those whose sales are average or below average (both 36%). However, for those with the highest sales, WLB satisfaction drops to 34%. That suggests that the correlation between professional success and WLB works only up to a certain point.

Roles associated with associated with industry average or better WLB are nurse advisor (57%), primary care specialist (47%) and KAM (45%), while sales management is associated with WLB well below average: 31% for first-line managers, 26% (with a shocking 58% dissatisfied) for second-line managers.   

WLB satisfaction drops steadily with time in role, from 48% after less than six months to 37% after eight years. This contrasts with the effect of time in the industry, where WLB satisfaction rises to a peak between four and eight years (53%) before trailing off.

The whole picture
The Pf survey broadly supports the view that work-life balance is about the mutual reinforcement of work and home life, rather than managing a conflict. But it also shows that conflicts are possible in certain kinds of role, notably sales management, and where individuals may be aiming too high.

Companies need to support WLB, especially with older employees, and understand that WLB is a predictor of good performance. They should promote flexibility without seeking a ‘one size fits all’ model. Above all, they should be mindful that the strongest driver of successful WLB is fulfilment at work.

Pf’s Iain Bate examines how contract sales organisations are taking their place among the industry heavyweights.

There can be little doubt that pharmaceutical employees – in particular sales and marketing executives – have taken some metaphorical hefty blows in recent times. All of pharma’s biggest heavyweights have announced ‘austerity’ measures as part of widespread job cuts across the majority of divisions in recent times.

Whilst pharmaceutical CEOs have enjoyed champion pay rises, the humble employee at ground level has been unable to duck and weave away from the dreaded knockout blow. As a result, the job market has been on the ropes. However, candidates searching for a career in the medical sales industry do not have to throw the towel in just yet.

The employment market has suffered many bumps and bruises in recent years – but Contract Sales Organisations (CSOs) are leading the fightback. Now regarded as a leading contender for those looking for a prolonged career in the medical sales industry, CSOs continue to punch above their
weight in a challenging environment.

Pf spoke to four leading CSO companies to provide a blow-by-blow account of how contract organisations have boxed clever in recent years. Why have they gained in popularity despite the employment market suffering a bloody nose? And what does the future hold for the contract sales movement?

The gloves are off

In the modern working environment, when uncertainty accompanies everyday challenges, the flexibility CSOs offer clients is a major attraction. “The fundamental driver is the requirement for an increase in flexibility from our biopharma customers,” says Helen Molloy, HR Director at Quintiles Commercial. “This is nothing new – but what has changed is the nature of that flexibility. It’s not just about numbers of people, it’s about expert teams with specific skill sets and evidence tailored address local priorities.

“Customers are increasingly looking to partner with us to help navigate challenges around proving cost effectiveness and long term value of a drug to a wider range of stakeholders. We are moving away from what has historically been seen to be the fundamental core of our services, and into much more specialised areas.”

Flexibility is certainly an attractive proposition for clients who have slimmed down sales teams yet still require the prowess to impress customers. However, flexibility isn’t the only factor driving CSO growth. Specialist skills are now required by clients to outwit the opposition. “Contract sales organisations are moving away from large-scale build, high noise proposition and are becoming much more specialist,”
says Emma Busby, Project Director at CHASE. “Organisations are demanding to have specialist skills and capabilities either to be equitable to their teams, or, in most cases, to offer more opportunity and more value within their teams. Their key objective is to heighten the level of capability that they have got on their headcount team.”

Pharma’s increased reliance on contract methodology is now reflected in the number of candidates turning to CSOs to develop a career in UK medical sales. “CSOs are becoming the only way into the industry,” says Emma. “We work with many blue-chip companies to provide an influx of trainees every year. Again those people go through organisations and develop. The trend went away from that for a few years, but it’s definitely coming back now. Companies recognise they need high-quality sales engagement. We can regurgitate skills but fresh attitudes and capabilities coming in will actually challenge the status quo.”

At a time when, as far as job security is concerned, pharmaceutical representatives fear the next barrage of punches, CSOs are doing more than ever to provide a shot at the big time in the industry. David Alexander, Contract Business Unit Team Leader at Star, says there are a number of reasons why CSOs have gained
in popularity recently. “Security, variety and skill development are key,” he said. “Working for a CSO
means people can move from one assignment to another and gather experience with different companies,
in different therapeutic areas and with different customers over time. Transferable skills and flexibility
are important qualities in today’s environment and working with a CSO will help people profile both.”

Swapping gloves

That value is also being recognised by clients seeking to boost sales at various stages of a brand’s life cycle. With the industry well on the way to manoeuvring itself away from the traditional sales model to a sophisticated fighting-fit key account approach, contract sales organisations are perfectly placed to augment teams or, in some cases, replace them. “A CSO can help do both,” says David. “It can either enhance a team or, if necessary, it can replace it. You can either have a bolt-on campaign, where contract reps target specific areas in fixed time periods, or, you can replace an entire team with a CSO key account team, enabling flexibility and resource in particular areas of the UK. This allows clients to be much more outcomes-focused.”

The next round

But what next for contract sales organisations? Will pharmaceutical companies decide to completely
shed their entire headcount and outsource functions to specialist organisations? Andy Holgate, Business
Unit Director from Ashfield In2Focus, believes this may be the case. “Contract sales organisations are expanding into new areas,” he says. “The model for CSOs in the next 20 years could be where pharmaceutical companies simply concentrate on research and development and strategic marketing and finance. Contract sales organisations will, potentially, then do all of the rest. I think that is the trend that CSOs are driving towards.

“We may be in a bit of a perfect storm at the moment where pharmaceutical companies, many of whom are being squeezed from above and are tinkering around the edges, are considering outsourcing services in areas where they would never previously have allocated external resource. Contract sales organisations are extremely good at being able to help pharma companies, and other clients, differentially resource people when and where they want them and when and where they don’t, be that in sales or other value-adding roles.”

In an austere environment when pharmaceutical companies are fighting against a whole host of external
pressures, it’s difficult to see how contract sales organisation will fail to grow in the coming years. The powerful combination of being an inviting proposition for individuals seeking a career in medical sales industry, and strategic allies for companies in need of flexible and specialist commercial expertise, CSOs are rapidly establishing themselves among the industry heavyweights.

Stephen Whitehead outlines the ABPI’s latest initiatives to facilitate collaboration – and how sales professionals have a key part to play .

This year the ABPI is launching a Regional Partnership team to help the industry establish and develop sustainable relationships with the NHS at a regional level. The team, deploying experienced industry professionals in each of the four regional SHA clusters, aims to promote and facilitate collaborative working as a means to improve patient outcomes. Its key objectives are to identify and remove existing barriers to accessing innovative medicines, to help develop regional partnership projects and to share best practice across the country. The initiative reflects the growing recognition that improving patient health in a constrained financial environment will be best achieved by adopting a more collaborative approach. And there is an increasing consensus across both parties that, after years of developing adversarial relationships, the direction of travel towards NHS/industry partnerships is the right one for patient care.

But progress is an incremental process. The perceived cultural barriers that have historically plagued the relationship and impacted access will not be overcome overnight. “Trust and reputation has widely been acknowledged as an issue for industry – but it’s getting better,” says Stephen Whitehead, CEO at the ABPI. “In fact, it has dramatically improved. You can 12 see that from the Innovation, Health & Wealth (IHW) review: the NHS really wants to partner with pharma. In turn, as an industry we know that we are operating within restricted NHS budgets, and that we need to make it clear that we are not always there to sell something. Joint working is not about developing something that can help companies achieve a sales target on a quarterly basis, it’s about establishing a new way of working that will redefine the relationship between us and the customer. That will take time.”

In an evolutionary process, the ABPI appears determined to take the lead – to trail-blaze the concept of partnership working from a top-line strategic position and help ease the concerns of more anxious NHS customers. “The driving platform for joint working from the side of the industry should be the ABPI,” says Stephen. “We established the joint working protocol with the DH, and have developed the code of practice and regulatory infrastructure to enable it to happen. We’ve therefore created the headroom to allow partnerships to be established. Most parts of the NHS have understood and grasped this. It’s now up to us to lead, and for companies to take the opportunities within that.”

IMPROVING ACCESS

With access to NHS customers a perennial problem for UK pharma, the battle to develop the joint working agenda is a challenging one for individual companies. Medical sales professionals are tasked with advancing discussions, but attempts are often stymied due to diminishing levels of customer access. The ABPI believes its NHS Partnerships initiative will play a major part in raising awareness of partnership working, and overcoming access issues on an industry-wide basis. “NHS Partnerships will help industry
engage with key NHS stakeholders in England and ensure partnership conversations happen at a regional level. It’s not about individual products – we will not be talking about those – but we will be a facilitator of dialogue around joint working, aligned with the partnership principles set out by David Nicholson. We will be looking closely at the national issues on uptake and access, and any policy that emerges around that – and reinforcing it locally. Critically, NHS Partnerships isn’t the creation of ‘talking shops’, it’s about being able to facilitate on the key issues – which are fundamentally about access and uptake of innovation.”

NHS Partnerships has already been welcomed by the Department of Health, whose Director of Innovation & Service Improvement, Miles Ayling, said: “The ABPI partnership team will help build stronger links between industry and the NHS, as described in IHW. Beyond medicines, we are also looking at how all concerned can share skills, expertise and knowledge to improve the health of UK patients and help transform lives.”

REPUTATION

The long-standing issue of industry mistrust does, at long last, seem to be fading within the NHS. This was reflected in the ABPI’s seat at the top table of discussions around IHW last year, and has been reinforced by Stephen Whitehead’s involvement on the IHW Implementation Board. In addition to the partnerships initiative, the ABPI (along with ABHI) has also established a series of pilot projects with the NHS Confederation to look at how joint working can make a difference in selected disease areas. Pilots are already underway in mental health, circulatory diseases, diabetes and long-term conditions. “This is about providing examples of best practice within the NHS so customers can understand what we mean and establish that there is nothing for them to be worried about,” says Stephen.

“We have a strong status, but we’ve not yet fully utilised it in the context of joint working capability. That’s what these initiatives have been set up to do. This is a whole new world and a very exciting one – ten years ago we could never have had these relationships. But now that we are here, we need to approach customers gently and appropriately, and work with the NHS collaboratively and co-operatively to ensure that we dispel any of those old misunderstandings.”

And so, in the new environment, what role will sales professionals and Key Account Management play in NHS engagement? “The role of sales is evolving quite rapidly,” says Stephen. “Sales engagement is increasingly about liaison, as well as detailing around a product. It’s about facilitating collaborative working – and the salesforce has a key role to play in this.”

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.

Fearless pharma blogger Maxine Vaccine prepares for her new job with a trip to Matalan, the Body Shop and the online NHS.

Yes, it’s true. After the Bank Holiday I’m starting a new job. Those lovely people at Pharmajobs helped me look for the right role, employer and region, put me in touch with specialist agencies and companies that matched my aspirations and talents. And then my line manager at Munchkin Pharma said “Would you like a new role?”

She explained about key account management. No more sales pitch blues, no more marketing message Mondays, no more NLP courses, no more free samples. A new life of consultative selling – providing solutions – being an expert on who you’re selling to rather than what you’re selling. In short, a proper grown-up job. Finally, she asked me: “Do you have any questions?”

I said: “Will I need a new outfit?”

My manager gave me her famous tight smile. “Ah yes, that’s something else we need to discuss. That attitude of yours.”

But seriously, what is changing in my professional life is the shift from a ‘lone wolf’ approach – hitting the road with one goal in mind, only talking when there’s a product to be sold, regarding my colleagues as deadly rivals, living just to put ticks beside names on my list – to a sense of being embedded in a dynamic professional network of stakeholders across various sectors. Every day brings new people and new ideas.

I’m not just a lonely sales functionary, I’m one of many points of contact between a changing company and its changing customer base, and my role is to communicate and learn, to work out how Munchkin Pharma can meet customer needs across a local healthcare landscape that is changing so fast it feels like the NHS has become a computer game. I feel more connected to my own colleagues as well as to the people with whom I’m building commercial relationships.

Instead of the false personalisation of sales – the fake smile, the fluttered eyelashes, the lowered voice – there’s the real personal engagement of understanding what your customer wants to achieve, the customer understanding what you want to achieve, and the common ground on which you both take a step forward. That only happens when you think hard instead of just talking hard.

Farewell to the black book, hello to the iPad. And what’s commanding my attention for much of the working day is the increasingly widespread and diverse character of the NHS online. It’s not just who is commissioning and prescribing, it’s how, for whom, on what basis and according to which budget. If the NHS had a Facebook profile its relationship status would be ‘It’s complicated.’

This weekend, I’m getting my hair reshaped and my wardrobe restocked. I’m partying in my usual restrained style. Another day for rest and recuperation, and I’ll be ready for the working week. And then the real fun will start.

The US government thinks pharmaceutical sales reps are not selling, but rather promoting. Maxine Vaccine asks whether the pharma industry could do itself a favour by agreeing.

It’s a hard life being a pharma industry CEO. There you are being passionate about improving patient outcomes and helping the weak and the wounded, and people look at you like you’re just in it for the profit. Don’t they realise those million-dollar bonuses are to compensate you for the sleepless nights you experience every time you make a few thousand people redundant? Can’t anyone feel your pain?

Then there is the emotional stress of a hostile takeover. Sometimes these little no-mark biotech companies just don’t know what’s good for them. And in the interest of those patient outcomes you feel passionately about, you have to show them the error of their ways by appealing directly to their shareholders to let you take over and take care of business. And are they grateful?

And then, just to add insult to injury, the interfering US government tells you that you should be paying your sales reps overtime because – wait for it – they’re not really selling at all. Outside salesmen are exempt from the US labour laws on overtime, because they get commission. But suddenly all your reps are claiming back pay for the ‘overtime’ they have spent schmoozing customers, talking trash on the phone and burning rubber on the highway – and the Labor Department is backing them up, saying they spend their working lives promoting products rather than selling them.

Hence the amusing exchange in the US Supreme Court where GSK’s lawyer said the plaintiffs were “two pharmaceutical sales representatives”. He clarified the point: “They were hired for a sales job. They were given sales training. They attend sales conferences. They are assigned to sales territory, and they are evaluated and compensated as salespeople.”

One of the court justices replied: “And they don’t do sales. Your long list sort of stopped one step short. They don’t make sales.”

Then another justice struck back with “They look like sales representatives to me.” We can be thankful she didn’t go into too much detail on that. I still have nightmares about the hotel bar at my first sales conference.

Rather cutely, she added that the work of drug sales representatives “includes dinners. Entertainment. Maybe golf. If you’re right, would the time on the golf course get time and a half?”

Enough already. It makes you want to move to a country where businessmen run the government instead of the other way round. Like the UK.

But every challenge is an opportunity, as you’ve told your board of directors a thousand times. And in this distinction between the salesman who exchanges goods for cash and the ‘detailer’ who influences purchasers to request your company’s products from a local pharmacy (or a not so local one, perhaps one thousands of miles away – but let’s not go there), there is a precious nugget of commercial insight for the 21^st century.

Your sales force do not sell. They manage key accounts. They access changing markets. They build partnerships with economic prescribers and healthcare managers. They build customised solutions. They position your company as a consultative partner in the provision of care.

Until it comes to pay day. Then they’re just jumped-up till girls and till boys with a few corporate perks. What do they expect?

The industry’s sales model has changed.

Has it?

Maxine’s views are not necessarily those of Pharmaceutical Field.

As the industry switches to a key account approach and individuals are given more responsibility, medical sales professionals are basking in the additional accountability now placed on their shoulders. Pf asks why.

Autonomy has always been one of the most important satisfying factors throughout the history of the Pf Survey. Always included in the top five factors yet historically never reaching the podium, it’s officially the nearly man, or woman, of the survey. However, last year, things started to change for pharmaceutical sales representatives.

For the first time in more than a decade the additional responsibility and freedom placed upon the shoulders of sales representatives was finally appreciated. Autonomy was voted as the third most satisfying aspect of the collective field force. It had finally made it. Tears were shed as it stood on the Pf Survey’s satisfaction factors podium listening to the national anthem of ‘belief in present products’ – needless to say, it wasn’t listening to ‘The Final Countdown’.

This willingness to take on more responsibility may have come with the average age of respondents creeping up. In the 2006 Survey, those aged between 25 and 34 ruled the roost. At the turn of the decade, an older, possibly more mature, age group had emerged. Jaeger Bombs for lunch had been replaced with a latte from Starbucks – until the expenses account was closed down of course!

Yet there has been a requirement for medical sales executives to become more streetwise. As the industry has shed jobs in the last few years, employees have been forced to take on additional duties – whether they like it or not.

There’s also the psychology behind it. The more responsibility and duties you’re asked to take on for your boss and the company as a whole, the more you believe you’re trusted. It’s easy to overlook the fact it’s either you given the task of managing and working on an important key account or a colleague who still struggles with the Sat-Nav.

Whilst autonomy can now call itself a leading light in the satisfying stakes, it’s hardly breaking any records in the motivational factors. Last year’s entry in tenth position shows that it’s nice to feel wanted but it isn’t everything when it comes down to it. In fact, it even dropped a position from its listing in the 2009 survey.

But with the announcement from industrial giants that further job cuts are to come as pharma continues to tighten its belt in the face of generic competition on major brands and healthcare budgets being reduced, the responsibility placed upon pharmaceutical sales reps looks set to increase again.

Whether those with added pressure placed upon them still appreciate this responsibility remains to be seen. As does whether autonomy will again take home a cheap bunch of flowers and a medal filled with chocolate around its neck. There’s only one way to find out. Have your say here.

A lot of noise has been made about the needed switch from a traditional pharmaceutical sales model. Apodi’s Tony Swift questions whether the complex sales models now in place are delivering and suggests a simplified alternative based on delivering value to customers.

For a number of years now it has been acknowledged that the traditional sales model needs to change. Access to GPs through the long-established sales route is increasingly difficult with more doctors closing their doors to the conventional representative detail.

Pharmaceutical companies have embraced this and reduced the number of traditional sales representatives that they employ. Furthermore, the environment in which companies are promoting products has, in recent years, become increasingly complex with the emergence of new stakeholders requiring additional market access, specialist expertise and key account management skills.

Pharma’s response
Clearly, pharma companies have responded to these dynamics in different ways depending on their individual circumstances. It is, however, possible to draw some general conclusions. The response has tended to be the establishment of complex sales structures involving a myriad of roles aimed at mirroring the complex structures of the customer: the NHS.  Most companies will have structures including some, if not all, of the following roles: business managers, regional managers, traditional representatives, key account managers, strategic account managers, market access specialists, medical liaison specialists and so on.

On paper, these structures are difficult to criticise given that they are aimed at addressing the apparent needs of ALL stakeholders within the customer environment. The real problem is that due to their complexity they are almost impossible to manage effectively. Cohesion, coordination and communication in structures of this nature are extremely difficult and companies that go down this route often find that improvement in performance – namely in the sales of product – is difficult to achieve.

Such structures can be expensive and companies find that savings made by reductions in the number of sales representatives are merely diverted into the new structure. Indeed, these are often more expensive than the old traditional structures. Although companies are also looking at less costly ways of detailing, such as e-detailing, and tele-detailing, most commentators believe there is no real substitute to face to face interactions.

Simplify, simplify, simplify
Whilst every company is different, they should all follow the principle that the simpler the sales structure, the easier it is to manage and the higher the probability of driving high performance into it. It is hoped that the much heralded simplification of the NHS, which puts money and power into the hands of the GP and Clinical Commissioning Groups (CCGs), may encourage pharmaceutical companies to simplify structures, making them more effective and less costly. So, for those companies looking to simplify ineffective and inefficient structures, what general principles should be followed?

Don’t turn the noise off
Many commentators suggest that the ‘noise’ model is dead and that companies need to look elsewhere to drive sales performance. In my view this is misleading. Creating noise is hugely important in any sales environment – the key is the content and whether or not it is effective.

The traditional representative is finding access increasingly difficult as GPs face growing patient demands and administrative burdens. GPs often see many interactions with representatives as providing little, if any, value and are simply not willing to spare the time to listen to a detail. Where GPs do perceive there to be value, they are more likely to open their doors and consequently there is more likelihood of changes in prescribing behaviour and resultant market share.

Simply put, many pharmaceutical companies should be looking at a sales structure model that encompasses the following characteristics:

NOISE + VALUE = EFFECTIVENESS.

We envisage this structure being driven by an ‘engine room’ consisting of Key Account Managers (KAMs), focused on strategic key accounts, and Customer Account Managers, driving key messages and value to the larger targeted population of healthcare professionals (HCPs). A KAM structure without Customer Account Managers in the new world of CCGs would need to rely on an effective platform of communication within the CCG from the strategic levels through to individual HCPs – this often does not exist in an effective form and much decision making will still be made at the individual HCP level.

Building the structure
In my last article, Moving on up, I noted that, ‘some observers believe that the pharmaceutical sales representative is one of the world’s most underutilised resources’. For most companies, their representatives are still the people who interact with customers far more than anybody else. These customers – the GP and CCG – appear now to be even more important in the buying process and therefore, common sense would seem to indicate that the role of the representative is more important than ever – not less so.

The only way that this can be the case though is if the role of the representative changes from delivering a detail to delivering value to customers – otherwise customers will continue to refuse access and react negatively to any interaction. Therefore, I believe that in many cases the sales representatives will, in the future, be better termed as ‘Customer Account Managers.’ This is not just changing the title of the person but involves a real change in the role which will include:

• Intelligent conversations with customers about the care pathway with, of course, the role of product within that pathway.
• Consulting to, and with, the customer about therapies and disease areas.
• Advocating improved patient outcomes and assisting GPs in delivering them.
• Providing additional value, based on the individual preference of the customer.

In existing structures this will require a transition phase as representatives increase knowledge, particularly around care pathways, therapies, diseases and improve interaction skills.

The engine room

Customer Account Managers should form the foundation for many promotional sales structures. Above them is the Key Account Manager role, and together, these represent the ‘engine room’ of the promotional sales structure. The role of the KAM is now well known to pharma, involving as it does, segmentation of the customer base, allocation of responsibilities – particularly between the KAMs and the Customer Account Managers – and promoting to key and more complex stakeholders. KAMs should also be able to assess if there is a need for more specialist help on particular accounts.

For many readers, this structure may appear as a dramatic over simplification of what is required to meet the demands of a complex customer – and perhaps it is. But it has been presented as such to be in stark contrast to the over complex and costly structures that many companies deploy. In fact, in some such structures, the role of KAMs sometimes gets lost and in some, the role of Customer Account Managers actually does not exist.

Mass customisation
A key role of the engine room is to provide value to customers, that is, value over and above that provided by competitors and so enabling the company to grow market share. Historically, much promotional activity to GPs has been based on a key fact – that all the customers are the same. This is obviously not the case.
However, marketing departments wishing to provide customised value are often unable to do so for a number of reasons:

• Representatives and others are not skilled in, or indeed tasked with, identifying individual value requirements of customers.
• Technological solutions have so far been found to be ineffective or companies have failed when attempting to execute them.
• The role of creating value propositions that can be tailored to individual needs often gets lost in the complex structures existing within pharma.

And yet the concept of mass customisation is very common in other industries. There are many examples of collaborative companies who conduct a dialogue with individual customers to help them articulate their needs and then customise the offering to them.

It could be argued that pharmaceutical companies sell a standardised product – the drug is the drug. However, it is important to realise that where companies cannot customise a product per se they can still customise what they offer and thus build learning relationships where their knowledge of the individual customer increases exponentially.

For a pharmaceutical company to do this effectively, it needs to visualise its offering in the broadest sense not simply as a product but as an object that provides a service, solves a problem or meets a need. Therefore, the total value offering includes:

• The core product: clearly this is a hugely important part of the overall value proposition, including the drug’s capabilities, safety record, treatment characteristics etc.
• To the GP there will be other enhanced value solutions which can be of enormous value – these can include: additional services, promotional and marketing communication, patient and clinical help lines, product support, access to Key Opinion Leaders, staff training, services that improve the patient experience and so on.

To provide this value in a customised way, companies needs to find out from the customer what value means to him/her, collate the information effectively and deliver the value. Many readers will be sceptical that this is deliverable – how delivery is achieved will be discussed in the next article in this series.

Conclusion
Simplified sales structures including the reinvention of the traditional sales representative role could be of real value to all stakeholders, including the representative, the GP, the patient and the pharmaceutical company. By placing the provision of value to each and every customer at the very heart of the company’s promotional activities, companies can be truly aligned to the NHS agenda and perfectly positioned to meet the needs of the turbulent market conditions that exist today.

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.