Dying young used to be a compulsory sacrifice for rock and roll ambassadors. Within a melting pot of torment, swimming pools, sex addiction and peanut butter, Pf’s lead singer John Pinching discovers the large consignment of pharmaceutical drugs that helped usher many of our most notorious hell-raisers into the abyss.

Hot damn it, what was God up to between 1969 and 1981? Brian Jones, Jimi Hendrix, Jim Morrison, Elvis, Keith Moon, Sid Viscous, John Lennon and Bob Marley – the greatest rock stars of all time – were condemned to exist as ‘footage’ for eternity, meanwhile Cliff, Rod and Elton all reached well over 100 years of age. What the hell were you thinking of, big guy? While we wait for God to return my call, let’s see which of our long-departed friends checked-out with their fingers in the medicine cabinet...

Jimi Hendrix (1942-1970)

A guitar player from, not god, but ‘the gods’. Tartarus, Eros, Neptune and friends combined to produce the most naturally-gifted, dirty, flaming, freaking-red-hot guitarist in the history of mankind.

The instrument wasn’t an entity – it was an extension of his being. Consequently, Jimi’s story is one of pure rock and roll. Put it down to experience; the Jimi Hendrix experience, if you will. Even today, hits such as, ‘All Along the Watch Tower’, ‘Voodoo Child’ and ‘Hey Joe’, have a much more contemporary, exciting and gnarly edge than the current torrent of anodyne pap music.

The coolest thing my mum ever did was to watch Hendrix play live. It doesn’t matter how many tenuous links to Jimi Hendrix I make in Pf, I’ll never top my old lady’s boast. Cruel, cruel world. Cruel, indeed – by the time mum had removed the daisies from her hair, Jimi was gone, forever. Not even one of his wonderfully elongated guitar solos could stave off the eternal dance of Dr D.

The year was one thousand, nine hundred and seventy. Hendrix was in London, with companion Monika Dannemann, and had spent the last day going into drug-induced orbit. When Jimi finally decided it was time for bed – still wired from the relentless conscience-rousing amphetamine – he ingested a massive dose of sleeping pills, using a fatal ‘balancing out’ theory. The combination of barbiturates and red wine ensured he eventually went to sleep, but also that he would never play the guitar with his mouth, or any other part of his body, ever again.

Exactly how he came to pass remains the subject of fierce debate, as Dannemann’s version of events has always been considered unreliable. She claims that, when riding in the ambulance, on the way to hospital, Hendrix was alive. Paramedics, however, insist that she wasn’t even with them in the first place.

Hendrix had been in the prime of his musical life burning brightly, like one of his ignited guitars, before disappearing in a purple haze.

Elvis (1935-1977)

It should be noted that, by the late seventies ‘The King’ was way past his sell-by date, and eating a dozen cheeseburgers every hour (lovingly prepared by a full-time chef who, in addition to a deep-fat fryer, travelled everywhere with him).

Bloated, sweaty, and attired in truly horrendous ‘jump suits’, Elvis was now being paid a fortune to sing ballads on the ‘hotel circuit’. He had become a shadow of the young, handsome and dangerous rock star of years gone by, and it was almost impossible to believe that the same person had once belted out ‘Jail House Rock’, while leaping around a mocked-up state penitentiary.

As he tried to wrestle control of his life, and come to terms with an extraordinarily passionate and global fan base, Elvis took solace in calorie-rich junk food; once consuming 150 deep-fried peanut butter sandwiches in 24 hours. His other bad habit came in the form of a gargantuan dependence on prescribed drugs, and he frequently indulged in polypharmacy, which refers to an individual abusing a cocktail of substances. In his case it was a relentless orgy of self-medication.

For a man who had once performed with such electrifying and groundbreaking energy, the spiral into dependency was as long as it was pitiful. The early to mid-seventies were punctuated by barbiturate overdoses and Demerol addiction, while his short concerts became ‘freak shows’ during which Elvis was static, badly dressed and incoherent.

As he became increasingly reclusive, Elvis was only able to consistently numb himself by relying on a rogue doctor who, during 1977, lavished him with a whopping 10,000 doses. On August 16 of that year he was, unsurprisingly, discovered dead in his bathroom.

It is widely accepted that the staggering pharmacopeia of 14 substances found in his system, had resulted in a massive heart attack*. Although he was religiously worshipped until the bitter end, it is perhaps best to remember Elvis as the snake-hipped, velvet-voiced Memphis master, largely responsible for creating modern rock and roll.

*Some particularly deluded fans insist that Elvis is very much alive. Sightings include, ‘on a mobile phone in a Milton Keynes branch of Burger King’ and ‘perusing the adult section of a library in Alabama’.

Michael Jackson (1958-2009)

He died as he lived... with a fully operational fairground in his back garden. Boy, those electricity bills can be a killer. It’s not just pensioners in Dundee that fall into fuel poverty, you know.

Michael Jackson was part of the ‘Jackson Militia’ of the 1970s. They were a finely trained, finely tuned, finely choreographed battalion of infantile pop professionals, known as The Jackson 5 or The Jacksons (depending on whether their number had decreased or increased above or below the ‘5’ threshold).

When ‘Jacko’ decided to leave the Jackson barracks, his siblings; Tito, Jermaine, Glenda, Marlon, Janet etc, were left to fend for themselves, as the most talented performer in the history of pop went hit-single crazy. His holy trinity of albums, Off the Wall, Thriller and Bad, were bought by every man, woman and child on the planet, making the Jackson allowance of old look like pocket money (which, of course, it was).

Meanwhile, however, Michael was doing strange things. Indeed, he became, perhaps, the greatest ever example of success going to someone’s head (or in Jacko’s case, his face). Friendships with primates, sleeping in an oxygen tent, frequent visits to the plastic surgeon, wearing gold pants over his trousers, marrying Elvis’ daughter and exorbitant shopping sprees crystallized MJ’s status as pop’s number one curiosity.

After Bad, however, Michael’s odd behaviour started to impinge on hitherto reliable musical sensibilities. His unsettling penchant for ‘sleep overs’ were beginning to get press attention and inevitably stories of improper pyjama parties began to emerge. Several court cases followed and money – lots of money – changed hands.

With huge legal bills, and his reputation in tatters, MJ still managed to command a huge legion of disciples, many of whom went to extreme lengths in order to replicate their hero’s bizarre appearance; moonwalking around in bubbles of unconditional devotion.

After years of living in his own reclusive fantasy, MJ’s days were spent spinning around (quite literally) on a carousel of mind-blurring, creativity-dampening medication. Finally, while bed-ridden and under the influence of benzodiazepine and propofol, he suffered a fatal cardiac arrest. The physician that administered the deadly dose is currently serving a four-year sentence for involuntary manslaughter, which is nice.

The Hotel Russell, Bloomsbury, sets the scene as Detective Inspector Pinching pulls up two tan leather armchairs for another caffeine-laced exchange. The man he’s facing is GSK’s Director, Academic Liason, CBE and Harry Redknapp-tormentor, Malcolm Skingle.

It’s bloody freezing. I need a chat that’s going to warm my cold editor’s heart. I arrive, and an incredibly enthusiastic woman leads me into the upmarket reception room of this legendary bed and breakfast establishment. Malcolm has the relaxed expression of a man who has stayed in practically every hotel on Trip Advisor. It was time to talk about football, erm, I mean pharma.

Hello Malcolm, what’s your story?

I trained as a pharmacologist and this defined the first half of my career, before I eventually started running a research group. I was fortunate to be part of a great department and during my time in the labs we discovered and developed some ground-breaking medicines including, Zantac, Trandate, Salbutamol, Salmeterol, Imigran and Zofran. After 20 years of bench science, I went to work at the interface of academia and industry, and this is an area I now know well. In the past the interactions between universities, medical schools, funders and pharma were clunky, and the challenge has been to vastly improve these vital relationships.

What exactly does your job involve?

I leverage science that helps underpin what GSK is doing. That might involve a technology that the company needs to drive one of its programmes, or talking to the head of a funding agency about working together on a certain scientific topic. I’ll form collaborations with anybody, either carrying out or funding good science; this includes government departments, charities such as the Wellcome Trust, the research councils and universities. We have academic collaborations in around 50 UK universities and interact with educational institutions in over 25 other countries.

How has your role changed over the years?

Universities and pharma companies are now far more open to collaboration. Twenty years ago big pharma would work in secret and not share information and best practice. We used to be fat cats, and money wasn’t an issue, but things have changed quite dramatically as companies try to get their research budgets to stretch further. We now work together in consortia, underpinning in-house efforts. The Structural Genomics Consortium, Dundee signalling consortium and EU Innovative Medicines Initiative are all collaborations where several pharma companies fund joint projects and share information. This type of activity will increase in the future as we collectively create the new knowledge required to develop new medicines.

What is your relationship like with the ABPI?

I sit on the Innovation Board and chair their academic liaison group. GSK takes the lead in several areas and we use it to share best practice. Pooling knowledge and data is positive for the industry.

How pivotal is the ABPI’s role in terms of reform?

They’ve got big responsibilities when it comes to collating messages from different pharma companies, who may not always have identical views on certain topics. Stephen Whitehead works hard to collate and articulate a consensus view.

Where do you stand on Ben Goldacre (metaphorically speaking)?

I’ve never met him, but I’d like to. The industry gets a bit beaten up in his book, but I do agree that we need to build greater trust with both the public and media. You need radicals like Ben Goldacre to make people rethink certain issues. I joined Glaxo straight from school; did my degree and PhD through the organisation and, in 40 years, I can put my hand on my heart and swear on my children’s lives, that I have never seen anything unethical.

How important is transparency and sharing information?

Companies are at different stages of wanting to share. Our Chief Executive, Andrew Witty, is a great leader and the sort of guy you would follow over the wall into battle. He was the first pharma chief exec to say that we’re going to publish all our clinical trial data. Some other companies aren’t quite there yet, but I am sure they will come around in the near future. It is vitally important to share data with other scientists, so that it can be validated.

GSK seems like an organisation that likes to be ‘out there’

We’re easily the most visible pharma company at the academic-industry interface and we have more collaborations than anyone in the country. This includes, not only pharma, but also companies from other sectors like aerospace and energy. Every two years the ABPI collect the data from all UK pharma, and GSK publish it. Part of my mission is to go around talking about what we do and I am passionate about GSK being transparent, our great science and being a good partner.

What partnership venture are you most excited about?

We’ve got an open access lab in Tres Cantos, Madrid, working on diseases in the developing world. This includes high containment facilities for pathogens, 120 GSK scientists and the capacity to take an additional 60 outsiders. The open access agreements mean that if someone has a bright idea for treating malaria or TB, for example, you can go there and have access to our chemistry and drug development technology. We’re serious about making a difference.

What successes have emerged from this project?

Five of our scientists screened two million compounds, by hand, in order to find leads against the deadliest malaria parasites. We then published a database last year containing all the 13,500 structures, which anybody can access as potential leads. Over 80% of these were proprietary and discovered by GSK. We want to share, as we can’t possibly carry out all the science connected with something like malaria on our own, so we stimulate interest in order to take a drug through. It’s been so successful that MMV (Medicines for Malaria Venture) has provided our compounds to more than 100 labs around the world. People feel proud to work for the company because of that.

Tell me more about what you’re doing with the universities

The most fruitful thing we do is post-doc collaborations that involve intellectual inputs from both the academics and us. We will also, at any one time, have around 250 PhDm studentships, which we co-fund with the research councils.

Are GSK keen to continue operating in the UK?

We’ve got a chief executive who is British, he’s Chancellor of Nottingham University and we’ve got our headquarters in Brentford. Does that sound like a company that’s just about to bugger off to New Jersey?

Malcolm, you’re clearly on the road a lot how do you strike the old work/life balance?

My wife is very understanding – I earn reasonable money and she’s good at spending it – and I’ve got two wonderful daughters. I love sport and used to play semi-pro football in the Isthmian League, and that has helped me to apply myself 100% to everything I do.

Hold on, who did you play for?

Firstly, Bishop Stortford – my home town – then Borehamwood for six years, before the company moved me to Greenford, and I joined Kingstonian. When they moved me back again, I played for Hertford. We had a few cup runs at Borehamwood, drawing at home with Swindon Town in the FA Cup, and losing the replay 2-0; we also won the league with 103 points. I don’t think that total has ever been beaten.

What position did you play?

I was a winger and also used to score goals, playing off a big man. When I got slower I drifted into central midfield.

Did you encounter any big names?

Yeah, I would regularly play against people, either on their way up or coming back down, like Gordon Hill, who was at Southall and went on to play for Manchester United and England. Sometimes I think I’m dreaming it, but when Bobby Moore finished playing and West Ham more or less dumped him, he managed the Oxford City team that I scored against. I remember it was pouring down with rain that day and Harry Redknapp was playing for them, just before his managerial career took off.

With the NHS in flux, there has never been a better time for joint working – but pharma might need some help to negotiate the new relationships. Pf looks at the key role of third parties in bringing industry and the NHS together.

Pharmaceutical companies in the UK might be forgiven for wondering if this is really the right time to engage in joint working (JW) projects with the NHS. There seem to be a few questions in the air. What is the NHS now? Who is making decisions there? What are the real priorities? Going into partnership with the NHS might seem like dating someone with too many unresolved ‘issues’ for it to stand much chance.

However, if you keep your nerve, there has never been a better time for JW. The combination of profound structural change and austerity budgeting means that the NHS badly needs support – and the need for healthcare to shift its focus from acute to chronic illness means that the right ways to transform the care pathway are at a premium. Suddenly that mythical bird of business transactions, the win-win, has to be real.

But the opportunities for partnership are highlighting the culture gap between pharma and the NHS. Meeting on the internet and getting married on the run may be romantic, but it won’t lead to a sustainable relationship. The partners need to learn each other’s language, meet each other’s family. This is where mediators and consultants can really make a difference by providing expertise and experience.

Pf talked to two companies that are actively involved in guiding and building JW relationships – one as a facilitator, the other as an active participant. Three common points emerged from their perspectives:

1. The major changes in healthcare in the UK are creating opportunities for pharmaceutical companies to work in partnership with CCGs, local authorities and providers.

2. The payoff for the pharma company is in terms of better medicines management, leading to the company’s products being used more widely and effectively.

3. Realistic mutual understanding is critical for JW – no amount of rhetoric about values and beliefs will help unless there are shared objectives and ways of working.

Embracing the unknown

Chris Morgan of ZS Associates argues that JW does not come easily to either side: “A true appreciation of the value of partnership is still fairly rare, within both pharma and the NHS.” For years, ZS Associates has emphasised the critical importance of key account management for pharma. The current NHS reforms and the development of the JW agenda have strengthened this argument and underlined the consultancy’s role as a thought leader for pharmaceutical sales and management.

“The established relationship between pharma and the NHS can be pretty toxic,” Morgan says. “ There isn’t a whole lot of trust established there. Before we can partner, we have to earn that trust.” He gives the example of a company ZS worked with that had spent six months piloting a new service idea with a PCT. “The PCT loved it, it worked well for the company, the patients loved it – and then they packaged it up and gave it to all their other account execs to sell, and a year later they had sold none.”

Why was that? “The first time they sold it, they thought they were developing a service – but what they were actually developing over six months was the trust required for the customer to buy that service. Then, when they showed up to every other PCT subsequently, the response was ‘Who the hell are you?’”

Too often in pharma, ‘trust’ is interpreted as meaning ‘goodwill’. That might work when the culture is the same on both sides, but between pharma and the NHS it won’t hold. Morgan explains that without clear mutual understanding “it’s not clear who is living up to their end of the deal, and it’s not even clear to you whether you’re living up to what the other person perceives as being your end of the deal.”

In addition, he argues, “those circumstances for partnership where it’s clear that everyone has something to gain end up being easier to defend, and more ethical, than those JW situations where there’s no apparent gain for the pharma company.” If a company sponsors an initiative in a therapy area where it has no products, two questions arise: does the company have the expertise needed, and what are its motives? JW has to be about “genuine mutual interest”. Quid pro quo agreements are not only non-compliant, but make no business sense: “I can sell you £10 notes for a fiver all day. There is no rational economic reason why you should reciprocate to a value greater than what I’ve just given you.” JW has to generate value, to the objective benefit of both sides.

Another key issue is defining who the customer is, and here Morgan illustrates the value of the KAM approach. “Too often we try and define the customer as being the doctor, the patient or the payer – but the only time you find genuine mutual value is when you think about all three stakeholders together.” Pharma companies need to involve providers as well as commissioners in JW projects, since the most successful providers “are actively going out and engaging with commissioners” to redesign care pathways – and thus are already on the JW road.

The best JW projects, Morgan says, often involve “care pathway re-engineering”. An area ripe for partnership is diabetes care, as its problems are well-known: poor service integration, poor medication compliance, high levels of complications. The JW opportunity is for the pharma company to help commissioners and providers improve care by improving diagnosis, monitoring or compliance, thereby reducing complications and hospital admissions. “The pharma company benefits as well because its product is used earlier, more persistently or in a larger or more appropriate group of patients.” The win-win is not only real, it is flying.

A time of change

Karen Bell, Business Manager at Ashfield In2Focus, argues that a window of opportunity exists now for pharma in terms of JW, and that there’s no time to waste. Ashfield In2Focus provides a range of services to pharmaceutical companies to help them develop and implement JW relationships with the NHS. Most importantly, it provides quality healthcare development managers (HDMs) and key account managers (KAMs), many of whom have NHS backgrounds, to mediate between the two sides and facilitate the process.

There are three reasons why this is a crucial time for JW, Bell explains. Firstly, the drive towards more patient-centred care, the QIPP agenda and the increasing role of private provider competition are all making the NHS engage with industry in new ways. Secondly, the Department of Health and ABPI guidance around JW have made the NHS “less nervous about working with industry and more open to win-win types of partnership”. Thirdly, its new emphasis on innovation has made the NHS more aware of its weaknesses in that area, and more ready to involve people with different experience.

The focus of JW projects is closely linked to the NHS’ need for increased patient throughput, especially in primary and community-based healthcare. “Typically the JW projects which we tend to see succeeding are in CHD, diabetes, women’s health, mental health – really any long-term condition, and also where there’s a drive to keep patients out of hospital” – while “for the sponsoring pharma company it means more patients going into the total patient pool for their product”.

However, the current business climate does not reward risks. Aren’t those pharma companies who decide to wait until things settle down being sensible? Bell’s response is emphatic: “They’ll miss the boat. Because we are now in a time of change or flux, with innovation and efficiency high on the agenda, the NHS is very open to hearing about and indeed engaging in new ways of doing things. Those pharmaceutical companies who go out there and talk about these initiatives now, and those NHS organisations who engage with them, will be the ones who will capitalise in the longer term.”

Even so, why is a mediator needed – isn’t that one partner too many? Bell argues that as a service provider already working with the NHS and industry, Ashfield In2Focus is a key link between the two cultures. It provides experience of working on both sides and knowledge of the regulations around the provision of NHS services. Any service it provides is backed up with the necessary documentation to “protect the NHS, the patient and the pharmaceutical company”.

In addition, Bell argues, Ashfield In2Focus is well placed to bridge the culture gap between the NHS and pharma: “When our HDM teams talk to an NHS customer, they can often be having a peer to peer conversation, and that facilitates the whole partnership process, building engagement, mutual understanding and trust from the start. As many of them have come from that background (we employ a number of ex-commissioners or Department of Health personnel), they understand the world of the NHS, and they can more effectively identify and implement a solution.”

JW projects require the right people to engage with “the new NHS stakeholders” and “to develop and carry through these initiatives and make them sustainable”.  They also need to be able to influence local authorities and Health and Wellbeing Boards, and to “talk coherently around the joint strategic needs assessment process”.

In classical mythology, Hermes was the messenger between worlds. Bell uses a similar image: “People sometimes see our staff as being one step removed from pharma – working for us on behalf of a pharmaceutical company, but not directly for them. Our nursing services are a perfect example of this.” In addition, she says, Ashfield In2Focus attracts and recruits quality personnel for these roles, through its vast database and network of contacts, by offering a permanent contract of employment to potential employees in uncertain times – reafirming the value of the third-party role for pharma and the NHS.

When I arrive at our agreed location (14 minutes early), I notice that the PM Society’s Anneliese Cameron (General Manager) and Carys Thomas Ampofo (Communications) have already had a coffee and been perusing the last two editions of the rebooted Pf mag. It’s a relief to know these ladies are alert and of uncommonly good taste. As I undrape my burgundy scarf, I realise that I am on the threshold of something rather wonderful. I order more coffee (the card machine is broken and the till guy is unapologetic – I rise above it) and begin the interrogation.

What do you think of the relaunched Pf ?
Carys: How much are you paying us?
As much as it takes.
Anneliese: I think it’s really refreshing to see a pharma mag with a consumer feel to it, and it’s lovely to focus on individuals. It’s got a real community feel.

Enough about me. What role will pharma play, as reform starts to unfold?
Carys: There are opportunities for all the healthcare industries to really help the reform process by not just providing and supporting treatments, but bringing experience from the private sector in order to understand processes, especially at a local level and with joint working.
Anneliese: It’s all about perception and, ultimately, we’re all patients. In the mainstream press there is a lot of negativity but, actually, pharma does a hell of a lot of good and that will continue to emerge in the next few years.

What does pharma need to do, in order to start hanging out with the NHS on equal terms?
Carys: Pharma needs to get smarter. Pharma personnel have to establish the same level of knowledge as the people they are talking to within the NHS. They must understand local needs, the role they can play in improving patient outcomes and how their product might fit into the bigger picture. One of the biggest challenges in the UK is where companies are expected to deliver campaigns that have been developed at a global level. There is no such thing as one size fits all now.

What is the PM Society doing to help people improve their performance?
Anneliese: The PM Society has undergone a period of modernisation in the last 12 months. It has identified some key areas of healthcare marketing that are hot topics at the moment, including market access, NHS partnerships, personal career development, digital platforms and patient engagement. With an interest group in each of these areas, led by an expert in the field, we are looking at providing the information, content and education which tackles those challenges. The role of today’s marketer has changed; there needs to be a much more fundamental understanding of all aspects of the industry, whatever role you work in.
Carys: It’s really important to get everyone that is involved in the drug development process switched on to health technology and marketing needs early on in the trial stages. You will then get the information that is appropriate to support the product, when you actually bring it to market. When the marketers at a national or global level release promotional material they also need to appreciate that the sales rep needs flexibility in how they canvas the information. This requires a significant cultural change.

Can changing a company’s ethos get results?
Carys: The most forward-thinking companies I have worked with in healthcare communications are those that bring everyone around the table, as part of a brand planning team, allowing contributions from all areas of the business and developing a strategy that suits everyone. I worked on one project with Daiichi Sankyo where this approach was put into practice brilliantly.
Anneliese: Yes, they’ve also really embraced info-sharing technology and all its sales staff have an iPad. It’s about presentation; doctors like to see how medication actually works, and what the benefits are for their practice and patients. This is much more exciting if it comes from an iPad rather than a flip chart. These days marketers need to be digital pioneers.

What have been the notable landmarks for the PM Society in the last year?
Anneliese: Personally speaking it would be taking the role of General Manager; a position that the PM Society has never had before. The organisation has been around for 30 years, but it needed to change from primarily a social entity into a forwardthinking, innovative organisation with a solid grounding in business.
Carys: It was a question of drawing a line in the sand, saying, ‘how can we meet our members’ needs in 2013, not 1983’, and preparing the Society for the next 30 years. We now offer greater flexibility, more visibility and, since 2005, marketing-specific modern training programmes, which really make a difference.
Anneliese: In the past we were perceived as bit of a club. But now we are a valued, completely independent organisation run by a voluntary executive committee and dynamic office team.

Do pharma employees regard the PM Society as a support system for their development?
Anneliese: Very much so. We are a none profit organisation, so they don’t feel like there is any pressure from a corporation. We provide impartial advice without charging a fortune for events and content. For me, it’s about making a positive difference during this exciting new phase. Members will also benefit from a partnership agreement we have just signed with the ABPI, which recognises the opportunities to communicate with pharma professionals at all levels.

Your recent market access gig, which I attended, was refreshingly enthusiastic about the possibilities of joint working and breaking down boundaries.
Carys: The meeting was a great example of how the PM Society can help pharma companies develop their skills to meet the changing market. The key experts and experienced speakers from the NHS made pharma employees start thinking about the possibilities of working with public sector colleagues. People attending definitely demonstrated a desire to form positive partnerships; they want to make things happen. It’s also about spreading the word, because inspirational partnerships between the NHS and pharma companies are already happening.

Your awards tend to recognise companies that have demonstrated positivity and teamwork.
Anneliese: The Advertising Awards are about creativity, but it’s also deeper. We examine the campaigns and look at what the outcomes were for both the companies and patients, and how effective those campaigns were in capturing public imagination and making a difference. We also have the only healthcare-specific Digital Media Awards, which last year saw a 30 per-cent increase in entries.

What nuts are you looking forward to cracking in the next 12 months?
Anneliese: I want us to dig deeper into pharma and raise awareness, not to a few individuals in a company, but the entire workforce. We’re very ambitious about creating a real community, which embraces all areas of healthcare. We’re also really keen to introduce ABPI members to our services.

Right ladies, I’m bringing the tone down. You both have high-pressured jobs, what do you do to relax?
Carys: I don’t really have much time to relax! I have three daughters, of six years and under, and have also found myself Chair of the Parent Staff Association (PSA) at their school.

Is that much different to the the PM Society?
Carys: Yes, but the politics are 100 times worse! Being a mother is very much part of who I am; it’s a really difficult balance, as a working woman; giving quality time to your family and also working productively. Intellectual stimulation is really important; I think I’d go mad if I had to spend every day with my children! In the future it would be great to see more professional flexibility for women.

How do you chillax, Anneliese?
Anneliese: I love rugby. I’m a big supporter of Dorking Rugby Club, who my son plays for. My partner is Welsh, so my allegiances have switched a bit, and last year I went to the Millenium Stadium for the first time, to watch Wales vs Italy [John’s internal voice – ‘Traitor!’] I’ve got two dogs and I love walking in the Surrey Hills. My partner recently launched Tillingbourne Brewery, so I help to promote cask ale in my spare time.

Will you be drinking the profits?
Anneliese: There’ll be plenty of market research!

On that note, do you think it’s important that pharma recruits more people from the ‘outside’?
Anneliese: I spent 15 years in the music business. I worked for Polygram [now Universal], on the classical side, during the ‘Three Tenors’ period. Although I didn’t know much about pharma and healthcare when I started, I knew a lot about marketing. I remember in my first year of running the PMEA, at a reception with Rob Wood (then a director at AstraZeneca). He asked me where I came from and, when I told him, he said, ‘that’s fantastic, we need more people from different industries’. Nowadays pharma is bringing talent from other sectors, and that’s really important, because they provide such a range of different attributes. Marketing, advertising and PR skills can always be adapted to a new environment.

You don’t necessarily need to know the secret ‘pharma’ handshake anymore.
Carys: I think it’s changed for the better, and it’s brought fresh thinking. If you only have people from a regulated system it can hinder creativity. Some of the best people I’ve worked with, in pharma, have come from outside, with fresh, exciting perspectives.

To get involved with the PM Society go to www.pmsociety.org.uk.

Fashion aficionado Sophie ‘sherbet fountain’ Hipgrave releases the male of the species from fashion police headquarters and into the Utopian pastures of panache...

A familiar battle between old and new, tradition and innovation is raging on the battlefield of menswear
collections. It is the alliance of the two, however, that is really going to make your look pop this season. Surrender the battle, because mixing irreverent styles and eras is the only way to really work it.

For a glorious collaboration let’s take the dapper gentlemen of the roaring twenties, the energy of the swinging sixties and the cool of modern sportsmanship.

Gentleman’s relish
Inspired by a new lm based on The Great Gatsby, the ‘dandy’ is self-assured, confident and places exceptional importance on his appearance. No detail was overlooked during this period of unreserved elegance and the same meticulous approach is being replicated in 2013.

The Hackett of London collection takes further inspiration from the Oxford and Cambridge boat race, making the preppy look hopelessly cool. ­The quintessentially British brand sees three-piece Savile Row tailoring take a nostalgic nudge from F. Scott Fitzgerald’s seminal novel. ­The double-breasted jacket works with pretty much anything in your wardrobe, but for work, combine with a commanding shirt and tie. You’ll be the centre of attention at those decadent parties. ­ The ultimate power suit will always show who’s boss in the style stakes.

This trend also allows for decorative detail and snazzy accessories, like a pocket square, a cane or – for the really adventurous – a pocket watch; injecting just the right amount of dapper when convincing doctors about your latest line. A silk necktie or smoking slipper will add an additional element of luxury to your look. Be sure to match the tones in your pocket square to the rest of your outfit – the tie in particular – to keep the look polished. Be evening-ready by swapping your matte suit for a metallic one, as seen at Versace.

It’s the little details that make all the difference, so lose the socks, add a tie bar and have your shirt cuffs fall below your jacket sleeves. Add some cuŽ inks, like these from River Island, £15.

Swing ball
From classic suave to the eccentric mod, make way for dashing prints. If you can’t quite get your head around an all-over print suit by the likes of Wooyoungmi ( find one similar in ASOS), test the water with a clashing shirt and tie. Look to Tom Ford for winning combinations and, above all, be brave.

Prints are the perfect transition from a dull winter to a vivacious summer and this season they are floral, microscopic and geometric. The Gatsby influence introduced checks, and Lacoste went dotty for spots. ­ The feel is fun and energetic. Ensure you’re appropriate for the office in clean, tailored lines. A white polka dot shirt is the way to ease your way in. Come May, you’ll have bought the red and blue too.

If prints aren’t for you, try a look Andy Warhol would be proud of, by rocking a contrast collar, like this one from Marks and Spencer, £39.50.

The contrasting vibe means stripes are back, in both nautical and mod styles. Emphasise your chest with horizontal stripes or try the leg lengthening stripe as seen at Prada.

Inject some youthful cool into your look with bold or patterned accessories. A flash of neon will give a nod to sportswear, while your choice of print will determine the man role you want to play. Go for grown-up panache in paisley, classic in stripes or quirky kitsch in polka dots.

Sport for the day
The punchy feel of the season is highlighted in the solid colour blocking we saw at Paul Smith. Imagine a look favoured by the yacht-owning, Hampton-summering, cocktail-drinking elite. Sportswear has upped the ante, but gone back to basics in primary colours. Set sail with some boathouse high life, contrasting jacket and trousers in bold block colours or team a popping hue with beige. Top off with a boater.

It comes as no surprise that with the turn of the season there comes the nautical pursuit seen at Tommy Hilfiger, Louis Vuitton and Michael Kors. This time, it’s less sailor, more Oxbridge.

The flags are down, but the red, white and blue is here to stay. When high summer arrives, take to the courts in head-to-toe white. Or, if it doesn’t bother (we are in England, after all), test the trend in a cream
suit, like we saw at Canali.

If you fancy venturing a little out of your comfort zone, opt for a pair of Bermudas: the key short shape this season. Lou Dalton has nailed this trend. Her models wore them above the knee and tailored. Team with a tie, jacket and loafers to show off some calf in the short suit.

The unpredictable English weather means parkas, macs, cagoules and trenches will always be a summer necessity. These classic shapes have taken on colour for 2013. J.Press’ orange raincoat and three-piece pinstripe combination shows how to mix two unabashedly cool styles.

American dreams
Although preppy has upped its game this season, the fifties jock still rules the school for casual wear. Embrace the denim dress shirt; pair with a printed tie and tailored jacket for an unexpected combo that works in the boardroom, straight through to the weekend.

Take your office look to after-work drinks by swapping brogues for statement trainers, as seen at Viktor and Rolf, or your jacket for a bomber. Choose one with subtle military detail to sharpen up even further. A white or cream brogue will add urban luxe to your suit without you having to sport a trainer.

The artist
While some take delight in the preppy high life, there is a seductive bohemian feel when revisiting a joie-de-vivre era. Influences range from Picasso and Matisse to today’s downtown New York art-dealers. Fine knitwear is draped over shoulders, layering is key and vivid tones and patterns are mixed with muted hues. Team plain separates with a vibrant jumper, tie or belt and take a nonchalant stroll to the river bank. Look to Raf Simons’ and Hackett of London for inspiration.

Adding a brightly coloured jumper will spruce your look into spring and keep you warm from the lingering winter chill: the perfect transitional piece. If you’re not a fan of ties, never rule out the powers of a printed scarf. In silk or cashmere, wear as a necktie, draped over your shoulders or between your shirt and jacket. Outside or in, it makes a commanding style statement.

Most palatable
This season Sou’wester yellow and cobalt blue have brought catwalks alive, while ice cream pastels offer a relaxed feel. It seems sun, sea and weekend getaways are leading the flash-pack to victory.

In a defiant response to years of snobbery, blue and green can finally be seen in the form of navy and olive. Experiment with colour blocking and this colour combination makes for the perfect casual smart look, wherever you are.

Style council
Accessorise with a long, sturdy umbrella, leather pouch and sunglasses. Always button your shirt up to the top and tuck your shirt in. The feeling is more relaxed this season, but don’t mistake for messy. Even hairstyles are tidying up. Spit and pull anyone?

Smart and casual collide to great effect this season, allowing different ends of the style spectrum to come together to form the modern, confident man. For best results, work it with unexpected detail, a futuristic spin on classics and a hint of nostalgia.

Be brave and bold in colours and prints, but sharp and polished in shapes. It’s not just about being a smooth operator; it’s about being too cool for skool. Remember, this season is definitely for the peacocks, not the pigeons, so stop loitering around bins and start showing your feathers!

We look back through the pages of Pf at what was happening in the pharma industry and the world five years and ten years ago.

February 2008

The Earth moved for thousands of UK pharma sales professionals in February 2008, but not on Valentine’s Day. The biggest earthquake in 25 years shook buildings at night, injuring a few people and scaring many. Kosovo’s declaration of independence led to political earthquakes in the Baltic region. And in the first tremor of the banking crisis, the UK government was forced to nationalise Northern Rock. In the cinemas, a woman with transplanted eyes saw the dead and gangsters ran but couldn’t hide in the grey streets of Bruges. Musically it was a month of soul, with a new Donna Summer album and Duffy’s happy handbag classic ‘Mercy’.

February’s Pf encouraged its readers to get to grips with the rapidly evolving NHS market, with articles on the new commissioning framework, practice-based commissioning and joint working. Industry insider Brad Abbey said the regulatory environment was throwing sales professionals to the “gladiators” of a hostile market. Professional development articles dealt with redundancies and job applications. Industry news included a parliamentary report encouraging the use of generic drugs; investigations into illegal patent protection by pharma companies; and the launch of a new class of HIV drug in the UK.

Pfizer used the February Pf to talk about its evolving field organisation, with new initiatives in account management giving the company increased traction with customers. VMC described the “strategic commercial and operational consultancy” it had developed to help pharma companies build the skills base they need. Star explained why its partnership with Nestlé Nutrition was the cream in the coffee of the latter’s UK sales operation. ACHiiVE discussed the industry’s learning and development needs in unstable
times.

February 2003

In February 2003, with the invasion of Iraq less than a month away, over a million people marched in London against it – the biggest demo in the UK’s history. Experts exposed the dossier of ‘critical’ intelligence information about Iraq issued by the UK government as a ragbag of material copied from old sources. The return of the past disturbed the month’s cinema, with films about a haunted videotape and a haunted planet. There were more ghosts in a song of forbidden love from Russian female pop duo t.A.T.u. that topped the UK singles charts.

The lead article in February’s Pf was a guide to getting into medical sales, with tips for newcomers and questions they should ask themselves – e.g. “Can I deal with the rejection from customers?” A feature on ‘shadowing’ explored the pros and cons of this complex approach to training. NHS articles discussed the new nurse and pharmacist prescribers and provided a guide to the corporate structure of the NHS. Our news section featured the “rampant epidemic” of drug counterfeiting, the worsening shortage of GPs in the UK, and the launch of the first approved treatment for acute stroke.

A new feature, ‘Appraisal Evidence’, offered readers 20 questions to test their knowledge of a professional area – in this case, the workings of PCTs. Repeated high scores in these tests could earn readers a Certificate of Achievement in CPD that they could present at a future appraisal.

Eli Lilly introduced its new ‘Business to Business’ team to support managed entry for drugs into the UK market by building commercial relationships with NHS organisations. Napp described itself as a “family owned pharmaceutical business” whose culture inspired loyalty while demanding expertise. Contract sales organisation In2Focus explained its goal of providing experienced, innovative professionals to pharmaceutical companies outsourcing their sales operation.

When the melting pot of NHS reform is divided into regions for the purposes of constructive debate, suddenly it seems like a battle that can be won.

If Darth Vader and Luke Skywalker had sat down in a bar – perhaps the one in Mos Eisley – to discuss how
the Dark Side and the Rebel Alliance could work together, a great deal of heartache and destruction could have been avoided. The NHS and pharma find themselves in almost precisely the same predicament as those guys, except that this isn’t a galaxy far, far away – it’s NHS reform and it’s happening on planet Earth.

Pf Insights is a space-hopping force for good and, over the last few months, it has been travelling through the known universe, galvanising relationships between two very different civilisations – the NHS and big pharma.

Voices of the revolution

During the first Pf Insights tour of duty, one thing became quickly obvious – people wanted to open the channels of communication. There was a genuine feeling that people were passionate about getting healthcare transformation moving.

The trial gigs – including shindigs in London, Newcastle, Walsall and Bolton – were rolled out in order to find out how responsive the two parties were to constructive dialogue and whether such meetings could assist with the germination of effective joint working. It was also an exercise in establishing exactly what the best platform for these forums would ultimately be.

For these initial meetings, we combined speakers who had vast NHS experience – and who also understood the ambition, challenges and infrastructure of private sector companies – and a combative pharma industry audience. These tailored presentations were designed to trigger debate and, on several occasions, it worked. Representatives from the biggest pharma companies in the land enthusiastically seized the opportunity to air their questions, concerns and opinions about the biggest NHS shake-up in 50 years.

Many of the points raised were pivotal to the success of the reform bill, and those on the front line of pharmaceutical drug sales were anxious to hear about how their products could be integrated into an historically protective NHS, and what it would take to generate the cultural changes necessary for positive
partnerships.

Many of the audiences contained straight shooters who simply asked, ‘is it going to be easier to access
NHS decision makers?’

As these conversations unfolded, it was clear that the old rhetoric about public-private unisons had been
replaced by candid and passionate debate about making change a reality. This was about embracing
a brave new world in which a proud industry and a much-loved institution co-exist in harmony.

Path to glory

As the shoots of NHS reform appear the only way forward is to keep encouraging these galvanising
conversations – not virtually, or even over the telephone, but face to face. This is why Pf has decided to embark on a second tour of duty – bringing forums to people throughout the UK.

Ports of call this time include the East Midlands, Bristol, London, Bolton and Newcastle. The variety of locations will give everybody the chance to get involved, have their say and make a difference in the ever-evolving healthcare landscape.

The speakers will, again, provide a unique insight into the NHS, from both a national and a regional perspective. Take the Pf Insights trip and let the force be with you...

The end to the ‘postcode lottery’ will have to wait a little longer. Hopes were raised earlier this year when the Department of Health unveiled plans to introduce an ‘innovation scorecard’. The scheme would prevent hospitals blacklisting expensive drugs recommended by NICE. Patients, regardless of their location, would be able to receive the latest treatments without delay.

The DH initially planned to have the scorecard “fully implemented by the Autumn.” But, after discussions with the NHS and the pharmaceutical industry, it now looks likely that the scorecard will not be in place until the end of the year.

Speaking exclusively to Pharmaceutical Field, a DH spokesperson said talks were still ongoing between the health service and pharma to “collect all the data and information needed to ensure the scheme is accurate and effective. It will be launched in the coming months.”

The new scheme is expected to work in three different ways:

1. The innovation scorecard will allow patients and the public to see which NHS organisations have adopted the latest NICE guidance on recommended drugs and treatments.
2. The NHS will no longer have an excuse not to provide patients with NICE recommended products. Treatments recommended by the Institute will now be automatically added on to local formularies, allowing doctors to prescribe more expensive treatments if they wish.
3. A new group will be established to help the NHS overcome any barriers when implementing NICE guidance. The introduction of new medication or treatment may mean big changes in the
   way services are delivered. The group aims to spread best practice across the health service.

The DH added that NHS Trusts receive funding for each new NICE appraisal, so financial issues should not be used as a barrier to the uptake of innovative new treatments.

Speaking when the details were first announced in late August, then Health Minister Paul Burstow said the “new regime” would be a “catalyst for change”. He added that the DH is “determined to eradicate variation” across the uptake of NICE approved drugs. “NHS organisations must make sure the latest NICE approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not,” he said. “Being transparent with data like this is the hallmark of a 21st century NHS. It is
a fundamental tool to help healthcare professionals improve patient care.”

The introduction of the scorecard has been backed by the ABPI. Stephen Whitehead, ABPI Chief Executive, said it would be a “valuable tool” to support the latest NICE recommendations. “There is still a great deal of variation across the country on which treatments patients are able to access and so I am hopeful the scorecard will help highlight discrepancies which can then be addressed,” he said.

Whitehead called the scorecard a “definite step forward” in ensuring patients receive the latest treatments as quickly as their European counterparts. He said the existing system was bad news for the health of the nation which resulted in a lost opportunity to “drive efficiency savings through the use of medicines”.

The NHS Confederation was equally receptive to the introduction of the scorecard. But former Deputy Chief
Executive David Stout warned its implementation may cause “unnecessary bureaucracy” and stretch NHS finances even further. “It is also important to remember that the NHS is facing an unprecedented financial challenge and organisations must live within their means while providing high quality care,” he said. “The reality is we can only afford to provide new drugs or treatments where they are cost effective and demonstrably add real patient benefits. In a health system with no financial growth, any new costs have to be offset by savings elsewhere.”

Stout added that the introduction of the scorecard will only be a success if the NHS engages with local communities and clinicians to decide what local priorities are.

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

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

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

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

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

The gloves are off

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

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

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

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

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

Swapping gloves

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

The next round

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

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

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

THE NHS Commissioning Board’s role in NHS reform is still widely debated. Pf looks at how it will direct the NHS of the future.

The new NHS Commissioning Board (CB) is unique in three respects. Firstly, it stands to take on more power than any arm’s length body in NHS history. For up to three years at a time, it will be entrusted by the Government to run the NHS and allocate its entire commissioning budget, without regular scrutiny by Parliament.

Secondly, it stands to hand over more power than any arm’s length body in NHS history. Of its annual £80bn
commissioning budget, £60bn will be delegated to the 212 Clinical Commissioning Groups responsible for commissioning local services. While the CB will commission primary care from the CCGs and ensure that they deliver on the NHS Outcomes Framework objectives, it will allow them to devise their own solutions and choose their own partners.

The powers of the SHAs are being delegated ‘upward’ to the CB, while the powers of the PCTs are being delegated ‘downward’ to the CCGs. The widespread concern about a potential gap in responsibility led Sir David Nicholson to say: “The NHS Commissioning Board could turn into the greatest quango in the sky. So it needs to have clinicians at its heart and the powerhouse for change in the system must be the
clinical commissioning groups.”

Andrew Lansley’s letter to the CB’s Chair, Malcolm Grant, in April about the Board’s strategic objectives stresses that its first responsibility is to make a “shift of power from national and regional organisations to CCGs, Health and Wellbeing Boards, local providers and patients.” The CB will not be a monolith within a static system: it will be a facilitator of future NHS transformation. That dynamic role is the third unique
feature of the CB, and the most important.

TAKING THE REINS

The DH plan Developing the NHS Commissioning Board (July 2011) outlines the intended structure and functions of the Board. It will have two broad national roles: to commission primary care and specialised services, and to ensure that the entire commissioning system is “cohesive, co-ordinated and efficient”.

Using £20bn of its annual budget, the CB will commission GP services and specialist health areas, including dentistry, maternity, community pharmacy and ophthalmic services. The Board will not govern the CCGs in a traditional way: it will “support” them and “hold them to account” while allowing them “freedom to innovate.” This support includes authorisation, an outcomes framework, guidance tools such as model pathways, and a means of intervening when CCGs are in difficulty.

The CB will host clinical networks to advise on specific areas of care and multi-disciplinary clinical senates to support CCG decision-making. Another key role of the CB is to lead the NHS Outcomes Framework by supporting local clinical improvement, providing “more services outside hospital settings”, improving acute care and the management of long-term conditions, and ensuring that CCGs implement NICE and other national standards.

In addition, the Board will lead patient-centred care by overseeing “the extension of patient choice and the expansion of information available to patients” and promoting both integrated care and innovative self-care.

Finally, it will develop a “medium-term strategy for the NHS” that will combine with the local priorities identified by the Health and Wellbeing Boards to provide a basis for local commissioning plans.

LEADER OF THE PACK

According to the 2011 outline, the CB will work in “partnership” with many other organisations: patient groups, healthcare professionals, healthcare providers, local government, industry and national organisations such as NICE.

The Board’s relationship with suppliers will “support its strategic approach to innovation and development” – in other words, it will play a part in the dynamic evolution of services and provider relationships.

The CB will be organised nationally around the five domains of the NHS Outcomes Framework, with a national lead for each domain. It will also divide its local teams into four ‘commissioning sectors’ reflecting the four existing SHA clusters, each with a sector lead.

The Board will take over functions performed by 8,000 people. It plans to reduce that number to 4,000 – a reflection of its ‘light touch’ approach.

RIDING THE WHIRLWIND

According to Lansley’s letter to Grant, the CB has a responsibility to “contribute to” improved health for “the whole population”, improved care and outcomes “for all patients”, and improved efficiency. Within this context, the Board Authority’s strategic objectives include “transferring power to local organisations” and “establishing the commissioning landscape”. The new NHS will then develop under its own steam, with the clinical networks and senates providing “leadership and insight rather than oversight and compliance”. The authorised CCGs will have the “assumed liberty” to design local services independently.

In addition, Lansley says, the CB will have a “vital leadership role” in enabling the personalisation of care by improving patient choice. This includes the use of personal health budgets. At the provider level, the CB will play a “crucial part” in developing a “level playing field” for competition.

In short, the role of the NHS Commissioning Board is to facilitate the evolution of a rapidly changing healthcare system. These changes will come not from the Board or the DH, but from the decisions of CCGs and their commercial partners.