Wowzers, what a beauty! And, to be fair, Lindsey Cook looks a million dollars too. We convinced her to park in a safe place, and climb into a spectacular gold frock, for a bit of car-based interrogation.

Your job title

Co-founder and director of Wicked Minds healthcare consultancy.

Job responsibilities

Commissioning, market access, healthcare policy and patient advocacy to the NHS, pharmaceutical and voluntary sector.

Your car

Range Rover Evoque! [Ed – Love the way you felt the need to shout that, Lindsey!]

Owned for

Seven very special months [Ed – Quite moving, really]

Car’s nickname

White Stallion [Ed – Curious]

How reliable

As reliable as me… which, by the way, means, very!

Miles per week

Varies week to week – could be 10 or 1000!

Place most driven

To my business partner’s home near Windsor.

Favourite gear change

From my work suit into an evening dress... oh I see what you mean now... I don’t have to; it’s an automatic!

Favourite destination

The airport, especially if I am going on holiday.

Car’s best feature

It’s sexy and it knows it!

Car’s most annoying habit

It runs on diesel and not air.

Drive time tracks

Anything by the Black Eyed Peas [Ah, Lindsey, you were doing so well]

In glove compartment

Gloves!

Word most used in car

Where are my gloves?

Snack most consumed in car

Peanut M&Ms.

What’s on your back seat

David Beckham (well, a girl can dream) – actually it is normally dry cleaning.

Most embarrassing car-related incident

You’ll never believe this, but I was driving on the M25 when suddenly glass patio doors from a mobile home, carried on a lorry, fell out and landed on my car!

Favourite car memory

Finally getting my car after the dealership made a mistake! I ordered a three-door Evoque and, after waiting eight months, they delivered a five-door! [Ed – Honestly, you wait ages for three doors, then five come along at once...] It took another four months to get the right one, but was worth the wait!

Biggest car-based disaster

I rolled my previous car on the A12 and was airlifted to Colchester hospital. Car was a complete write off though I came away without a scratch!

Dream car

Audi R8.

What car did your folks drive back in the day?

Triumph Spitfire. Looking good Dad! (See above.)

The 27th Pharmaceutical Marketing (PM) Society Advertising Awards had the largest number of entrants ever (350) and saw the event expanding into the digital and exhibition arenas.

Notable winners among the advertising agencies included Langland Advertising, which won in seven categories (with 10 commendations), and VCCP Health, which won in three categories (with two commendations).

Of 36 pharmaceutical companies competing for the PM Society Awards, the most successful was Abbott with four wins and five commendations.

Three pharmaceutical companies – Astellas, Bayer and Johnson & Johnson – won two awards each, and another five – CSL Behring, Eisai, Janssen, Sanofi Pasteur MSD and Takeda – won one each.

Neil Smith, PM Society Advertising Awards Chairman, commented: “As ever, the truly aspirational creative treatments stand head and shoulders above the rest and their success is reflected by our industry and healthcare judges.”

From over 50 campaigns entered for the Awards, the most successful on the day were Langland’s campaign for Abbott’s drug Hidrasec (four wins and one commendation); the same agency’s campaign for Bayer’s Sativex (two wins and two commendations); and Lime’s campaign for Astellas’ Protopic (one win and two commendations).

Remarkably, Concentric Advertising won both the Primary and the Secondary Care Target Awards for one advertisement.

Two of the most coveted awards were the Healthcare Industry Award, won by relative newcomer VCCP Health, and the Geoff Brook Innovation Award, snagged by the Woolley Pau Gyro agency.

New awards were presented in three digital advertising categories, and exhibition displays were recognised in a new category for the first time.

The lunchtime awards ceremony in London was hosted by broadcaster and former MP Gyles Brandreth.

The PM Society, which promotes marketing excellence in the healthcare and life science industries, is a non-profit organisation with members in over 230 UK companies.

In 2012 the Society launched Interest Groups addressing key challenges facing UK pharmaceutical marketers: market access, digital marketing, NHS partnerships, patient engagement and personal development.

The ABPI and the Pharmaceutical Marketing (PM) Society have formally agreed to work together in promoting and advancing the UK pharmaceutical industry.

The two organisations have signed a memorandum of understanding (MoU) committing them to align activities that are relevant to their shared interests.

Areas of joint working suggested by the MoU include training, events and member surveys to identify issues and facilitate planning in the industry.

The PM Society promotes marketing excellence in the healthcare industry. Run by volunteers as a non-profit organisation, it has members in 230 UK companies.

In 2012 the PM Society introduced a number of Interest Groups focused on current challenges: market access, digital marketing, NHS partnerships, patient engagement and personal development.

The ABPI represents research-based biopharmaceutical companies in the UK, and is recognised by the Government as the body negotiating on behalf of the branded pharmaceutical industry.

“The PM Society reaches out to the operational heart of the UK pharmaceutical and life sciences industries and is a natural partner to promote debate and discussion with the people we serve,” said ABPI Chief Executive Stephen Whitehead.

“The working groups in market access, NHS partnerships and patient engagement, aligned as they are with many of our strategic imperatives, offer particular potential for joint working.”

Neil Copping (pictured), Chairman of the PM Society, commented: “Since we redefined the Society early last year, we have looked to address members’ needs more effectively in the rapidly changing healthcare environment.

“Aligning strategic and grass roots level activities by joining forces with the ABPI, we aim to open new doors and deliver increased value and benefit to both organisations’ membership.

“It will also avoid duplication on initiatives that are relevant industry-wide and might otherwise have been under discussion by both organisations.”

The ABPI sets out to deliver tailored support and advice to healthcare providers on the medicines its member companies produce. Kevin Blakemore, NHS Partnerships Manager at the Association of the British Pharmaceutical Industry, discusses the advantage of partnerships in healthcare.

The pharmaceutical industry has experienced tremendous change and, as part of that evolution, forming successful partnerships in healthcare has become integral to our way of working. The NHS delivers outstanding care to patients – utilising the innovative medicines the pharmaceutical industry produces – so it makes perfect sense for us to work together, ensuring the best possible outcomes for patients. There are some points, however, to consider when embarking on ‘joint working’ ventures – these partnerships must be managed and guided to ensure that the process is efficient, seamless and offers patients maximum benefit.

Often these partnerships can result in patients spending less time in secondary care settings, and can deliver significant savings. Patients benefit most when those with a stake in their care work effectively, enthusiastically and efficiently together.

Joint working describes situations where, for the benefit of patients, NHS and industry, organisations pool skills, experiences and resources for the joint development and implementation of patient centred projects and a shared commitment to creating a streamlined, joined-up care pathway, where patients are kept at the heart.

Flexible joints
Joint working has already benefited thousands of patients across the UK and to help achieve greater outcomes, the Association of the British Pharmaceutical Industry (ABPI) has developed the ‘NHS Partnerships Team’. My dedicated team work with healthcare providers up and down the country, providing specialist advice and support, while facilitating successful working relationships.

The NHS Partnerships team is made up of eight individuals, each responsible for a different area of England. Their knowledge and expertise includes experience of working within the pharmaceutical industry and the NHS. They also bring their knowledge of innovative and effective medicines created by the industry, and this can be utilised for the benefit of patients. The central focus of the team is improving the healthcare environment in order to increase access to and uptake of innovative products. The team consists of Diana Vegh, Karen Thomas, Carol Blount, Harriet Lewis, Andy Riley, Mike Ringe, Angela Logun and myself.

Diana Vegh started her career in the pharmaceutical industry within regulatory affairs in AstraZeneca, working in scientific roles of increasing seniority. She then moved to the NHS where she held senior positions in the Strategic Health Authority, two PCTs and a Foundation Trust in the South West.
Diana returned to industry in a commercial capacity at UCB Pharma, working in market access for products. She has extensive networks across the industry and the NHS, and a wealth of practical, positive experience.

Veteran’s parade
Karen Thomas – a recent addition to the NHS Partnerships Team – has extensive experience of working in the pharmaceutical industry, and for the past 12 years Karen has worked for Bristol Myers Squibb, where her roles spanned finances, sales, commercial and market access, covering several therapeutic disease areas. Karen joined the ABPI in November 2012 as the Regional Partnership Manager for London.

Harriet Lewis has been a pharmacist for over 20 years. She has worked in a wide range of healthcare sectors including industry, community, hospital and primary care. Before joining the ABPI, Harriet’s most recent role was Associate Director for Medicines Advice with the National Institute for Health and Clinical Excellence (NICE). Harriet has led on a number of NHS support programmes, including local formularies, local decision making, controlled drugs, accountable officers and ‘specials’. She has authored several key documents for NPC and NICE. Harriet is the Regional Partnership Manager for the North.

Most recent additions to the team are Andy Riley and Mike Ringe. Andy joins us as the ABPI Regional NHS Partnership Manager for Midlands and East. He qualified as a pharmacist in 1987 and has held posts in hospitals, community pharmacies and health authorities in London, the North West and the West Midlands. Mike joins us as the ABPI Group Therapy Manager directly from the NHS, and previously held the position of Chief Operating Officer at Luton Clinical Commissioning Group.

My role is the NHS Partnerships Manager and I manage the team. Previously, I have worked in the pharmaceutical industry for over 25 years – at UCB and GlaxoSmithKline (GSK) – and I have been responsible for developing national level methodologies and frameworks to support patient and market access programmes.

Bonded by blood
The ABPI recently undertook a joint working project at a hospital trust in the North of England looking at epistaxis – one of the most common ENT emergencies in England, with over 27,000 patients presented to secondary care between 2008 and 2011. In 2009/10 the trust admitted 250 patients presenting the condition, with the average length of stay at over two days, costing a minimum of £400 per patient per day.

Like many other hospitals, the trust had limited specialist ENT experience in their emergency departments, and as a consequence nasal packing was frequently used as a first line treatment – even for small volume bleeding – when a more conservative or targeted approach would have been safe and effective. There was a clear opportunity here for the patient pathway to be revised and a different approach taken.

Through the ABPI, a joint working project was instigated between a local pharmaceutical company and the trust. They jointly agreed – through a joint working agreement – to truly address the challenges within the current treatment regime and completely redesign the service. Consequently, it addressed the training requirements within A&E and junior doctors.

The new treatment pathway encouraged clinicians to identify the bleeding point, if possible, and in cases of continued bleeding, to consider the use of a product manufactured by the local company – thereby avoiding unnecessary hospital admissions. The company and trust continued to work in partnership to develop training materials in order to develop the new treatment pathway and introduce the use of the medicine where possible.

This venture resulted in a number of positive outcomes, which included a reduction in hospital stays, improving productivity and cost savings. But most importantly, when compared with the three preceding years, the audit of the venture showed that the total number of bed days due to epistaxis, was reduced by 30 per cent and length of stay was reduced by 21 per cent. Additionally, staff were motivated to consider an alternative to immediate nasal packing/admission, which also resulted in a reduction in the length of stay.

QIPP while ahead
Working with the Department of Health and the NHS, we have developed a toolkit on successful joint working. Joint working is a relatively new concept for many, but has already shown tangible benefits to patients, the NHS and industry. For example:

East Lincolnshire Primary Care Trust (PCT) reduced hospital admissions for Chronic Obstructive Pulmonary Disease (COPD) by 23%, through working with three companies to target and screen patients, train clinicians and set up specific COPD clinics.

In Ashton Leigh and Wigan the PCT is tackling low life expectancy, high rates of heart disease and diabetes by working with industry on a ‘Find and Treat’ strategy.

The innovative approach to patient care adopted by that trust was aligned with the Quality, Innovation, Productivity and Prevention (QIPP) programme. QIPP is an NHS initiative to improve the quality of care it delivers, while at the same time making savings that can be reinvested into the service. It engages with staff from across the NHS, at local and regional level, and is supported by QIPP plans and work streams that provide guidance and tools.

The NHS also works with a range of partners to deliver QIPP, one of which is the pharmaceutical industry. Apart from supplying medicines that improve the quality of patients’ lives and outcomes, the industry can contribute business skills and expertise, as well as extensive knowledge of the therapy areas relevant to its medicines.

Joint working is the foundation for creating, developing and implementing innovative healthcare solutions which can lead to better health outcomes. We believe this is the way forward in healthcare and both the NHS and industry must seek out more opportunities to work together.

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.

The introduction of value-based pricing (VBP) will not solve the issues around the access to new medicines in the UK, a new report says.

Current Stakeholder Perspectives on Value-Based Pricing, a report from charity Myeloma UK, notes 19 recommendations the Government should consider to improve VBP.

Eric Low, Chief Executive of Myeloma UK, said the recommendations “ensure any new system of VBP is the best it can be”.

The report questioned opinion leaders and experts from academia, the NHS, patient groups and the pharmaceutical industry to generate the recommendations.

They focus on price-setting, threshold setting, uncertainty and medicines uptake at a local level. Recommendations include:

• The Government conducting research to establish the relationship between pharmaceutical pricing and the location of research and clinical trial centres
• Cost-effectiveness thresholds under VBP should be set by a new, independent advisory body
• VBP should involve greater coordination between NICE, pharma and other stakeholders to ensure there is appropriate evidence collection about a new medicine prior to its launch
• Determining the value-based price of a new medicine should be a transparent process, but the price agreed could remain confidential to protect the UK as a reference-pricing market.

The Department of Health revealed plans back in December 2010 to replace the existing Pharmaceutical Price Regulation Scheme with a value-based approach from 1 January 2014.

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.

The European Commission (EC) is to reduce the time it takes for decisions to be made on the pricing and reimbursement of medicines.

The Commission wants a reduction in the number of days on decisions for innovative medicines and generics in order to increase the rate of medicines entering the market.

Antonio Tajani, European Commission Vice President, says that faster decisions are required nationally to “maintain a dynamic pharmaceutical market and to offer citizens better access to pharmaceuticals”.

Currently, after the EC establishes the quality, safety and efficacy of medicinal products during the process of marketing authorisation, Member States then make a further evaluation to assess whether the medicine is eligible for reimbursement under procedural rules as part of the Transparency Directive.

The new directive simplifies a 1989 ruling which no longer reflects the increased complexity of the pricing and reimbursement procedures in Member States.

A 2009 report by the EC found that delays in pricing and reimbursement decisions can go up to 700 days for innovative medicines and up to 250 days for generics.

Under the new proposals, decisions for general medicinal products should be made within 120 days instead of 180 days, except for more complex cases, and generic products within 30 days instead of 180 days.

The EC intends to use strong enforcement measures to ensure the directive is effective and advises Member States to designate a body with powers such as awarding damages to applicants and imposing penalty payments. It also intends to make Member States report decisions and the duration of these.

“Our proposal will lead to substantial savings for public health budgets, for example by allowing earlier market entry of generic products. It also creates a more predictable environment with greater transparency for pharmaceutical companies, thus improving their competitiveness,” said Antonio Tajani.

Tracking and responding to NHS change in a highly competitive Olympic year will be a test of endurance for medical sales professionals. In a light-hearted article, David Round examines why winning a place amongst the medals will depend upon getting your preparation right.

It’s a well-worn cliché that a little knowledge is a dangerous thing. But as the UK pharmaceutical industry heads into an Olympic year when the pace of change amongst its NHS customer-base will undoubtedly increase, medical sales professionals will need to demonstrate more than a little knowledge to achieve a podium position for their products. The Health and Social Care Bill may still be some way from the finishing line, but as the health service continues its transition towards the seemingly inevitable, changes on the ground are already taking place. And the implications for pharma are huge. The industry cannot afford to sit and wait – it needs to act now to ensure its sales and marketing communications are reaching the right customers, with the right message at the right time. For pharmaceutical sales executives, it’s about developing more than knowledge: it’s a question of intelligence. And the answers may be right at their fingertips.

It has been widely documented that the NHS is working its way through a period of unprecedented change – both in its working practices and, of course, in its organisational structure. As a result, pharmaceutical companies – often criticised for being ‘data rich but information poor’ – will, more than ever before, need to maximise their data assets to deliver a more customer-centric approach to selling. And sales professionals will need to draw on all the information at their disposal to develop and deliver relevant and robust value propositions that satisfy customer need.

The noise-driven, share of voice model of pharmaceutical sales and marketing has become like Monty Python’s parrot: it has ceased to be. Today’s approach, which relies on a reduction in call volumes, is less linear, more selective and much more sophisticated. Key Account Management is leading the industry pack. But whilst the approach is, in theory, more measured, making it work requires quality customer data as a platform to identify ‘key accounts’ and, crucially, the ability to translate that data into meaningful market intelligence. Companies are becoming much smarter in segmenting their key customers – but faced with moving targets across a changing NHS, maintaining the accuracy, and in the process the efficiency, of the approach is not easy. It is, however, imperative.

The race to reform
The transition towards the new environment is already well under way. Last year in England 152 Primary Care Trusts (PCTs) were reorganised into 51 PCT Clusters of variable size, while the ten Strategic Health Authorities (SHAs) were restructured to form four large regional clusters. By April 2013, PCTs and SHAs will be extinct and Clinical Commissioning Groups (CCGs) and the National Commissioning Board will spearhead the commissioning of NHS services under a new-look structure. If you throw into the mix the onset of Clinical Senates, Health and Wellbeing Boards and new Commissioning Support units (which may well emerge as private organisations and therefore new customers), it is easy to see that an already complex customer matrix is set to become even more complicated. And that’s simply the start line.

Critics of the reforms claim that the situation on the ground is fast approaching chaos within the NHS, as the wider organisation struggles to implement changes even before the Health and Social Care Bill has achieved Royal Assent. But in the interim period while the health service readies itself for the inevitable, UK pharmaceutical companies cannot afford to let their sales and marketing operations become similarly chaotic. Tracking and more importantly responding to change throughout the transition period will be vital for medical sales professionals if they are to support their customers through the metamorphosis and, in the process, meet their own commercial objectives.

Access to quality data that can not only enable Account Managers to make the right targeting decisions, but can also help them engage in the most appropriate customer dialogue, will be critical to success. It is not simply a case of knowing who to target – understanding why and how they should be approached is equally important. It is this understanding that separates knowledge from intelligence. And separates winners from also-rans.

Keeping on track
Sales professionals not only need to identify their ‘key accounts’, they also need to understand the varied environments in which these individuals operate. What challenges do they face? What are their key priorities? Do they carry out more than one role – or sit on a variety of boards and committees in addition to their main job? If so, how does this impact their spheres of influence? How pivotal are they in driving service redesign, influencing formulary decisions, or facilitating joint working within their local organisation? Where do their roles and their needs overlap with your product or service?

This is standard market access. And it’s vital. Pharmaceutical sales professionals need to define how they engage with the NHS and why their customers should want to engage with them. They need to establish how they are going to deliver value and improve outcomes for the health service and its patients. And to achieve this, they must understand their local health economy, its priorities and objectives, and identify the key stakeholders whom they can help support to meet those needs. What is the structure of the local organisation? What is its indicative budget and its strategic plan? Who is responsible for commissioning in your disease area? What areas are emerging Commissioning Support Units going to be supporting commissioning in – and what are they not? As PCT clusters evolve and CCGs take shape, which customers are most relevant today, and how relevant will they be tomorrow or indeed in two years’ time? Only by tracking customers in real time as they make their transitional journey towards the new NHS can sales professionals be sure that their interactions are aligned with that change, and be prepared to respond accordingly when required.

Technology in a team sport
The Key Account Manager in the modern market must, therefore, have the mental preparation of an Olympic athlete – but work on the basis that the race is never won. The NHS is a dynamic marketplace where change is continual. The Key Account teams that are best able to track, capture and share intelligence will be best placed to emerge victorious. The role of the Key Account Manager is, after all, an individual pursuit in a team sport.

The tools to support ‘informed’ Account Management are already here. Customer Relationship Management (CRM) systems that help capture and share vital customer intelligence have been in common currency across the UK drug sector for many years. But never before has their value to the medical sales professional been so important. Industry surveys suggest that CRM usage amongst front-line sales professionals could still be improved – and this is essential. CRM systems are only as good as the data that is put into them. But when collected and shared properly, that data is there to help medical sales professionals. In a fast-evolving customer environment that will almost certainly intensify as the NHS continues its inexorable march towards a new structure, key account management can only be enhanced by the knowledge and intelligence a good CRM system can help deliver.

In fact, the sheer volume of likely NHS change in the next 12 months could provide a catalyst for 2012 to become the year when CRM finally comes of age. And those sales professionals who recognise its potential to significantly support customer interactions – and make for a more intelligent and appropriate engagement – will undoubtedly reap the rewards.

But the time to act is now. In an Olympic year, the fast track is the only option. After all, a little knowledge is a dangerous thing.

David Round is UK General Manager, Cegedim Relationship Management.

There has been a lot written about the industry’s apparent move to Key Account Management and its impact on call rates and targeting. David Round provides a welcome break from the rhetoric and concentrates instead on the facts.

Mark Twain famously said that people often use statistics as a drunk uses a lamppost: for support rather than illumination. But when used properly, data can be incredibly illuminating – not least for the UK pharmaceutical industry. And analysis of pharma’s ongoing modification of its sales and marketing model is well worth putting under the spotlight.

In the past few years, experienced pharma commentators have looked in vain for evidence to support an inexorable, yet often anecdotal, march towards Key Account Management (KAM). The rhetoric said that pharma was taking a more sophisticated approach to sales and marketing activity and, in the process, delivering a more efficient and effective commercial model using a targeted KAM methodology. But the reality, and indeed the numbers, seemed to suggest otherwise.

The UK pharmaceutical industry may have taken the surgeon’s knife to its collective sales force and cut back on the volume of field-based staff. It may also have rebranded its sales representatives as ‘Account Managers’ and encouraged them to take a more measured approach to targeting key customers. But, until very recently, the number of GPs being seen by medical sales professionals across the year remained as high as ever – belying the claim that companies were moving away from the apparently inefficient ‘share of voice’ model that had served them so well in the past. Critics claimed that the traditional sales rep had simply been issued an Account Manager’s business card and given the accountability and autonomy to be more selective in targeting key customers – as well as a call rate target that was directly at odds with the KAM philosophy. And the statistics did little to quell the debate.

Data from Synmetrics, Cegedim Relationship Management’s activity benchmarking tool, shows that between December 2009 and December 2010 – and in the thick of widespread opinion preaching the gospel according to KAM – 92.7% of UK GPs had a face-to-face call or meeting with a representative from a pharmaceutical company. This indicates that, far from adopting a more considered approach to targeting its customers, the industry was still carrying out almost blanket coverage of GPs. What’s more, the 2010 data merely continued a similar trend from the years that preceded it – with annual industry coverage in the past decade consistently reaching over 90% of the total prescriber population.

But the past 18 months seem to represent a watershed for pharma sales operations in the UK. Something, it would appear, is happening. In the 12 months from July 2010 to June 2011, Synmetrics data show that the number of GPs who have had a face-to-face call or meeting with an industry representative has dropped to 85% – a fall of some 7%. Alongside this, in the first six months of 2011 the total number of GPs who have had a similar contact has slumped to 73%.

Whilst the half-year figure may not be wholly indicative, the July 2010 to June 2011 full-year data appear to represent a trend. And upon closer scrutiny, it’s a trend that’s been developing incrementally over the course of the past decade. Figure 1 shows that the total number of contacts on GPs has, apart from an uncharacteristic spike in 2008, been gradually declining since 2001.

Contact is classified as either a traditional face-to-face call or a meeting, and analysis of the contact rates for each of these methodologies is equally revealing. The number of face-to-face calls (per rep, per day) has been steadily falling year-on-year. Conversely, the number of meetings (per rep, per day) has gradually risen – and in fact grew disproportionately between 2007 and 2008. The Synmetrics data show that there are more meetings taking place today than at any point in the past ten years; and that, crucially, in 2010 the number of meetings per day overtook the number of face-to-face calls for the first time.

Significantly, the number of face-to-face calls being made each day has halved over the course of a decade. That’s a pretty spectacular statement. So spectacular that it’s worth repeating just to reflect on it: the number of face-to-face GP calls, per rep, per day, has halved since 2001. This has nothing to do with field force size and the fall in the number of representatives – it’s literally the number of calls per rep.

Moreover, data shows that 17,000 GPs – around 35% of the total population – have not received a face-to-face call in the past twelve months. In truth, this is another staggering revelation: the bread-and-butter, conventional pharma approach of face-to-face engagement between GP and representative has reached a point where more than a third of GPs have not received a call in the last year.

And so the ‘real world’ data are piling up. There are now fewer representatives, who are collectively making fewer calls. There’s an increase in the number of meetings, but a significant drop in activity, with daily call rates halved and over a third of pharma’s traditional customer population not receiving a single face-to-face call. It is a breathtaking decline, but it has not just happened overnight.

The implications
So what does all this mean? Does the 7% drop in GP coverage over the last 12 months provide the first conclusive evidence that Key Account Management is beginning to take hold in the UK? Or does the incremental decline in contact activity over the course of the past decade merely confirm that customer access, for reasons that are well documented, has shrunk considerably? Have GPs increasingly decided to close their doors to industry representatives, or have pharmaceutical companies taken a more measured approach and chosen not to target them? Drawing a distinction between the two is difficult. It’s most likely to be a combination of both factors.

What we do know, of course, is that the industry’s customer-base has broadened extensively in the past few years with the emergence of a new breed of decision-makers – loosely classified as payers. As a
result, pharmaceutical companies have been forced to balance activity between traditional customers and more influential stakeholders in medicines management and commissioning functions. With GP call rates
falling by half it would be easy to assume that sales professionals are spending up to half of their time refocusing on payer engagement. But this may be too simplistic a conclusion. The payer population has rapidly earned a reputation for being difficult to access, and building relationships with the new stakeholders is widely accepted to be a long-term process that will take time and effort.

However, it would be disingenuous to conclude that half a sales professional’s day is being spent calling upon payers, and to use this presumption as the ultimate proof that Key Account Management has finally
established itself is probably a leap too far – it would perhaps be more realistic to assume that the effort and preparation required to see these payers is what is taking up a greater part of the sales professional’s day.

Yes we KAM?
It’s still too early to make definitive claims that the KAM model is firmly embedded in UK pharma. The indications are that the approach is beginning to take shape, but there is perhaps still some way to go before companies finally feel confident enough to entirely let go of the traditional share of voice model. But while that transition continues, the need for a more sophisticated approach to targeting customers remains as strong as ever. Pharma companies need to use all of the available data to drive their promotional plans, and use every available channel to reach their customers.

The industry needs to be as targeted as it can be, and sales professionals must be as smart as possible in their approach. Quantity is being replaced by quality. As the number of daily contacts being made continues to decrease, it’s vital to make sure that every face-to-face call or meeting actually counts. As
Account Managers are encouraged to develop their own call plans and become more accountable for their
own business, the need for robust and effective data to help make informed targeting decisions in the process is paramount.

Statistics can, of course, be used to provide reassurance and justification for a decision; but when considered more carefully, robust data can stimulate much greater illumination. For UK medical sales professionals, gaining access to information that enables you to shine a light on all of your customers and establish which ones provide the greatest potential, could make the difference between staggering around in the dark and giving your sales figures that extra spark. Don’t allow yourself to become the drunk at the lamppost – it only ever leads to a headache the following day.

David Round is UK General Manager, Cegedim Relationship Management.