APODI’S Jan Cox examines the importance of focusing on individuals’ strengths and talents when recruiting.

Over the past decade, Gallup has surveyed more than 10 million people worldwide on the topic of employee engagement, and only one-third “strongly agree” with the following statement: “At work, I have the opportunity to do what I do best every day.” A natural conclusion is that in an average organisation, approximately two-thirds of employees do not believe they are maximising the talents they have.

The repercussions of such a massive waste of talent – for the economy, for individual organisations, and to the quality of life of every one of those employees – is mind blowing. When attempting to explain to our clients the impact that such a scenario has on performance, we suggest that they explore this by changing the roles of a small number of employees to maximise their talents. The results are usually dramatic. We then ask the organisation to consider these outcomes if they were to be extrapolated across the whole company.

Implications for recruitment

The implications of such findings for recruitment, development and promotion strategies are significant. At Apodi, we have built a recruitment model that incorporates four key attributes that we test when recruiting every individual. These are: strengths/talent, competencies, cultural fit and mental toughness. Most companies traditionally recruit on competencies (i.e. what people can do) rather than on strengths/talent (what they are really good at, have a passion for and are usually inherent within an individual). The problem with recruiting based solely on competencies is that organisations risk hiring people that can do something, but may have no real inclination to do it. They may lack passion or excitement, display little energy for their work and therefore underperform. This results in disengaged employees who are unlikely to stay with a company for long.

Conversely, those companies that have adopted a strengths/talent-based approach to recruiting are showing dramatic results. Banks in the US are seeing significant increases in sales revenue from representatives recruited based on strengths. Financial services companies in the UK are reporting ‘improvements in quality and lower staff turnover’, and Starbucks have established a clear link between recruiting for strengths/talent and customer satisfaction.

The benefits can be summarised as follows:

 

Company	Employee
Increase in productivity	More engaged, happier and motivated
Reduction in staff turnover	More likely to achieve goals
Increase in interview offer to fill rate (% of those accepting job if offered)	Higher levels of energy and vitality
Increased diversity of applicants and talent pools	Develop quicker and more effectively improving career development opportunities

Talent , competencies and strengths

The link between talent, competencies and strengths is simple: talent + competencies (knowledge/skill) = strengths. Talent can be defined as those capabilities that individuals naturally exhibit based on experiences and knowledge usually gained in early life, or those that an individual seems to be ‘born with’.

Talent can obviously be displayed in diverse circumstances, however, wherever it is utilised, it gives individuals energy and enthusiasm. Knowledge and skills are those things that are learned, studied and practiced. When combined with innate talent, skills and knowledge can be converted into real strengths. It is these strengths which drive performance. It is because of this causal link that leading recruitment organisations recommend that clients assess talent and competencies separately and as part of a strength-based assessment process.

How to assess for strengths

A strengths-based selection process has many similarities with that used for assessing for competencies. There are, however, some fundamental aspects which must clearly focus on the strengths of an individual. Assessing for strengths can be summarised as follows:

Creating strength-based profile

Profiling tool

Design strength-based interviews

Design strength-based assessment centres

Review and measurement process

a) Strength-based role profile

A company can develop the profile by reviewing organisational structure and business strategy, developing performance criteria for the role in question, and studying the best performers in the role to identify the strengths that are contributing to success.

To help identify and define the strengths it is seeking, organisations can turn to experts in this field for guidance. For example, Tom Rath in his book Strength Finder identifies 34 particular strengths that may be important in different roles in commercial organisations. For instance, a company looking to recruit sales representatives may identify the following strengths as being the key to success in the role:

• Achiever/results focus – real focus on results, targets,completing tasks, meeting deadlines
• Empathy – identifying with customers and seeing what is important from their perspective
• Resilience –dealing with rejection and setbacks easily and moving forward positively
• Self confidence – strong self belief in own abilities
• Initiative – working independently and taking important decisions quickly to make things happen
• Communication – bringing propositions to life through effective communication.

b) Strength-based profiling tool

An appropriate profiling tool should be used to assess the key strengths of each individual applicant and how well they fit the selection criteria. The report generated can then be used as part of the strength-based interview.

c) Strength-based interviews and assessment centres

Fundamentally, interviews and assessment centres need to be focused on how individuals have previously
used their strengths to achieve success in their business and personal lives. In addition, they should also explore whether:

• The aspirations each individual has for the future
  are consistent with the strengths they display
• The individual will be able to apply the strengths
  they have to the specific challenges the company
  faces and the challenges of the role.

d) Review and measurement process

Recruitment decisions are among the most important that management can make and yet recruitment is one of the most ‘under’ managed processes in corporate life. It is rarely subject to stringent review and measurement, and consequently many ineffective and unsuccessful recruitment processes remain in place. Those more enlightened companies considering strength-based recruitment should ensure that new processes are reviewed and measured systematically and regularly. This will drive a system of continuous improvement and encourage buy-in from senior management and the organisation as a whole.

Conclusion

A reliance on purely competency-based processes for recruitment decisions is almost certain to ensure suboptimal recruitment decisions and, ultimately, sub-optimal performance. However, world-class recruitment processes are a strategic imperative for a company’s future success. Not only has the strengths/talent model been shown to add value to recruitment decisions, it can be a catalyst for performance improvement across any organisation.

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 Health & Social Care Bill has finally completed its arduous passage through parliament. In normal circumstances, the landmark of Royal Assent would provide a key moment of clarity for the future of the healthcare in the UK. But this is the NHS – and nothing is ever that simple. Whichever way you look, the health service is bedevilled by variability. NHS Alliance CEO Mike Sobanja and Cegedim Relationship Management’s David Round look at the implications of the Bill for industry in the next 12 months.

The Health & Social Care Bill has, as we all suspected it would, survived the onslaught and made the statute book. But the hard work really does start here. In truth, implementation of the reforms on the ground began many months ago – but the process will continue for some years to come. It is a time of great uncertainty for NHS and industry alike. We now have official confirmation of where we are heading, but do we really know how we are going to get there? And with health need omnipresent, what should we be doing to protect the needs of patients today as we journey towards the health system of tomorrow? The wider call is for more collaborative working between the industry and the NHS. And there is much that the industry can do to support the significant challenges its customers face.

So where are we now? And what do pharmaceutical companies, facing an NHS in flux and customer groups in transition, need to do to support the health service and drive improvements in care? At a time of uncertainty, the industry must first do two things: follow the law, and follow the money.

Following the law and the money
At the moment – in law – we still have the presence of 151 Primary Care Trusts (PCTs). These are, of course, clustering together, while alongside them a high number of Clinical Commissioning Groups (CCGs) are steadily being established. For now, however, PCTs remain legally responsible for the delivery of healthcare services in the UK – and will continue to do so until April 2013. PCTs are currently accountable for about 80% of a total NHS budget of roughly £110 billion. It is estimated that approximately £30 billion of this has already been delegated to around 250 CCGs. But whilst PCTs can legitimately delegate their powers, they cannot delegate accountability. If someone in a shadow CCG busts the budget or, worse still, a patient dies by virtue of a poor decision elsewhere – the ultimate responsibility still lies with the PCT.

The situation on the ground is therefore complicated. Power currently rests with a number of PCT clusters acting on behalf of still legal and existing PCTs, who are delegating cash and power on the ground to CCGs. In turn, the CCGs are enjoying increasing control over finances, though technically, they are not yet legally in existence.

So if the task for 2012 is to follow the law and follow the money, pharma must focus on developing its powers of local intelligence. The fundamentals are simple, but the devil is in the detail. The law tells us who is technically responsible, the money tells us who has been delegated the power and the pound. The £30 billion question for pharma, however, is: where has the money been delegated? And the answer, of course, varies from locality to locality.

Developing the knowledge: think local, and national
And so the industry is playing a new game called ‘Spot the Commissioner’. To compete, pharmaceutical companies – and in particular their field-based professionals – need to build and maintain knowledge of local circumstances that, to a large extent, they’ve not previously had.

The move towards a localised health service is a direction of travel rather than an absolute. Moving forward, the industry perhaps needs to view the NHS as a healthcare system that operates within a national framework, but with more local decision-making. The balance of power between local and national is dependent upon which aspect of the healthcare service, and which therapeutic area, is being discussed. NICE provides a good example. In theory, the statutes require that funding is made available for technology appraisals as formal TAGs within three months of NICE making a declaration. But the reality is that whereas NICE doesn’t have to consider affordability, local decision-makers do – and therefore exactly how they implement that will inform their local decision.

As such, pharmaceutical sales professionals need to keep one eye on the national scene and one eye on the local scene – and apply that knowledge to their individual therapeutic area. They need to think very hard about how any national decisions will affect their product at a local territory level. The promotion of pharmaceuticals has moved beyond the traditional sequential sale – it is now much more sophisticated. This sophistication is only likely to increase in the future. An example of this will be the introduction of Health and Wellbeing Boards. These are already establishing under the umbrella of local authorities and will bring together interests from a wide variety of other groups: employers, magistrates, courts, local authorities etc. These will have a significant influence on local health services.

Variability: process, progress and prescribing
In such a changing and dynamic customer marketplace, the challenge of playing Spot the Commissioner becomes ever more difficult. Ironically, the only one constant is the prevalence of variability. There is variability right across the system, particularly in terms of progress around the health reforms. For example, there are local areas adjacent to one another where one locality has seen significant lawful delegation of powers to CCGs, while its neighbours have seen very little. This variability is likely to continue for some time – beyond the point where CCGs are authorised as official legal bodies. Authorisation itself is not a simple ‘yes’ or ‘no’ – it may be conditional. A conditional authorisation may mean that a CCG has power to make decisions over some things, but not others. A CCG may, for example, be authorised to commission acute services locally, but not mental health services.

At a wider level, variability in local progress with NHS reforms is surpassed by the even more significant issue of variability in care across the UK. The introduction of the Atlas of Variation in November 2010 has brought the issue into much sharper national focus and highlighted areas where progress can be made. There is, of course, variability in every disease area. Here are two very different examples. For patients with type II diabetes, the likelihood of suffering a lower leg amputation as a result of the disease is greater in the South West of England than it is in the South East. On the other hand, around the issue of cancer referral times, there is huge variation across the country in terms of GPs referring patients to secondary care for earlier diagnosis. The latter is an example of variability in health care – the former is a great illustration of variability in health outcomes.

Addressing inappropriate variability is a key priority for the NHS. And it is an area where the pharmaceutical industry can help make a real difference. Pharma companies could start by looking at the variability in the prescribing of their own products. If they can identify where that variability is and draw it to the attention of the health service locally, they will be better placed to offer support to help address it. The industry could consider undertaking Health Equity Audits to generate disease-specific data to support commissioning. For example, if you are a sales professional, what could you tell a customer about how your therapy is used in terms of its distribution among social classes, poor or rich and ethnic groups? What can you say about its relative prescribing across geographical areas? This is key information. It’s likely that there will be all kinds of variability going on that the industry could be helping the NHS address – and in doing so, it will also drive the market. By combining publicly-available prescribing data with activity data and other readily-available metrics, companies can improve their sales and marketing strategies by providing customers with the best information to help inform commissioning decisions.

The value of data
Robust data and information is the lifeblood of good commissioning, and good commissioning is the lifeblood of good health outcomes. At present, few, if any, commissioners will have complete and comprehensive access to the right data on which they can base critical commissioning decisions. But, in a collaborative environment, many would be willing to work with the industry to help create that evidence-base. As the NHS restructure unfolds, pharma can be a credible source of information for commissioners – though probably only one of a number of sources. Increasingly the health service will seek to identify data itself, and the Atlas of Variation is a good example of that. Increasingly, there are good examples of joint working where parties have come together and delivered results. In a collaborative era, wracked by challenge and change, the industry and the NHS have a responsibility to develop that relationship further.

Pharma can certainly emerge as a valuable partner to the NHS as it moves through its transition. But the generation and communication of robust and relevant data will be key to progress. In the game of Spot the Commissioner, the best sales professionals will be those who understand the local situation, understand what is driving it and align their key messages so that they are seen as part of the solution, not part of the problem. Undoubtedly, access to good data will underpin everything.

Mike Sobanja is CEO, NHS Alliance. David Round is General Manager, Cegedim Relationship Management.

Novo Nordisk is planning to expand its US workforce by nearly 15% to support its business model and create a structure to meet the needs of its clients after a sustained period of growth.

The Danish-based company has experienced approximately a 10% increase in its US employees in the last five years and is now recruiting further across a number of specialities.

Jerzy Gruhn, President of the Novo Nordisk US affiliate, said the move reflects the “strength” of Novo’s business model, the “increasing demand” for its diabetes products and the “steady output” of its pipeline.

Currently, the company has three regulatory submissions being reviewed by the FDA and several other products in phase II and III clinical trials.

While the majority of pharma companies are downsizing, Novo plans to strengthen its sales team with medical liaisons, diabetes educators and field management positions also available.

In addition to the sales and medical operations opportunities, Novo continues to recruit for scientific positions in its new type 1 diabetes research centre in Seattle, Washington, and in its manufacturing facility in Clayton, North Carolina.

US and European pharmaceutical sales and marketing executives believe that the current business model is ‘broken’, according to a new survey.

More than two thirds (68%) believe that pharma’s current sales model needs to be rejuvenated to face current industry challenges.

Danielle Rollmann, a partner in Booz & Company’s global health practice, says industry is in the “eye of a hurricane of change” and companies need to “identify and focus” new capabilities needed to succeed.

The survey, conducted jointly by Booz & Company and National Analysts Worldwide, asked 156 sales and marketing leaders, most with global responsibilities, how the industry can adapt to face a changing healthcare environment.

If found that respondents noted that growing healthcare prices along with the need to highlight value and outcomes were the greatest challenge faced by sales representatives.

More than half of respondents now expect to invest heavily in marketing to key accounts and payers to counter these challenges. New pricing approaches, new service models and new partnerships with clients were also highlighted as being important.

“Those of us who work with pharma companies to develop and implement commercialisation strategies know very well the challenges of maximising asset value in this new environment, where both key customers and customer expectations are being redefined,” said Susan McDonald, CEO of National Analysts Worldwide. “We’re not surprised to hear people acknowledge that they can’t count on doing ‘business as usual’ and that they’re looking for new ways to gain traction.”

Respondents said the strategies which they believe will be the most important moving forward include:

• Organising sales and marketing activities around diverse stakeholders
• Taking a more creative approach to customer relations and partnerships
• Effectively demonstrating value through outcomes to clients
• Innovatively using digital media channels.

“Virtually everything is changing in the model and the market,” commented Rolf Fricker, a Munich-based partner at Booz & Company. “In response, most respondents say they plan to spend more on all their target marketing activities. Yet this is not aligned with what pharma is doing and needs to do at a company level. The companies that focus, prioritize, and follow a coherent strategy will be the winners.”

With so many pharmaceutical companies undergoing some sort of restructuring plans as a result of mergers, acquisitions or simply cost-cutting measures, field force worries immediately turn to job security. Apodi’s Tony Swift discusses valuable ways to ensure your job isn’t one under scrutiny the next time the axe is wielded, and how to progress in the new pharmaceutical world.

In the past a competent sales representative could look forward to a long and secure career in the same or similar role, often with the same company. For the more ambitious representative it was also possible to climb a well-defined ladder towards seniority – as field trainer, sales manager, sales director and beyond.

However, much has changed. Sales representative positions have reduced dramatically and the ladder to seniority appears far more difficult to climb. Job security and traditional long-term career planning is disappearing into oblivion. The situation is just as precarious for those half way up the ladder, in first or second-line management roles, and restructuring is affecting job security and career planning throughout companies in the industry.

These seismic changes are not temporary. We are seeing a transition to a new world order in the pharmaceutical industry where:

• Traditional career paths are disappearing
• Management roles are fewer and are just as susceptible to restructuring
• Employees can no longer rely on the organisation to develop their careers – career and personal development is an individual’s responsibility
• The company needs to provide support and experiences to individuals to learn new ways of adding value to the customer and the company itself
• Creative expertise to address the new NHS is in huge demand by pharmaceutical companies. This presents an enormous opportunity for representatives and managers who may currently be worried about their long-term future in the industry.
  

Personal development
I recently interviewed a number of successful pharmaceutical industry executives to assess how they addressed the issue of personal development. Almost all of them stated that they could not have solely relied on the organisations they had worked for to either fully develop their skills or, indeed, their career.

In the majority of cases these successful individuals had made a decision to take personal charge of their careers. By keeping abreast of changes in the industry, anticipating new developments and consistently reviewing and updating their skills and relationships, when changes did occur in the industry or company, they were often well placed to take advantage of the new opportunities these presented.

At Apodi, our resourcing division sees first-hand the changing dynamics of the marketplace. Quality market access and key account managers are much in demand and are, at times, very difficult to recruit. There are also lots of sales representatives looking for jobs, with many believing they now have to look outside the industry to secure their future. However, representatives who are aware of the changing dynamics and have adapted their skills are now often successfully obtaining those market access and KAM roles.

Taking charge
One conversation with a successful executive led to a more in-depth discussion about what sales representatives can do if they want a long-term career in the pharmaceutical industry. The executive detailed the steps he had taken, and I believe this serves as an interesting case study for those unsure about their prospects in the industry. He said: ”It quickly became apparent to me that to take charge of my career I had to focus on a number of key areas.” To summarise, these were:

• To develop a clear view of the future of the industry and the likely impact of this on an existing position and potential future roles
• Be successful in a current role –  believe that new opportunities will only arise following success
• Find a systematic way of increasing knowledge, skills and relationships – do this to differentiate yourself from colleagues.

The future
In a previous article, Leading the way – Pharmaceutical Field, September 2011, I mentioned a couple of quotes. One was from a leading member of the NHS responding to how pharmaceutical companies could more actively engage with the health service. They said: “Don’t just bring pills and gadgets in the future, bring us value added solutions that drive the QIPP agenda with a documented and robust cost/benefit analysis.”                                   

The other, by Sir Ian Carruthers, NHS Chief Executive Innovation Review Team, stated: “The pharmaceutical industry needs to think more in terms of working in partnership with the NHS rather than just sending in the sales force… the NHS needs your disruptive contribution to help NHS reform, but too few companies are coming forward.”  

Despite such prominent views from the NHS, many companies are still sending out sales representatives with a very limited agenda – primarily delivering some key messages about a particular product. Indeed, some observers believe that the pharmaceutical sales representative is one of the world’s most underutilised resources! And, given the limited ambitions of each visit, it is perhaps not surprising that HCPs are continuing to reduce access.

To counter this, companies are deploying key account managers whose role is to provide value over and above the ‘noise’ associated with a traditional rep visit. We believe there will be a gradual merging of the functions of sales representative and KAM in the future. This means that everyone representing a company in the field will need to operate to KAM principles and provide significantly more value than before. Indeed, our research shows that historically excellent representatives have effectively operated to KAM principles, irrespective of the training and direction received from head office.

Current success
Whilst each sales representative has key performance indicators (KPIs) to meet – often merely call rates, we believe that individuals need to focus on providing added value to their customers and their companies irrespective of their targets. By taking a more strategic view, identifying the key stakeholders, delivering and developing solutions with the help of their company’s marketing, medical and promotional functions, representatives will become a more valued partner to both parties.

Representatives can only do this if they are experts in their products, the therapy area concerned, the care pathway and the local healthcare economy. Additionally, they will need knowledge of best practice and potential solutions.

Unfortunately, to some this may be perceived as going ‘beyond brief’ and will sometimes result in knockbacks. However, we believe the risks attached to this are far less than continuing with the limited role noted above. The risks of a representative failing to distinguish themselves and failing to provide real value will leave them susceptible at times of restructuring, and with fewer skills needed to attract jobs in the new healthcare economy.

Using initiative 
Fundamental to taking charge of your career is to take responsibility for personal development. A colleague told me about how he had done this successfully with a process that included the following:

A) Yearly audit – produce an annual plan that addresses the following:

• I am currently known for…
• Next year I want to be known for…
• My personal development last year included…
• I currently differentiate myself from my colleagues by…

B) Quarterly plan – each quarter produce an action plan:

• I aim to develop a more in-depth knowledge of the product, therapy area, care pathway and local healthcare economy by…
• I will develop closer relationships with key stakeholders in my company by…
• I will develop closer relationships with key customers by…
• I will develop a better understanding of best practice and consider the most appropriate solutions for my customers’ problems by…

C) Quarterly assessment – assess the potential to drive value into internal/external customers against the following parameters:

• Do I demonstrate more than financial value to key accounts?
• Have I increased the number of internal/external relationships where I add real value?
• Do I possess specialist knowledge that I can share with colleagues/customers to add value?
• Have I influenced any changes to the benefit of the company or customers?

This learning and knowledge was primarily delivered through personal research using books, magazines and the internet. My colleague also constantly suggested projects that he could work on, even in his own time, that he felt could transform the value being provided to customers. Many of these were rejected, particularly initially, but eventually he developed close enough relationships with people in the company who recognised the value these projects might create. These projects were a very valuable learning tool and a superb way of displaying his talents.

In summary
Pharmaceutical companies are looking for new and innovative ways of providing value to customers. As decision making within the NHS increasingly shifts to those regularly interacting with the end user (patients), the opportunity for primary care representatives to adopt a more customer-centric approach based on KAM principles grows exponentially.

The advantages of this may lead to less complicated field force structures, reduced costs and additional value added for customers. With such developments, companies will be in a better position to assist each individual in developing their careers to meet the demands of the new healthcare economy.

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.

Who exactly is pharma’s customer these days? Jessica Henderson takes a look in the NHS customer showroom and urges sales and marketing executives to examine all the features and benefits when choosing the right vehicle for their brand.

The UK Government’s floundering Health and Social Care Bill has been widely decried as “a car crash that has already happened”. But critics predict further pile-ups around the corner as the beleaguered Health Secretary finds himself increasingly stuck in bad traffic on the road to reform. It’s fair to say that the Bill is enduring a difficult journey towards Royal Assent – but irrespective of when, or indeed if, it reaches its final destination, it’s clear that work on the ground to transform the NHS into its new shape and structure has been ongoing since the White Paper in July 2010. There have been delays and roadblocks along the way, but across the country, local NHS organisations have been moving towards the promised land of Clinical Commissioning Groups for well over a year. And as a consequence, the pharmaceutical industry’s customer-base has incrementally shifted – with the prospect of more twists and turns to come. We may not yet be motoring towards reform – but the wheels are well and truly in motion. And it’s driving pharma companies down a familiar road where they are being forced to revisit the age-old question: “just exactly who is my customer?”

The NHS customer showroom
For UK pharma, NHS customers have always been a moving target – but the rate, scale and definition of impending change has meant that the latest movements are proving more difficult to track. In the car (or should that be ‘care’?) showroom that is the NHS, the staff, partners and customers all know that there’s a new model on the way, but they don’t entirely know what it will look like when it arrives, and whether it will work when it gets here. And it may not even leave the factory. But many also believe that the second-hand model that’s been driven around since 1948 is old, creaking and costing a fortune to keep on the road. It was certainly built for a different era where there was far less traffic. And as demand has increased, the size of the problem, as well as the size of the NHS itself, has increased with it. For pharma, the NHS customer showroom has expanded rapidly.

The Toyota Prius: CCGs
The proposed new model is, of course, an NHS that, in England, is led by Clinical Commissioning Groups (CCGs). There are already a few early models in the showroom – in fact, more and more are being test driven right across the country as we speak. CCGs can perhaps be considered as the health service equivalent of the Toyota Prius – a hybrid model comprising of clinicians and commissioners, with similarly green objectives to save their environment and become sustainable vehicles that use their resources effectively.

From BMW to white van? The depreciation of PCTs
For the past decade, the NHS has been run by PCTs, who issued instruction to clinicians in primary care and commissioned and managed local health services. As we know, under the new proposals, the old PCT model is to be discontinued. The inference is that PCTs have, like a saloon BMW with added extras, become expensive to run and, in austere times, are an unnecessary luxury. Instead, commissioning responsibilities will be passed to clinicians – chiefly GPs – who will be handed the car keys and given the authority and autonomy to drive local services as they see fit.

GPs have become accustomed to playing the role of a reliable Ford Focus, simply and efficiently getting the job done and concentrating on the core competency of delivering patient care. But now they are at the crossroads, deciding whether or not to upgrade and move into the fast lane of a more adventurous commissioning role within a CCG, or to stay within their comfort zone of standard general practice. At the same time, many within PCTs face the prospect of the BMW being downgraded to a simple White Van; delivering support to CCGs from the edges as part of Commissioning Support Services (CSSs),  a marketplace that is apparently – and perhaps contentiously – open to huge competition. 

The Porsches
One customer group that appears to have emerged unscathed from the reforms is Medicines Management, perhaps the Porsche within the NHS customer showroom. These will remain important, high-powered and influential customers that preside over high budgets.

What car?
The question for pharmaceutical sales and marketing executives, then, is which customer vehicle is the most appropriate for their individual brands? With the immediate direction of travel for the Health and Social Care Bill still unclear, an already complicated customer matrix becomes ever more difficult. Will the NHS landscape really be governed by a generation of hybrids? Will there be a power struggle between CCGs and CSSs, or will the previously powerful PCTs allow themselves to be reduced to ‘white van delivery vehicles’ without putting up a fight? Or will they simply be rebadged as CSSs and surreptitiously given the same powers as before?

The answers will, of course, vary from region to region – with a clear message emerging from the reforms that a one-size-fits-all solution to health service delivery is simply not feasible in the modern day. Local health economies are being given the autonomy to develop health services to meet the needs of their patient populations, and as such, regional approaches will evolve at varying speeds. But, despite the alleged congestion at ground level, there are already parts of the country where proactive local health organisations are making real progress along the road to reform. Whilst each local health economy will be unique in its approach, lessons can be learned and best practice can be shared – both from an NHS and an industry perspective – by examining progress within the more proactive health organisations, and how they are approaching the change process.

Learner plates for pharma
Working within the Transformation Team has demonstrated how important it will be for pharmaceutical sales and marketing executives to understand their local health economies – not only as CCGs become embedded, but equally as importantly, as they move through the transitional phase. The opportunities for pharma to help local NHS customers to equip themselves for the new model are great – but to maximise them, and in the process give their brands the best chance for success, companies must ensure they are engaging with the right customers. So which ‘vehicles’ should pharma invest in? The answer will vary from region to region and from disease area to disease area. But some general lessons can already be learned:

The CCG Prius
This will undoubtedly seem the most obvious vehicle choice for pharma, given current trends – but at this stage, it may not always prove the most successful approach. In some parts of the country, real GP leadership is already evident, typified by the movement of QIPP programmes to CCGs. But some readily-formed CCGs may in fact be BMWs disguised as a Prius – and less susceptible to working differently. The GP Commissioner in these organisations may not yet be your best customer – and you may need to change gear to accommodate this.

The Ford Focus GPs
The enormity of the challenges ahead has slowly dawned upon even the most proactive GPs. It is now clear to them that the scale of their prospective responsibilities are vast and potentially intimidating. The responsibilities associated with the ownership of costs associated with high referrals and inappropriate prescribing are quickly being realised – but helping jobbing GPs to minimise these costs could present a real opportunity for pharma. Primary care does not need to be a swanky Ford Focus ST, but it can’t afford to be a 10-year old rust bucket either. The more proactive pharma companies may be able to help them learn to drive.

The Porsche Medicines Management
Medicines management is not only here to stay, but it will remain a key customer for the pharmaceutical industry. GPs have recognised that medicines management has assumed huge importance in a cost-driven climate and, as embryonic CCG arrangements develop, many proactive clinicians are considering employing medicines management directly on headcount rather than parking them in the car lot of CSSs.

The white delivery van CSSs
The power of these organisations is likely to be variable across the country. Less engaged CCGs may well devolve a lot of decision-making to CSSs, which could really put them in the driving seat – to the extent that they become rebadged BMWs. At present there has been real conflict of interest between PCT clusters trying to get their CSS models in place without a definitive financial envelope as CCGs consider how to carve up the £25 a head budget alongside trying to negotiate the authorisation process and design the organisation they want. An outcomes-based approach by CCGs to the development of CSSs may make CSSs a real opportunity for industry to tap into. In addition, there are a number of other vehicles that pharma should not rule out:

• The Rolls-Royce – the National Commissioning Board (NCB). Although the NCB’s role is not supposed to be prescriptive, the concept of sharing best practice and buy-in to initiatives with demonstrable outcomes may present pharma with opportunities for partnership.
• The people carriers – Clinical Senates. These will play an advisory role, with disease area specialists providing a clinical check on commissioning plans for CCGs. At present, the geography of clinical senates appears to be largely mirroring PCT clusters, but their final form may depend on how the NCB develops a regional presence.
• The cross-border ferry – Health and Wellbeing Boards. As integrated care becomes a major priority, in disease areas where health and social care overlap, this alternative means of travel may well be worth boarding
• The 4-by-4s – the hospitals. The integrated care agenda has seen the hospital model of care come in for much criticism for being expensive and unsustainable – but the big providers will remain important and will be working towards improved outcomes. They will need all the help they can get.

Moving through the gears
The NHS landscape continues to change and with it, the industry’s key influencers – and the influences they have – are moving too. In a variable and dynamic marketplace, pharmaceutical sales and marketing executives must be agile and flexible enough to adapt to change. Only by taking the time to understand the environment – not only at national level but, more importantly, at local level – will the industry reap the rewards. There is a new roadmap for the NHS and, for individual marketers, the challenge is to ensure your products reach the final destination: being used by your target patient. Success will depend upon making sure you go to the right customers via the quickest route, and this should be achieved through doing what you do best; networking and tracking where your key customers are going.

Selling into the NHS has always been a challenge – it is a complicated customer matrix. The industry’s influencers are different everywhere, dependent upon region, disease area and economics. The most successful marketers will be those that understand local needs and tailor their services that help meet them, delivering relevant outcomes in the process. Whatever the fate of the Health and Social Care Bill, the terms of engagement between pharma and NHS are unlikely to change and the key ingredient for success will continue to be the ability to be customer-centric.

The Government’s NHS reforms may yet prove to be the car crash that has already happened, but don’t allow your sales and marketing approach to become exposed to the same accusation. The industry can help all of its NHS customers drive improvements to patient care – it’s all about finding the right vehicle. Now belt up!

Snapshot review of an emerging CCG

In October 2010, I was seconded into the NHS to provide additional resource to a Transformation Team charged with managing the transition of a PCT into the new CCG model. The project covered a large geography and involved three established PBC teams, each with different responsibilities, structures and cultures. The Transformation Team was multi-disciplinary, but included clinicians who were strong advocates of clinical commissioning. The group would eventually emerge as one of the first wave Pathfinders.

The transition project required the team to evaluate every function of the existing PCT, and to establish which of these should form part of the CCG function and which could be outsourced. The scale of functionality of a standard PCT is broad and vast. It includes aspects such as medicines management, information/data management technology, decision support systems, HR support, contracts/procurement, legal finance and communications.

The challenges and considerations were huge; which services are critical to running a commissioning organisation with a budget of around £700 million, and therefore should remain in-house? Which could be outsourced to CSSs, who may be able to provide them more cost-effectively? Should the CSS be brought in-house, to ensure control over key aspects such as IT and other back-office functions? Should medicines management be included on headcount?

The CCGs established a Clinical Commissioning Board, comprising a multidisciplinary panel of CCG and PCT representatives, to drive decision-making and ensure it was clinically-led. The CCGs were divided into seven localities, each with a Locality Lead that had previously sat within the PBC groups. As part of the transformation process, the GPs who have declared an interested in assuming commissioning responsibilities are being taken through a training programme to upskill them for the future model. This process is ongoing. The scale of the challenge for GPs is recognised to be huge.

The Board created a blueprint for  Commissioning Support Services and agreed the outcomes that they wanted to achieve from it, its functions and objectives. This was done in collaboration with over 100 GPs, who worked through a long clinical commissioning transformation process to jointly agree how existing PCT functions would be transformed and where they should sit within the CCG.

The NHS is currently firefighting with uncertainty, but alongside all this transformation work there is still the undercurrent of ‘business as usual’ to ensure the wheels are kept on the organisation. Commissioners are continuing to carry out their day jobs amongst all this uncertainty, and need support to make their mark in what will be a competitive jobs market as commissioning roles reduce to accommodate the £25 a head budget which has been granted to CCGs.

Jessica Henderson is a Research Associate at WG Consulting Healthcare Ltd.