Vaccines are the most important breakthrough in modern medicine: the jewel in the crown of the pharma industry. What can the success of vaccines teach us about healthcare and the industry’s commercial model?

Out of the virus immunity comes.

Killing Joke’s lyric uses vaccines as a metaphor for the human ability to find a positive meaning in the darkest threat. The history of medicine has shown, time and again, that every disease holds the seeds of its own treatment – but to find the answer, you have to look deep inside the problem.

It has been said that no other health initiative, with the exception of clean drinking water, has done as much as vaccines to improve public health. Medical sales professionals love selling vaccines, for two reasons. Firstly, their potential to protect the young and the old against highly dangerous diseases is beyond reasonable doubt. Secondly, the sales model for vaccines is as dramatic as its medical impact: the supplier becomes responsible for securing the immunity of a population.

Yet, on the face of it, the public might wonder what the fuss is about. Vaccines are one-off medical treatments that protect against specific infections. Many are prophylactic: they don’t work if you have the disease. They are not 100% reliable, since pandemic infections have many competing strains. And they can have harmful side effects. So why should healthy people bother?

The answer lies in the list of deadly and disabling diseases that once cast a shadow over human life, but now are preventable: smallpox, polio, tuberculosis, measles, mumps, chickenpox, typhoid, cholera, bubonic plague, rabies, tetanus, diphtheria and pneumonia. For some viral infections, vaccines are the only effective treatment.

Vaccination programmes demand collaboration across disciplines and borders to protect populations and share medical innovations.  This collaboration model meets with scepticism on two sides: those who mistrust public health provision and those who mistrust the pharma industry. It’s not surprising, therefore, that vaccines meet with antagonistic campaigns and conspiracy theories from a coalition of unreason.

The body’s weapons

Vaccines are different from conventional medicines because they do not directly attack the disease: they provoke the body’s natural immune response against the disease, like a mock-invasion used as a military training exercise. A vaccine dose consists of dead or inactivated disease organisms, or biochemical agents derived from them. In designing a vaccine, scientists trade off risks and benefits.

The first vaccination was conducted by the rural English physician Edward Jenner in 1796. Hearing that local milkmaids who contracted a minor infection called cowpox never seemed to contract the deadly smallpox, he deliberately infected a farm lad with cowpox and then, when he had recovered, with smallpox. (Medical research ethics have improved somewhat since then.) The use of a live disease culture for immunisation is now called inoculation.

The first use of an artificial vaccine was conducted by Louis Pasteur in 1885, using a vaccine developed by his colleague Emile Roux by dessicating the spinal tissue of rabies-infected rabbits. Pasteur gave the vaccine to a boy who had been mauled by a rabid dog. He came to no harm.

Vaccines are still news, with global mobility and shifting demographics making the challenge of immunity more complex and urgent than before. In 2012, new vaccines were developed to treat meningitis, shingles, rotavirus (a cause of infant diarrhoea) and whooping cough. Vaccination against HPV, the cause of cervical cancer, is a new priority for health systems. The GAVI Alliance, dedicated to providing vaccination programmes for children in the developing world, has funding from the Bill & Melinda Gates Foundation and the support of many pharma companies.

A vaccine coalition

A leading company in the European vaccines field (and the only specialist firm) is Sanofi Pasteur MSD, a collaboration between two major pharma companies with a long history of investment in immunity. Sanofi Pasteur is founded on the work of the Pasteur Institute, while Merck’s Dr Maurice Hilleman developed vaccines for measles, mumps, hepatitis A and B, chickenpox, meningitis and pneumonia. The joint company protects half a billion European people against 20 major diseases.

Paul Hardiman, Communications Manager for Sanofi Pasteur MSD, told Pf about the company’s unique role in the European immunity landscape. There are three reasons for the collaboration, he explains: “It avoids a duplication of effort in the drive to develop new and innovative vaccines. It also allows a focus on the strengths and suitability of vaccines for different markets from both companies’ portfolios. This in turn gives flexibility and supports public health priorities.”

The two parent companies are both deeply involved in the global project of the GAVI Alliance. Both Sanofi Pasteur and MSD “use a policy of tiered pricing (linked to a country’s ability to pay) to enable access to vaccines in GAVI-eligible countries. This has included significantly reduced prices on vaccines against HPV and rotavirus and a pentavalent childhood vaccine against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type B.”

In the UK, Sanofi Pasteur MSD plays a major role in public health immunisation programmes for children, young adults and elderly people. These “are secured through competitive national tenders, requiring the consistent and timely supply of large volumes of high-quality vaccines”. The company has dedicated vaccine representatives selling directly to pharmacies and GP practices.

“Every year, the Joint Committee on Vaccination and Immunisation (JCVI) carries out a horizon scanning exercise to identify all potential new vaccines expected from manufacturers that may have an impact on public health over the following five years.”

As public health in the UK shifts to local authority provision, vaccine suppliers need to be fully aware of the economics and logistics of immunity. Sanofi Pasteur MSD’s UK sales force are “vaccine experts, engaging with practice nurses and GPs to support them in the areas of vaccine supply, campaign organisation and communication, and the education of vaccinating HCPs.”

The company is now supplying Gardasil for a schools-based vaccination programme to protect teenage girls against HPV and hence against cervical cancer. It is also preparing to supply Zostavax for a national programme, starting later this year, to immunise senior citizens against shingles. In the future, the company hopes to target, cancers, allergies, addictions and diseases of the central nervous system.

Immunisation programmes deliver savings both in the short term (by reducing the need for acute treatment) and in the long term (by reducing disability and chronic illness). As the focus of healthcare shifts further into the community, vaccines are increasingly crucial weapons in the HCP’s armoury. Their value, the company maintains, can be expressed in both health and economic terms.

Diplomatic immunity

In February 2013, nine female health workers responsible for delivering polio vaccination programmes in the Kano province of Kenya were murdered by gunmen after a local preacher condemned the vaccine as a plot to cause infertility. Similar killings have happened in Pakistan. In the US, ideologues opposed to public health programmes have accused the Obama government of spreading disease in order to experiment on the public with dangerous biological agents. The internet has given these conspiracy theorists a large audience.

In the UK, a spurious panic was created around the MMR vaccine by Andrew Wakefield’s article in The Lancet in 1998, which claimed the vaccine was a cause of autism. As the BMJ has recently reported, the article was scientifically discredited within a year, and has since been exposed as an “elaborate fraud” based on research that never took place. However, Wakefield’s claims are still declared to be accurate by the Daily Mail and its bizarre columnist Melanie Phillips.

Why do vaccines inspire so much mistrust? The reasons are complex. Some people believe that harnessing the body’s immune response is ‘interfering’ with nature. Others maintain that public health programmes violate the responsibility of the individual to determine their own healthcare. Still others claim that immunisation programmes are a form of covert surveillance, or even of biological warfare.

Paul Hardiman argues that vaccination may be a victim of its own success: “Anti-vaccine sentiment is thought to arise when people no longer fear the disease for which they are being encouraged to accept vaccination. As vaccine coverage increases, serious disease starts to disappear along with people’s fear of the disease. As people lose sight of the threat, so anti-vaccine sentiment may replace the good reasons for vaccinating – raising concerns in people’s minds.”

Doctor and writer Ben Goldacre, whose book Bad Science is strongly critical of anti-vaccine conspiracy theories, argues that the industry is not blameless: “I think it’s fair to say that anti-vaccine conspiracy theories are a kind of poetic response to the obvious regulatory failure in medicine and in the pharmaceutical industry. People know that there is something a little bit wrong here.”

For example, he notes, the recent murders in Nigeria took place in the same province where Pfizer had run the Trovan antibiotic trial in 1996 – a trial whose controversial nature led to Pfizer paying the Nigerian government £75 million to settle out of court, and inspired John le Carré’s novel The Constant Gardener.

Goldacre comments: “There’s something interesting happening when a very destructive anti-vaccine conspiracy theory built around fear and anxiety that drug companies are behaving badly arises in the same very small province in northern Nigeria where Pfizer have been running a trial which many regard as unethical.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why have employees kept a belief in company culture despite major structural reforms to sales forces?

If you cast your mind back to the mid-1990s you’ll probably recall tapping along to a song sang on screen by a warthog and a meerkat in one of the most memorable scenes in The Lion King. The moral of hakuna matata was that regardless of your surroundings you have to make the best of them. The same could be said for key account managers working within in today’s medical sales sector.

There’s no getting away from the fact that the way pharmaceutical companies conduct internal operations has changed and continues to evolve. The same could be said of their philosophies. A few years ago – in an era of feet on the ground before the patent cliff – pharma companies could rightfully claim holy values, visions, beliefs and habits. However, after widespread job cuts where thousands of people have lost their jobs can the same still be said?

It seems the answer may be a resounding ‘yes’ – and that’s coming from employees! Respondents to the Pf Company Perception, Motivation and Satisfaction Survey again highlighted the importance of company culture after it was voted the fifth highest motivating factor for more than 1,200 people working in the medical sales industry. However, its fifth placed ranking shows there’s still room for improvement.

Employees working for contract sales organisations placed less emphasis on company culture than those employed on a permanent basis within the pharmaceutical industry. Interestingly, it was younger respondents who felt more motivated than older colleagues. Respondents aged less than 25 voted company culture as their main motivating factor whilst at work. But those aged 54 or over said it was only the seventh most important factor to them.

But what have the sweeping job cuts done to satisfaction levels? Overall, 59% of respondents claimed to be satisfied with their company culture with slightly more than a fifth (22%) claiming to have concerns. Women (61%) were slightly more satisfied then men (57%), with a higher proportion of males (26%) saying they were disillusioned with existing policies. Despite ranking company culture as only the seventh most motivating factor, those aged between 25 and 34 were the most satisfied of respondents with 68% saying they were happy. But those aged 54 and over said they were the least satisfied with 27% voicing their opposition.

Leading the way
The importance of company culture has long been recognised. It forms the environment in which people judge the appropriateness of their behaviour and their actions. A positive company culture – one which staff ‘buy in to’ – will influence how individuals work on a daily basis and reflects their motivation and performance.

As the pharmaceutical industry strives to be more transparent the emphasis placed on company culture has increased. The importance of leadership where company culture is concerned cannot be underestimated. The leadership structure of an organisation almost drip feeds the principles it wishes to be known for. However, overall success usually results from effective leadership, an engaged workforce and good lines of communication between the two.

Yet open conversations only play a minor part in establishing and developing company culture. There has to a commitment by managers and their own leaders to act in a way which they would expect from those at the lowest run of the ladder. Training and competence, compliance with procedures and organisational learning also make up essential values.

While it’s not easy to establish and maintain company principles it’s even more difficult to change and introduce new methods. A cultural change can take several years to introduce. Humans are creatures of habit and employees are no different. Teaching old dogs new tricks really is a time consuming process – regardless of how much investment there may be.

Choosing the one
The website learnmanagement2.com says there are four main types of company culture. The first, usually found within small or medium sized organisations is power culture. Here, control is a key element. Decisions within a business are usually centralised around one key individual. That person usually has control over decisions and the power to enforce them. This allows efficient decision making. However, this method does have its problems. A lack of consultation between other members of staff can lead to a feeling of being undervalued and a lack of motivation. A high turnover of staff is also associated with this type of company culture.

Then there’s role culture – possibly the most common and logical in organisations across the globe. Here, businesses are split into divisions or groups where individuals are assigned particular roles and responsibilities. This has the benefit of specialisation where bosses can rely on individual skill sets and employees to highlight their worth to a company through performance measures.  

Task culture sees a team-based approach assigned to a particular project. Popular in today’s business society, task culture offers benefits both to staff and their employers. Individuals feel motivated when tasks are completed or achieved and a sense of value after being selected for projects by senior management. NASA is one high-profile organisation which promotes task culture through its missions into space.

Finally, there’s personal culture. This is more commonly found in charities or non-profit organisations. In this instance a focus is placed on the organisation without any thought for personal progress or gain.

Changing principles
Research has shown that the most successful companies all have a strong culture – whatever it may be. The two are interlinked. But it’s not a question of luck either bringing the two together. The CIPD says that evidence has shown that organisational success is dependent on having the “right mix” of human resources in place. Also, there must be an ability, motivation and opportunity for staff to support cultural ideologies. Firstly, companies must recruit the correct people with the ability to understand and promote set values. Managers must then ensure that staff are effectively motivated in the workplace and to provide them with the right opportunities to use their skills in well-designed roles. 

It’s in the initial stages of recruitment where company culture CAN be defined and discussed between employees and their bosses. During induction days it’s rare for company culture to be discussed, let alone a handbook given out. However, during the interview process, bosses can get the chance to assess whether those sitting in front of them will be able to meet and enhance set beliefs.

So there you have it. If you want to improve your levels of company culture it’s important to find an organisation with the same philosophy as yourself. If you can find a company whose values match your own you’ll soon be tapping along again to hakuna matata – it’s a problem free philosophy!

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.

With jobs at a premium and the cost of living continuing to rise, job security has suddenly become a main priority for employees.

The global recession has affected each and every one of us in one way or another. Sweeping job losses throughout the medical sales sector – and in the pharmaceutical industry in particular – have seen even the most experienced personnel joining the queue at the job centre. For those lucky enough to have avoided the dreaded axe, it seems to have made us appreciate our job a whole lot more.

Last year was somewhat of a breakthrough year for as far as job security is concerned. Results from last year’s Pf Company Perception, Motivation and Satisfaction Survey highlighted how job security had gone from a passing thought to one of the main motivating factors for respondents. Ranked behind salary, relationship with manager and work-life balance in the 2009 survey, job security was suddenly thrust into the top-two motivating factors last year.

It has maintained its position this year behind salary as the second highest motivating factor after pharmaceutical companies continue to introduce ‘efficiency’ plans in an attempt to sustain profits and counter bleak pipelines. During an uncertain last twelve months it would seem that satisfaction levels in job security have also improved. Job security moved from 14th position last year to 11th in the latest set of results. Are companies doing more to reassure staff their jobs are safe, or are employees learning to live with the fact that their week at work may be their last?

Moving on
Attitudes towards job security have also affected respondents’ outlook on where they’d like to be within 12 months’ time – see Figure 1. In last year’s survey, 15% of respondents indicated they were searching for a move away from their current employers with 56% content to stay where they were. However, this year’s results show a slight increase in those figures with 13% of people within the medical sales sector looking for a new job and 59% happy where they are. 

Its men that indicated a stronger desire to change companies with 17% wishing to move organisations and a further 24% saying it was a possibility. However, female respondents were less sure about joining a new organisation with only a tenth wishing to move away from their current employers.

The importance now placed upon job security may also arise from the fact that employees are still very mindful of a turbulent few years – despite a glimpse of light at the end of a very, very dark tunnel. Dr John Philpott, Chief Economic Adviser at the Chartered Institute of Personnel and Development (CIPD) recently told a panel of directors from Yorkshire that modest economic growth in the UK would see unemployment levels stabilise this year. He also discussed the potential of a stronger recovery resulting in a sudden, sharp fall in unemployment levels and employers again going on the hunt for talented staff to meet increasing demand.

Job security works both ways. It shouldn’t be something that only staff on the ground worry about. Stability and medium to long-term assurance ensures employees are engaged and motivated enough to be committed to company goals and objectives.

Although job security may be a state of mind, there are ways of improving one’s mindset. If a company can ensure or encourage career development and progression, an employee will feel a greater sense of loyalty and commitment. With this in place a sense of dedication allows employees to focus on their individual skills and capabilities and become a consistent performer. In turn, an employer gets a happy and productive employee in the work place.

Trust levels
However, it’s not always that easy it? Memories of colleagues and friends being made redundant can last for a very long time. Geoffrey James, argues on the website inc.com, that job security is defined by who you are, what you do and who you trust. If you’re an individual who is happy going along with your job, undertaking everyday tasks and playing second-fiddle to other staff then you’re more than likely to receive your marching orders, James says. Individuals should strive to stand out from colleagues and be different to the majority of the workforce. “If you really want job security, there must be something about you that’s different, that makes you more relevant than anybody else who does what you do. More importantly, other people must perceive that difference and see it as valuable,” he says.

Then, of course, there’s the trust issue. Do you think you can rely on your boss not to put a red cross next to your name if there are further redundancies? James – who pens one of the world’s most-visited sales-oriented blogs – suggests a novel approach to assessing trust whilst at work or in the field. People that you speak with on a daily basis – be they family, friends, colleagues or business associates – should be placed into three categories: those who trust you completely, those who moderately trust you, and those who vaguely trust you. When these have been grouped together, remove the people in the final two categories – these are the people unlikely to return sales calls, James adds – and then calculate the number of people who you believe completely trust you. If, he says, you have more than 20 people on that list, then you have a greater sense of job security. If you haven’t, it might be time to start building some bridges.

So there you have it. Job security ultimately comes down to who you can trust and who trusts you. Can you hold on to trusted colleagues at work whilst the UK tries to climb out of a double-dip recession. Or, are the people who you believe you rely on merely providing a crocodile smile during work hours? It’s probably wise to start drawing up that list...

Medical sales executives continue to lead the way in the pay stakes, but how do they continue to defy remuneration odds?

A recent Channel 4 documentary exposed just how sensitive the issue of salary is in the workplace. Employees at a leading plumbing firm in London were asked, face-to-face, to reveal their salary to their colleagues. The outcome wasn’t pleasant. Employees working alongside each discovered they were, in some instances, paid tens of thousands of pounds less than the person working only a few feet away from them. Whilst employees’ pay was eventually brought in-line with their unsuspecting workmates, the moral of the film highlighted just how much people dislike being short-changed – especially in their wage packet. 
The Pf Company Perception, Motivation and Satisfaction Survey – now in its 11th year – again highlighted the importance of salary to those working within the medical sales industry. It’s of little surprise that in an era of austerity salary came out on top as the main motivating factor for respondents. While the significance of money is there for all to see, the satisfaction respondents feel when they open their wage slips is somewhat surprising – despite being paid well above UK average. Satisfaction ratings showed salary placed as the 13th out of 18 options.

Figures from the website Payscale.com show that the average salary for men in the UK is now a slightly more than £30,000. For women it’s around six thousand pound less. Short change when compared to figures from the Pf Survey where the median salary from men is £45,000 and women £40,000. Despite nearly all pharmaceutical companies announcing plans to tightening its belts, employees in the medical sales sector are clearly still extremely well paid.

Overall figures from the survey show that annual remuneration packages range from £11,000 up to a wallet-busting £107,000. The median salary for full-time workers travelling from job to job around their territories was £43,000. Even those on part-time hours earned a medium salary of £26,702 – with the highest earner working reduced hours taking home a cool 54k.

The going rate
A career in the medical sales industry pays. The median salary for respondents who have less than six months’ experience within the sector was £23,000 - see Figure 1. One individual began their career within the industry taking home £58,000 per year! The median salaries of those with additional years of experience continued to rise with those clocking up eight years or more earning an average of £45,000. 
Age also plays an important factor.  The median salaries of those aged 25 and under continue to rise to respondents aged between 45 and 54 years old. Individuals in that age bracket reported a median salary of £45,000, yet those aged beyond their 54th birthday saw their median annual wage fall by two thousand pound. With an ageing workforce, has the medical sales industry targeted this age group to make savings?
Patients may suffer as a result of the postcode lottery but it also seems that medical sales executives do as well – see Figure 2. Median salaries ranged from £42,125 in Scotland up to £47,000 in London. The south east, south west and Wales all clock up median salaries of £45,000 with the north east and Midlands/east slightly behind.

Individual roles
Pharma’s switch in methodology away from a traditional headcount approach to a key account model is reflected in the survey with the median salary for Key Account Managers being £10,500 more than that of a Primary Care Representative (£33,000). Primary and Secondary Care representatives reported a slightly better median salary at £38,880. However, that figure is almost doubled by the median salary of second-line managers at £74k. At the other end of the pay scale, nurse advisors reported the lowest median salary at 30k – as highlighted in Figure 3.

Although public sector workers may have had to endure pay freezes, the same can’t be said of medical sales executives. For the second year running respondents have again reported hearty pay rises – one lucky individual banked a £20,000 rise! Overall, the median salary increase was slightly more than a thousand pound. Key Account Managers reported £100 on top of that figure with second-line managers again enjoying the largest slice of the pie, after receiving a median rise of £2,778.

On top of generous salary increases, respondents also enjoyed bonuses the majority of workers from other sectors – banking aside – could only dream of. In total, the survey found that sales executives received a median bonus of three thousand pounds. The maximum bonus was £50,000. Key Account Managers saw their bonuses fall in line with the average median figure, primary and secondary care representatives were rewarded a thousand pound less than everybody else, and first-line and second-line managers again enjoying generous gratuity sums.

However, very much like salary, respondents were clearly unimpressed with their bonuses. In the satisfaction stakes, only share scheme finished behind bonus in the minds of respondents. It would seem, much like pharma’s shareholders, medical sales executives are a difficult bunch to please – despite enjoying above-inflation rewards.

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.”

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.

The number of global pharmaceutical sales jobs fell by nearly two per cent (1.8%) last year as the industry faced a challenging twelve months, according to new research.

An audit by Cegedim Strategic Data (CSD) found the number of sales representatives fell from 421,223 in 2010 to 413,565 last year.

However, the decline in medical sales positions would’ve been far more had it not been for an increase in pharmaceutical sales jobs in emerging markets such as China or Brazil.

CSD research found that the US had the most pharmaceutical sales representatives (73,762), despite losing 7% of roles compared to the previous year.

China followed with more than 65,000 sales roles after it continued to enjoy double-digit job growth creating an increase of 18.6% in jobs last year. Japan ranked third with 54,236 jobs, despite seeing a decline in pharma jobs of 10%.

France saw the biggest decline in sales jobs in Europe as roles notably declined by 12%. Jobs were also down in Germany by 2% and in Italy by 1.7%. But markets in Spain and the UK remained relatively stable.

The news was much better in Brazil where field force levels increased by 3.5% in 2011 and saw the country have the fifth most pharmaceutical sales jobs of any country.

The audit also found that sales reps preferred detailing to healthcare professionals as the main channel for communicating promotional and clinical messages, and that sales representatives accounted for more than 60% of global marketing investments in 2011.

This month’s Pharmaceutical Field looks at some of the major issues affecting UK pharma at present; the evolution of its customer-base, an increased focus on compliance, the developing training needs of medical sales professionals and pharma companies’ ongoing challenge to attract and, crucially, retain talent.

The DH’s Innovation Health and Wealth document, published at the tail end of 2011, seeks to address the most significant challenge for UK healthcare – accelerating the adoption of innovation within the NHS. There is much that pharma can do to help enable innovative medicines reach patients more quickly.

Regulatory compliance remains a key priority for pharma as recent and impending global legislation puts pharma’s engagement with customers under increased scrutiny. In the process, the changing legislative landscape is having a significant impact on the training needs of medical sales professionals in the UK. This, in turn, is having a domino-effect on the pharmaceutical employment market, where a notable ‘skills gap’ is having a huge impact on recruitment and the quality of applicants for commercial roles.

Faced with an apparent dearth of quality candidates for sales positions, companies are needing to work hard to create the best working environment to retain their most talented employees. Pf’s annual attitudinal survey of the UK sales force reveals that, in some parts of the industry, there remains much to be done to ensure that the company culture advertised in the corporate brochure matches that experienced by employees in the workplace.