After all the hullaballoo, the controversial Health & Social Care Bill quietly achieved Royal Assent during the afternoon of the final Tuesday in March. One suspects that the difficulties the Government had in getting the legislation passed through will be dwarfed by the challenges the NHS faces in implementing its complex measures. Tuesday 27 March was most likely the calm before the storm.

At present, the NHS is in transition. Within twelve months, 151 Primary Care Trusts will be replaced by circa 250 Clinical Commissioning Groups, spearheaded by a National Commissioning Board. Of course we already know this. But while we wait for the momentous occasion to arrive, how does the pharmaceutical industry approach the critical issue of targeting its key customers?

As Mike Sobanja, Chief Executive of NHS Alliance, notes in this issue, pharma is currently embarking on a new game: “spot the commissioner”. PCTs are currently legally accountable for around 80% of a total NHS budget of roughly £110 billion. Of this, approximately £30 billion has already been delegated to CCGs operating in shadow format. The challenge for medical sales professionals does not end at identifying who holds the purse strings for that £30 billion. The trick, once they have, is to understand their customers’ environments – and their commissioning intentions in their own specific disease areas – in order to have the best chance of securing a slice of the pie.

The next twelve months will provide the strongest test yet for the industry’s recently-acquired penchant for the account management model. Faced with a health service in transition and a ‘confusion of NHS customer-groups’ (Ed. – the most appropriate of collective nouns), the battle ahead will be tough.

Only account managers with the most robust local knowledge will win.

Chris Ross, Editor.

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.

Pf Editor, Chris Ross, asks who pharma’s customers really are as the NHS reforms continue to progress.

The journey towards NHS reform was always likely to be a long and painful one for the coalition government – but, as opposition to the Health & Social Care Bill grows stronger by the day, it’s becoming increasingly difficult to predict where the journey will end. At present, Royal Assent seems many miles away.

But despite the fierce political and ideological objections to the proposals, in many parts of the country the NHS has already ventured some way along the roadmap to reorganisation. Embryonic Clinical Commissioning Groups are steadily establishing themselves across England, and the transfer of powers from PCTs to the new commissioning organisations is well underway. It is likely to prove costly for NHS productivity and patient care if the journey to reform finds itself at a dead end and the Kill the Bill movement finally succeeds.

Whatever happens in the coming weeks and months, the ramifications for the pharmaceutical industry have already been significant. Since the introduction of PCOs, PCGs, PCTs and, of course, NICE in the early 2000s, UK pharma companies have spent the best part of a decade trying to establish exactly who their customers are and realigning their sales and marketing efforts accordingly. During that time, it’s become increasingly clear that a one-size-fits-all solution to customer segmentation will not work, and that the identity of so-called ‘key accounts’ will vary from region to region, and disease area to disease area. In such a dynamic and fast-moving environment, the work of field-based medical sales professionals becomes ever more important. The role of the rep may have been redefined in the past ten years, but while numbers on the ground have dropped significantly, their value to UK pharma in a changing marketplace has only increased.

Chris Ross, Editor.

There isn’t a day which goes by now where you don’t read or hear about another financial crisis in the news somewhere around the globe. It doesn’t take a financial expert to work out that the world is broke. Greece can’t afford to pay for anything, Americans still can’t afford to pay for healthcare and the UK no longer wants to pay for those living at home on benefits – amongst other things.

So, is there any real point going to your boss and asking for a rise in your salary? Is it worth being laughed out of the office? Money is a delicate issue at the moment – probably because nobody has any. Although, that’s not entirely true. Banks are still posting billion pound profits – as are pharmaceutical companies. The last few weeks has seen a raft of pharma’s biggest players release their financial results for last year. To the best of my knowledge, not one of them made a loss in 2011.

Although the gains may not have been enough to satisfy greedy shareholders, the pharmaceutical industry is alive and kicking. Billion pound profits may not immediately drop their way down to those working within the field, but it does show that the pot isn’t empty just yet.

I recently attended a meeting of UK sales managers. While discussing Pf’s Company Perception, Motivation and Satisfaction Survey, I was told this temperature check of the industry had been used to convince those with the purse strings that they were worthy of a pay rise. After using last year’s survey data they found they were being paid less than the industry average for their role.

No company wants to lose experienced, skilled staff – especially egotistical pharmaceutical companies trying to save a few quid. Unlike other surveys where thousands or pounds can be won or a new mini will be sent out in the post first thing Monday morning, Pf’s survey actually helps those working within the industry. Results are used both by pharma companies to ensure they’re not being left behind by rivals in the industry, and by skilled staff to ensure they’re not being taken advantage of.

It takes only ten minutes of your time. Just think, this time next year, you could’ve benefitted by taking time out of your day. Complete the survey here. For every completed form, HSP, the publishers of Pharmaceutical Field, will make a donation to Birmingham-based charity, Home from Hospital Care.

As 2011 draws to a close, it's clear that the world of the medical sales professional continues to change. In an environment increasingly dependent upon proving value, it's pleasing to discover that on a global scale, the work of the drug representative is valued by more than 90% of physicians. Undoubtedly however, the number of representatives in the market place has fallen dramatically in the past few years. In the UK, commentators estimate the collective field force now totals somewhere between 6,500 and 7,000 - a significant reduction from the heyday of some 12,000-plus less than a decade ago.

A key article in this month's Pharmaceutical Field moves beyond the rhetoric of a changing field force and, in an all-too-rare moment of clarity, presents some actual real world data that shows how both contact rates and face-to-face calls with GPs have incrementally fallen in the last ten years. 93% of global physicians may well value the information exchanges they enjoy with industry representatives, but in the UK, access to GPs continues to be a major challenge. In a changing NHS, starved of resource, this will only continue. The fall in contact rates may, of course, simply be due to the industry's wider transition towards a KAM approach – and the fact that newer customers and influencers may be even harder to access than the traditional GP.

One further area of change for sales professionals is the incremental move from traditional detailing methodologies, to more digital means of presenting information using mobile technologies. Between 2006 and 2009, only 16% of new marketing initiatives in Pharma was being developed for mobile devices. By 2010 this global figure is now around the 50% mark – and many of these developments are being placed in the hands of sales representatives via iPad and other mobile devices. Developers and, more importantly, customers claim such presentation is more engaging and memorable – but crucially, the delivery of information to GPs via mobile technology still requires human interaction to bring it truly to life. Digital detailing is there to support the work of the 'rep', not replace it.

So there is much to look forward to as medical sales moves into a new year. The landscape is changing and the challenges don't get any easier – but the value of human-to-human interaction in the exchange of key medical information remains as strong as ever.

Sometimes, reporting on the UK pharmaceutical industry feels a bit like Bill Murray’s Groundhog Day. In the late 1990s, when I edited my first title for UK pharma, all the talk was of the move from GP Fundholding and the imminent introduction of Primary Care Groups.

By 2000, New Labour’s NHS Plan promised a revolution in healthcare built around delivering improvements in ‘partnership, performance, patient care and prevention’. The politicians were about to ‘modernise the health service’.

Fast forward almost 12 years and we’re still being read the same script; new politicians, the same old lines. Four Ps – partnership, prevention, productivity and patient care – continue to dominate airtime, only this time, of course, it will be different.

Different? Some hope. This is Groundhog Day. So how is the UK pharmaceutical industry responding to change? Its customer-base, meticulously redrawn through 10 years of implementing the NHS plan, is yet again being reshaped. PCTs are on the way out. CCGs and Clinical Senates are on the way in. Keeping track of decision-makers and influencers is critical. Getting in front of them in the right volume, at the right time and with the right message is life and death.

The industry is currently pinning its hopes on Key Account Management (KAM), supported by a Customer Relationship Management (CRM) philosophy that promises to enable the field force to have a more detailed understanding of individual customer needs across a diverse and complex landscape.

The tools to support the CRM approach are impressive, established and evolving in time with the modern technological advancement. They also provide huge value to medical sales professionals, and the ability to enhance customer interactions.

But, as ever, this is Groundhog Day. Twelve months ago, Pf’s annual survey into field force attitudes revealed an apathy amongst some sales professionals towards the use of CRM. A year later and it appears that, despite its many advantages, the value message for CRM is still not being heard by all of those who can undoubtedly benefit from it.

This year, 90% of Pf’s survey respondents have access to a CRM system – but only 43% of these find time to use it in the field, and more than a fifth admit that they fail to record post-call reports accurately.

In a fast-moving, dynamic marketplace, generating, sharing and maximising real customer insight is one of the best ways for sales professionals to achieve competitive advantage. CRM tools provide the perfect mechanism for this. Only the foolish would pass up the opportunity.

I feel like I am repeating myself. But then again, this is healthcare Groundhog Day. Next month: more NHS reform.

Chris Ross
Editor