Selling medicines in today’s marketplace should be built on partnership principles. ABPI CEO Stephen Whitehead talks exclusively to Pharmaceutical Field about the importance of NHS/industry partnerships.

Back in 2009, Chris Brinsmead – then President of the ABPI – told Pharmaceutical Field that the future role of the pharma field force would be to facilitate partnerships between the NHS and industry. Three years later and the partnership agenda is slowly inching forward. Progress has been made, but adoption of a more collaborative approach across the country has been variable. As ever, there are early adopters, and those that wait. Last month, Pf led with an ABPI announcement that predicted the NHS and industry would ‘become partners within 3-5 years’. Why not now, came the familiar cry? Why not, indeed. The ABPI seems determined to address this.

This month, Pf spoke exclusively to Stephen Whitehead as he approached the first anniversary of his tenure as CEO at the ABPI. It is clear that, in challenging times for the UK industry as it battles to ensure that patients gain access to life-changing medical innovations, partnership sits at the heart of the ABPI agenda.

“There is a currently a big commitment to move the joint working agenda forward,” says Stephen. “Strategically, over the past 15 years there has been the emergence of many different influences on prescribing – NICE, local commissioning and local formularies are obvious examples. The industry now has to work with a wide variety of stakeholders to demonstrate the value of its medicines. And traditional sales representatives have to work with many different and more complex audiences than they used to when they were purely detailing. Increasingly, I think joint working is the vehicle best suited to satisfy these varying demands.”

Innovation Health and Wealth
The environment for a more collaborative approach is certainly improving. The Innovation Health and Wealth review last December reiterated the need for greater partnership working to help accelerate the adoption and diffusion of innovation in the UK. Crucially, it said that the NHS needed to be ‘open for business’ on partnership. As such, advocates from both parties are working hard to raise the profile (and the benefits) of the approach. But resistance and misunderstandings around joint working remain.

“One of the problems is that there are variable definitions and understandings of what joint working is,” says Stephen. “In simple terms, joint working is a partnership approach focused on solving a patient-driven issue. The industry has disease expertise, it knows how to manage conditions and has developed medicines in those areas. Joint working is about bringing that expertise together with the providers and focusing on patient outcomes. And often we can find cost savings in delivering those outcomes as well.”

Importantly, says Stephen, joint working is not sponsorship. “This is not about industry paying for something. Historically we have funded a lot of things and sometimes there is a real benefit to us bringing money to the table. But this is about changing that perception. Partnership is where two parties, with different strengths and weaknesses, come together to focus on a shared goal. In this case, that has to be patient care.

“The fundamental issue is about recognising the value of innovation and its implications for a pathway of care. By working together to find out how these medicines can be used appropriately, we can save money in the system, we can prevent unnecessary and costly hospitalisation and we can improve patient care.”

Medicines in the middle
In recent years, discussion has focused on whether UK pharma companies should reconsider their product-centric approach to customer engagement, and concentrate instead on developing services with the NHS. The caveat being that a specific medicine would form the core part of any service. But joint working is not an exact science. There is no one-size-fits-all solution – it’s simply about working together to establish the most appropriate approach in a given disease area. “It’s about products and services,” says Stephen. “Some of our members do offer services. But the way I look at joint working is that there is always a medicine in the middle of it – because that’s what we discover, develop and sell. In today’s environment, the only way that the value of that medicine can be truly realised is through joint working that reengineers the pathway of care.”

At present, most joint working initiatives are being built around new innovations – and are being used to redesign services and improve the care pathway. A good example of this is in the field of anticoagulants, where a number of new brands are coming to market. “The new class of drugs have gone through NICE have been recommended and should therefore be utilised,” says Stephen. “Old warfarin clinics should now be closing as patients move onto the new drugs. But to achieve that, and to free up the funds to be able to use the new innovations, we need to take other measures. And you can only do that, in my view, through joint working.

“It is my passionate belief that in most cases, innovative medicines will save money in the system – in the short, medium and long term. We simply need to work together to deliver it.”

Implications for pharma sales
The implications for pharmaceutical sales professionals are significant. While joint working is not always appropriate – aspects such as disease area or where a particular product is along its lifecycle are key factors in whether the approach is applicable – adopting a partnership approach most certainly is. “Joint working is a natural evolution of partnership principles,” says Stephen. “Industry engagement has changed from being a simple seller/buyer transaction, into seeking to work in partnership with customers to ensure the NHS properly maximises the value of medicines. The UK has a low price and a slow uptake of medicine – and as a consequence, the UK system is not as efficient as it could be. It would be more efficient if it adopted innovation more quickly. And if it did, we would certainly have better patient outcomes.

“Joint working is best used when you want to coax the system into innovation. It is not always the most appropriate approach. But whatever you have in your medicine chest, partnership is always applicable. In today’s marketplace, how you approach selling that medicine should always be built upon partnership principles.”

A new service to coordinate 24-hour palliative care in Bedfordshire has been commended for improving patients’ experience during the difficult phase of end of life care.

The Bedfordshire Partnership for Excellence in Palliative Support (PEPS) Coordination Centre is an innovative venture between NHS Bedfordshire, local health and care services and the national charity Sue Ryder.

It is the first point of contact for patients, families, carers and healthcare professionals who require 24-hour advice and support for palliative care.

The service is being piloted across the country and has also attracted national interest. The Centre will host a visit from DH leaders working on an end of life care strategy later this month.

Launched in December last year, more than 360 local people have already registered to use the service.

Sarah Martin-Merchant, Care Centre Manager at Sue Ryder-St John’s Hospice, said that the majority of people like to remain at home during their palliative care.

“The PEPS Service brings organisations together to deliver this care, including that needed out-of-hours, which is in line with patients’ preferences and choices,” she said. 

“By working as a partnership, PEPS aims to minimise the need for hospital admission by providing more end of life care at home and to improve continuity of care for patients, their families and carers.”

UK pharmaceutical companies conducting early stage clinical trials will be able to collaborate more extensively with leading medical academics following the government’s launch of two pioneering partnership programmes designed to accelerate the development of innovative treatments from lab to patient.

The first two National Institute for Health Research (NIHR) translational partnerships – in respiratory and joint-related inflammatory diseases – will give life science companies access to a ‘unique network of top clinical scientists’ in government-funded research facilities, leading universities and the NHS.

The government says the partnerships will also provide unparalleled access to ‘cohorts of well-characterised patients’ – cutting through red tape to speed up the recruitment and testing of NHS patients, and ensuring quicker access to life-changing new therapies.

Access to the Partnerships will be via the NIHR Office for Clinical Research Infrastructure (NOCRI), meaning that when a company wants to collaborate, only one legal agreement is required rather than having to negotiate with each NHS Trust and University.

The new initiative represents an attempt to address a sharp decline in the UK’s reputation as a world-class location for medical research, and also reflect a growing appetite across the pharmaceutical industry to find efficiencies in its R&D model through greater collaboration with external specialists.

David Willetts, Minister for Universities and Science, said the research partnerships would provide a unique model for collaboration between the life sciences industry, the NHS and universities. “They will be a key driver of growth and innovation, reducing the time it takes to translate research into benefits for patients and the economy,” he said.

The ABPI has welcomed the initiative, citing collaborative working with clinical academic investigators as pivotal to the changing model of drug development for the pharmaceutical industry. “Translational Research Partnerships offer an efficient and effective way for companies to work with some of the UK’s leading translational research experts through NOCRI,” said Dr Allison Jeynes-Ellis, Medical and Innovation Director, ABPI. “Companies will see great advantages to working with the partnerships and consequently they will attract ground-breaking research into the UK.”

The government will provide £1.3 million to help set up the first two partnerships; inflammatory respiratory disease and joint and related inflammatory diseases. The NIHR partnership for translational research on respiratory diseases – such as asthma, COPD, allergies, cystic fibrosis and acute lung injury – includes hospitals and universities in Northern Ireland, Oxford, Manchester, Southampton and London. The partnership in joint and related inflammatory diseases, such as rheumatoid arthritis, osteoarthritis, and synovitis, includes Barts and the London NHS Trust, the University of Birmingham, UCLH and Cambridge University.

Terms of the partnership are likely to include identifying more efficient ways of tapping into suitable patient groups for clinical trials, and unlocking funding beyond life science investment in exchange for shared intellectual property rights for any breakthrough discoveries.