Power to the people

June 29th, 2010

The coalition’s recently unveiled Programme for Government and proposals for a new Health Bill promise significant change for the NHS. Patient power, value-based pricing and clinical leadership will be take centre stage. But what will it mean for pharma? Chris Ross examines the rhetoric.

Plans to review NICE and introduce value-based pricing have received a cautious welcome from the UK pharmaceutical industry in the wake of the new coalition government’s first announcements on health.

The ABPI has said it supports an assessment of NICE’s remit and the way in which it assesses value, but warned that the move towards value-based pricing faces some significant design issues.

The two proposals formed part of a series of new initiatives unveiled by the new government, design to facilitate a devolution of power and responsibility within the NHS and give patients and doctors more control in a clinically-led health service.

The new approach, outlined by Cameron and Clegg in their Programme for Government and expanded upon within the subsequent Queen’s Speech, aims to bring an end to the ‘bureaucracy, top-down control and centralisation’ it claims has ‘diminished the NHS’.

Health Secretary Andrew Lansley, MP said the new NHS will be one in which patients enjoy a prominent voice. “Decisions must be taken with patients, closer to patients and with clinical leadership to the fore,” he said.

The BMA has welcomed the pledge to develop a clinically-led health service following an increase in NHS management in recent years, but urged the coalition to deliver beyond rhetoric. “Doctors want to work constructively with the new government and we are pleased with plans to prioritise clinical engagement with the medical profession. But it is essential that this dialogue is meaningful and does not just pay lip service to the notion of involving clinicians in proposals for the health service,” said BMA Chairman, Dr Hamish Meldrum.

Plans to introduce a Health Bill that cements the coalition vision for the health service were unveiled in last month’s Queen’s Speech. The Bill, which will be put before parliament in around 18 months’ time, will propose an NHS run by clinicians and free from political interference. A flagship component will be the creation of an independent NHS Board, which will be responsible for apportioning resources and providing commissioning guidance. It will also give GPs power to purchase services for their patients.

Other measures include the establishment of a Cancer Drugs Fund to enable patients to access the cancer drugs ‘their doctors think will help them’, an increase in the responsibilities of the Care Quality Commission, and awarding new powers to Monitor to act as an economic regulator ‘to oversee aspects of access and competition in the NHS.’ Further attempts to improve efficiencies within the service will see a reduction in the number of health quangos in a bid to cut administration costs in the NHS by a third.

 

The Health Bill – at a glance

Purpose:

To build a sustainable national framework for the NHS

To support a patient-led NHS focused on outcomes

To reduce bureaucracy

Benefits

An NHS led by clinical decision-makers that is more responsive to patients

A system which drives up standards of care, eliminates waste and achieves outcomes

A service where patients have greater choice and control in decisions about their care

Policy

The establishment of an independent NHS Board to allocate resources, provide commissioning guidance and to allow GPs to commission services

Strengthening the Care Quality Commission and developing Monitor into an economic regulator to oversee access and competition in the NHS

A reduction in the number of health quangos, cutting the cost of NHS administration by a third

Programme for Government

The Queen’s Speech followed hot on the heels of the coalition’s Programme for Government, which was unveiled by Prime Minister David Cameron and Deputy Prime Minister Nick Clegg shortly after the new government was formed. The Programme guaranteed a ‘real term’ increase in health spending in each year of the parliament and an end to ‘top-down reorganisations of the NHS’ that it said had ‘got in the way of patient care.’ The government pledged to stop the ‘centrally dictated closure of A&E and maternity wards’ and give people better access to local health services. Key measures outlined in the Programme include:

  • NICE reform and a move to value-based pricing so that all patients can access the drugs and treatments their doctors think they need
  • Establishing a Cancer Drugs Fund
  • Strengthening the power of GPs as ‘patients’ expert guides’ through the health system by enabling them to commission care on their behalf
  • Prioritising dementia research within the health R&D budget
  • Setting health targets in key areas such as cancer and stroke survival rates and reducing hospital infections
  • £10 million a year from 2011 to support children’s hospices
  • A new per-patient funding system for all hospices and providers of palliative care
  • An extension of best practice on improving discharge from hospital –maximising the number of day care operations, reducing delays prior to operations and enabling community access to care and treatments
  • Helping elderly people live at home for longer through home adaptations and community support programmes
  • The development of a 24/7 urgent care service throughout England
  • Giving every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers

The programme’s commitment to end an era of top-down NHS reconfigurations and instead give power back to local communities has been highlighted as a key component of change. Health Secretary Andrew Lansley said: “We are committed to devolving power to local communities – to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. Local decision-making is essential to improve outcomes for patients and drive up quality.”

Lansley said he expects decisions on NHS service changes to:

  • Focus on improving patient outcomes
  • Consider patient choice
  • Have support from GP commissioners
  • Be based on sound clinical evidence

Local NHS organisations that have started to look at changing services will need to ensure their plans match these criteria. Lansley had said he was looking to NHS London, the biggest authority in the health service, to lead the way in working with GP commissioners in their reconfiguration of NHS services. However, the head of NHS London, former GSK Chairman and CEO Sir Richard Sykes, resigned from his position late last month following the new government’s decision to halt a wave of hospital reorganisations. Sykes was said to be furious at the Health Secretary’s decision to scrap a review of healthcare in the capital. The review included the possible closures of some A&E and maternity units.

Reaction

Reaction to the recent announcements has been varied. The ABPI said that the UK is slow to allow patients’ access to innovative new medicines, despite having the lowest prices compare to other countries – and therefore was pleased to see the proposed review of NICE. A spokesman told Pf: “We would welcome a review of NICE, its remit and the way it assesses value, so that British patients get better outcomes and access to medicines available to patients in other countries, and the NHS spends its total budget as wisely as possible.”

Its views on value-based pricing, however, were more cautious – with its successful implementation being dependent upon collective responsibility between the industry, government and the NHS. “The ABPI strongly supports the principle that NHS patients should receive faster access to innovative new medicines. Industry needs to be accountable for demonstrating the full value of medicines, while NICE and the NHS must put in place systems commensurate with evaluating this full value,” it said. “Value-based pricing (VBP) is clearly a priority for the new coalition government, but faces some significant design issues – and we look forward to a dialogue with government on these issues. No other country has yet implemented a full VBP system and its design will be critical in order to avoid unintended consequences for patients, government, the NHS and industry alike. The current PPRS runs until 2014 and, under this scheme, the UK enjoys the lowest prices in Europe.”

Anna Dixon, Director of Policy at think-tank The King’s Fund, said the proposals confirm that the NHS is embarking upon a period of significant change. "Strengthening the role of doctors and the voice of patients will create some difficult dilemmas," she said. "In setting up an independent NHS board, careful thought will need to be given to the relationship between its responsibilities and those of ministers, who will remain accountable to parliament for NHS expenditure".

“We welcome the acknowledgement of the critical role played by GPs within the NHS and the clear signal that changes are needed to improve the quality of general practice. If, as expected, these changes include transferring budgets to GPs, it will be important to learn from the previous experiences of GP-led commissioning in the United Kingdom and other countries to ensure it delivers benefits for patients and efficiency savings across the health system while ensuring accountability for public expenditure.”

But analysts have warned of the dangers of giving financial accountability to clinicians. Dean Arnold, head of health care practice at Deloitte, said: “Putting patients first is always a positive thing to do, so too is empowering clinicians. However, this requires some caution as clinicians are not specialists in cost management – a skill that will become increasingly important. With power becomes greater accountability. Patients should be able to hold clinicians to account. It can be argued that today health care managers and executives are far more accountable to patients than clinicians. It will be vital to get the right ‘checks and balances’ if we are to put the NHS in the hands of clinicians.”

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The power of networks

June 29th, 2010

Research has shown that peer opinion is one of the most significant influences on doctors’ prescribing behaviour. So how can you maximise the impact of your customer meetings? Matthew Butcher investigates.

Aristotle said it first, or at least best: “Man, by nature, is a social animal.” You just have to look to the success of websites like MySpace or Facebook for proof that social networking is an integral part of our lives. And, further, that the act of socialising influences our behaviour.

Peer pressure

That holds true even for groups of people we usually think of as highly rational and data-driven – doctors. This has been known since 1954, when Herbert Menzel and Elihu Katz conducted the first major study on the impact of physicians’ social networks. By examining the social process by which doctors influenced each other to adopt a new drug, tetracycline, they found that the diffusion of information was a social process. Funded by Pfizer, the study was originally intended to assess the impact of medical journal advertisements. Surprisingly, Menzel and Katz discovered that while promotional materials enabled knowledge and awareness of the drug, it was not sufficient to convince physicians to adopt the product. The more significant factor impacting a physician’s prescribing rate was the subjective assessment of his or her peers.

Since then, numerous studies have confirmed Menzel and Katz’s findings and further expanded the level of detail to track the specific diffusion paths by which physicians influence each other. A 2006 study conducted at the Brigham and Women’s Hospital evaluated the network of influential discussions regarding women’s health issues among 33 primary care physicians across four separate clinics in a six-month period. Again, the findings confirmed the impact of peer interactions, and supported the concept that efficient dissemination of information can be achieved through peer influence.

Interaction equals action

With these results in mind, how can pharmaceutical representatives optimise their communication with healthcare professionals to support their products? In rating the effectiveness of practices designed to promote behavioural change among physicians, Dr Jeremy Grimshaw conducted a meta-analysis in 1998 that evaluated 1,139 references. Grimshaw, Director of the Clinical Epidemiology Program of the Ottawa Health Research Institute and Director of the Centre for Best Practice at the University of Ottawa’s Institute of Population Health, found interactive educational meetings (participation of healthcare providers in workshops that include discussion or practice) were among those consistently most effective in promoting behavioural change among health professionals. Among interventions of variable effectiveness was the use of local Key Opinion Leaders (practitioners identified by their colleagues as influential) presenting their case experiences followed by interactive discussion. And among the interventions that had little or no effect were theoretical lectures, for example.

In short, interactive educational meetings in which healthcare providers could engage in active dialogue offered greater impact than traditional instructive educational meetings with no interaction and relevance to day-to-day experience. And yet, most medical communications programs today such as audio visual lunch meetings or medical education meetings still rely on presentations in the theoretical format without interaction.

This might suggest a possible reason why such medical educational programmes are not delivering the expected results. The value of key opinion leaders is not in question; rather, it is the nature of the format in which they present. A format that allows for maximum peer-to-peer interaction and day-to-day relevance may well mean the difference between a high-influence and a low-to-moderate-influence programme.

Like attracts like

Another method of optimising the effectiveness of medical educational meetings is by choosing your audience wisely. It has been found that the dialogue between an audience of healthcare professionals who professionally resemble each other tends to provide an even greater effect than interactions between those individuals without similarity.

For example, a primary care physician may look to a professor for updated information on disease states or therapeutic choices, but a primary care physician may be influenced more readily by another primary care physician when learning best practices based on clinical experience.

“Interpersonal communication is usually more effective when there is a high degree of professional resemblance between the individual attempting to introduce the innovation and the recipient,” states Robert Sanson-Fisher in a recent report in the Medical Journal of Australia.

Therefore, the choice of delegates depends greatly on the topic of the meeting, as well as the representative’s aim of the meeting, for example, do they wish to enhance disease state knowledge, do they wish to challenge day-to-day practice, etc?

Keeping to the Code

Delegate choice must also be considered when choosing a venue to host such meetings. For example, a large number of key opinion leaders might require a hotel as it has a larger capacity, as opposed to a meeting with a small number of nurses possibly requiring a small private function room in a local restaurant. A presentation topic that is relevant to a local trust would be more likely to require a venue very local to the target audience, as opposed to a topic relevant to a national audience, which would probably require a venue in a location off a motorway, or near a train station, in a central part of the UK.

These factors must be taken into consideration at all times when organising a medical educational meeting to ensure that the venue choice is “appropriate and conducive to the main purpose of the meeting”, as stated by the PMCPA, as well as ensuring that the meeting is compliant with the ABPI Code of Practice. It is also fundamental that, in order to organise a meeting that is ABPI Compliant, the venue should not be luxurious, or recognised for its sporting facilities, for example, and a private function room must be available to ensure that no members of the public are able to hear or see the contents of the presentation.

In summary, it is clear that the era of medical education and peer-to-peer influence tactics is upon us. However, with the pressure of smaller field forces and fewer resources and stricter codes of practice, representatives need to be more innovative and targeted in their approach, and spend their time and money wisely. Evidence suggests that discussion and interaction during such medical educational meetings enhances peer influence as opposed to non-interactive presentations, and delegate choice is key.

Matthew Butcher is Managing Director of CompliantConferences.co.uk, which offers an online search engine to assist in the organisation of meetings by locating venues with private function rooms, caterers, takeaway and delivery services by postcode, as well as additional resources to help towards reducing workload when arranging a successful medical educational meeting. Visit the website or contact enquiries@compliantconferences.co.uk for more information.

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The rookie manager: your first four weeks

June 29th, 2010

Just been promoted or seeking promotion to regional management? Ama Verdi-Ashton shares the benefits of her experience in the industry to ensure you get the best start in the job.

“We are delighted to offer you the position of Area Manager….” I can still recall those words being said to me when I achieved my first manager’s position. They were words that evoked emotions of happiness, a sense of accomplishment and excitement. I also recall, however, a few days later when reality bore through my soul that I was now a bona fide manager of a real live team. I would be expected to develop business for a major pharmaceutical company on an area that currently had a £2.5 million turnover! The feeling of fear came to visit along with trepidation. The need to scream loudly would bubble at the back of my throat quite often in those days. My thoughts were always: “What should I do?” “Will this work?” “What is right?”

I wished, at the time, that there was a Manager’s Guide for our industry. Something that could direct me when I did not know something and a guide that would confirm when I got something right.

Now, years later, as I approach a major birthday, I am delighted to be writing such a guide. It is based on my experiences as a manager who built many teams successfully. I hope you find it useful and that the strategies work as well for you as they did for me.

This will be a simple, step-by-step guide for the first four harrowing, yet exciting, weeks of becoming a manager in pharma.

The right foundation

We need to first consider what the foundation of our role is and, in my opinion, there are three key plates that you need to spin. Consider these and decide the percentage of time you will spend in each. Make your foundation strong by doing your homework and be embroiled in what is on these plates.

- THE BUSINESS

· What are the sales doing on the area and individual territories?

· What are your sales targets?

· What projects are happening to drive the sales?

· What’s the business plan look like?

- YOUR PEOPLE/THE TEAM

Your people are the richest resource you have available to you to help drive sales. You will need to identify who are your high achievers, who are your ‘cash cows’, who are weakest links, who needs more support. This will take time, however, the task will be infinitely easier if you set your stall right from the start as set out in this article and be a visible and proactive boss.

- INFLUENCERS

Who are the people internally and externally that influence your business and team? In this article I have not the space to discuss external customers. For internal customers, build a relationship with them and network, network, network. This will gain you more credibility as a manager and can even lead to extra budget!

Internal influencers are:

· Product managers in Marketing

· NHS liaison personnel

· Secondary or Primary Care

· Your manager

External influencers are:

· Policy makers (for guidelines protocols)

· Key consultants, GPs, GPSIs, pharmacists

· Any other decision maker

If you ever feel lost in a mire of ‘too much to do’, self-coaching around these three key areas will usually bring clarity.

So let’s look at what we do with in those first crucial weeks.

Week 1-2

  1. Contact team members individually by phone

This is an introduction to you and should be done on Day 1 or before if possible. Let the individual know how excited you are to be working with them. Offer support if needed. The outcome of this call should be an individual business meeting booked in week two and to let them know about the first area meeting you will be organising.

  1. Contact internal influencers

Mobilising the internal influencers for your business is key to success. Regular contact with, for example, your NHS liaison person, will give lots of benefits for the business. Spread that net wide to find these key people. The outcome of this call should be an appointment to see them with an agenda agreed as to what you will discuss.

  1. Organise your first area meeting and send out date

I urge you to refer to my previous article about Area Meetings to help you make the most of this important resource.

Week 2 – 3

You will now begin to have the meetings you have planned. Here is a suggested agenda for meeting with your representative:

  • Complete a coaching contract. This is where you lay out what is important to you on a daily basis, e.g. you might hate it when people are late and you expect them to be on time, you might only like people to ring you before 6pm and not after. The representative may like forms filled at the end of the field visit not at lunch time, they may prefer you to remain quiet in calls, for example. It includes anything you both deem important to ensure your relationship is on sturdy ground right from the start and can be reviewed as often as you wish.
  • Talk about their take on their business and customers.
  • Talk about their last appraisal.
  • Talk about their career aspirations and how you will help them.
  • Engage them personally. Remember they work for YOU, you are the company to them, and so getting to know and understand them will always help.

You should also start field visiting with the team. If they see that you are positive and enthusiastic, that is exactly what they will be. Your organisation will probably have its own guidelines on what to do and how to behave on field visits, but the most important thing is to keep upbeat and enthusiastic. You want to leave the representative feeling energised to go out the next day and perform for you and for them to look forward to future field visits. Keep the feedback objective and not subjective.

Here is a suggested agenda for a meeting with your internal customers:

  • The Business on the Area including customers
  • Their business plan
  • Successes
  • Contract how you will work with them
  • Establish what they need from you and your team to help drive success
  • Always invite them to future business meetings, as they are imperative to you hitting your sales target.

Week 4

It is time to hold your first area meeting. You will need to cover the following:

Sales summary

  • Research your sales. Complete a SWOT analysis with the team to better understand what is going on.
  • Where are you now? Graph the data, as a region, territory and per individual area. Graph the competitors, talk about potential for the area.
  • Graph the targets for the year. Breakdown to quarters and even down to individuals. Asking a representative to achieve a yearly target of £200,000 is a lot more daunting than breaking it down to 12 scripts a week, for example.
  • Use the graphs to coach the group based on the good performance of individuals, share best practice etc.

Activity report

  • Research your face-to-face calls. What is the team achieving for meetings and contact rates? What do you need the team to achieve? Graph the data.
  • Again, coach and brainstorm around individual performances to help leverage the best practice that will drive sales.

Create a vision

  • Creating a team vision together helps establish a framework for significant strategic success.
  • Please see my previous article on Area Meetings on how to create a vision with your team (or contact me via Facebook).

Expectations

  • Here is where you can begin the contracting process by sharing your expectations with your new team, for example, that you expect a fair day’s work for a fair day’s pay.
  • You could also use this session to talk about field visits and what you expect from them.
  • Always let the team know what they will get in return for honoring your expectations. For example, you will be an ambassador for them and their careers, selling them just as hard as they are selling the products for you.
  • Give them an opportunity to voice their expectations of you as their new boss.

At the end of week four, take stock and contemplate what you have done so far. What went well, what needs readjustment?

Table: Your first four weeks’ actions

TIME

ACTION

WEEK 1

Contact all representatives individually
 

Contact internal influencers and make appointments to see them
 

Ensure you have individual meetings set up with team members

WEEK 2

Organise area meeting for week 4
 

Understand your business by sales, success factors, activity and projects
 

Practice how will create a vision with your team
 

Write your ‘Expectations’ slide for your area meeting

WEEKS 3

Hold individual meetings with representatives
 

Hold individual meetings with internal influencers
 

Start field visiting

WEEK 4

As above
 

Hold your first area meeting for the team
 

Review your first four weeks

Tips for the future

  1. Understand your team better by carrying out Belbin, which highlights the strengths of each individual. This will help you delegate tasks to your team members that are right for their natural style and ability.
  2. Hold regular team meetings or ‘buzz sessions’. For example, if the team activity is sliding, a quick ‘buzz session’ for a couple of hours may be all that is needed to re-motivate them or find out what the issues are.
  3. Take a leaf out of Management Consultant Tom Peters’ fantastic book In Search of Excellence’ where he shares with us a technique known as ‘management by walking about’, which was popularised by Tom Peters and Robert Waterman in the early 1980s because it was felt that managers were becoming isolated. At Hewlett-Packard, where the approach was practiced from 1973, executives were encouraged to know their people, understand their work and make themselves more visible and accessible. Management by walking around emphasises the importance of interpersonal contact, open appreciation and recognition. It is one of the most important ways to build civility and performance in the workplace.

In short, spend time with your richest resource – your team, and your sales and your activity will be superhuman! Most of all, enjoy yourself, inspire your team, and have fun in this most vital and wonderfully rewarding role. Good Luck!

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A glimpse of coalition – ABPI Conference 2010

May 29th, 2010

Pf Editor Chris Ross reports on an annual ABPI conference coloured by pre-election fever and driven by a determination for industry and NHS to work together for the good of the nation. But will the wider industry be able to build on its manifesto pledges?

The spectre of an imminent General Election loomed large over the 2010 ABPI Conference, which took place ten days prior to polling day. Proceedings became a strange portent for the post-election political discussions that would later emerge, centring as they did on the need for two parties to work together in partnership for the greater good. A full working coalition between the NHS and the pharmaceutical industry has until now appeared as likely as a Liberal Democrat sitting at the top table of government. But in this figurative time for change, joint working is now considered ‘in the national interest’ – and the ABPI conference addressed it with relish. Unlike political coalition, however, the collaboration between NHS and industry cannot be considered as a temporary measure. It must, the conference concluded, become a long-term commitment.

Unlike the 2010 General Election, the ABPI Conference managed to deliver an overwhelming majority – with presenters and audience members alike united in the view that the old adversarial pharma/NHS relationship is ‘old politics’, and that joint working represents the future for both parties. Political rhetoric? It cannot afford to be. The experts claim partnership working is an obligation not an option. Me? Well, to use some recent political vernacular, “I agree with Nick.”

ABPI Director-General, Richard Barker, told delegates that partnering with the NHS was the biggest issue facing industry at the moment. The agenda, he said, had been put together to help debate solutions to a range of challenges:

  • How can we partner to bring new medicines to market via UK research and clinical trials?
  • How can we evaluate them more broadly and more fairly across the UK?
  • How can we provide patient access to the best available treatments?
  • How can we work together with NHS management and NHS professionals to reduce the burden of disease?

Within the auditorium, conformity with these principles and objectives was widespread – but as with many such conferences, it is often the audience outside of the room that matters most. Persuading the non-believers of the need for change will remain the biggest challenge.

Barker said the industry’s relationship with the NHS was now entering a third phase. The first phase has previously been described as ‘trench warfare’, whereby the industry sought to promote its products and the NHS sought somehow to avoid it. “The second phase, which I’m delighted to say is where we have been for a few years now, is in experiments in joint working,” said Barker. “We’ve got more than a dozen of these experiments going across the UK and some of them have got to the point in their lives where we’ve been able to demonstrate real impact in what they achieve on the burden of disease. But I’d like to see us move to a third phase of relationship with the NHS, which is partnering to address each other’s challenges.”

The challenges facing the NHS are well-documented and have been further highlighted by the glare of publicity the general election has provided. The UK’s desperate economic climate has driven an annual funding gap of between £15-20 billion by the end of the next planning period. To help achieve it, the QIPP agenda, is crucial – and joint working is seen as a significant component in delivering success.

The financial drivers for progressing joint working were further outlined by Mike Farrar, Chief Executive, North West SHA. Farrar said that the business case for working together more effectively had never been more compelling in terms of the patient, the taxpayer and the economy. “If we can get our act together and add value to what we do, we can really help transform the state of the economy. It behoves us to find a better way to work together than perhaps we have done in the past. We can’t afford to do what we’ve always done,” he said.

The need to change behaviours was a resonant theme of the conference, but Farrar warned that old behaviours and perceptions are stubborn and difficult to shift. Progress, he said, would require both parties finding a common language. "The language we talk about constantly is the QIPP challenge – Quality, Innovation, Productivity and Prevention. And the pharmaceutical industry can help us meet this challenge.” Outlining the four pillars of the agenda, Farrar pinpointed where the industry can play a part:

  • Quality – the pharmaceutical input into the quality of patient care is significant, not only in terms of new products, but also existing products. The challenge is to ensure patients get swifter access to them and are supported in terms of compliance to make sure we get the benefits. “We also need to make sure our services are aligned to them, so that we have a whole service offer not just a single product offer.”
  • Innovation – the creation of the Life Sciences Delivery Board is an opportunity to bring sectors together – NHS, industry, academia. “This makes sense in terms of aligning businesses, getting business-to-business relationships and adding value to the processes we share. Innovation will be a clear manifestation that we are getting this right. Waste often occurs in industry business processes because the health service hasn’t specified what it wants properly. By sharing the pipeline earlier, building business processes so that as the NHS goes through selection of those products it can actually be prepared for their entry, we will deliver value and get products used sooner.”
  • Productivity – executives across the industry will be sitting on information where they know that if the pharmaceutical inputs can be got right in terms of the care pathway, NHS and associated care staff would be much more productive. In the process, lengths of hospital stays will reduce, the number of operations will increase and more opportunities to care for people within the existing inputs that we’ve got will emerge.
  • Prevention – this is not only relevant to the NHS, but also to every single country whose health service costs have increased due to the extra demand driven by the ageing population and new technologies. The demand side of the equation has not yet been managed.

“In all these dimensions, the industry can help me achieve these challenges,” said Farrar. “In return, I can offer value back and allow you to avoid the waste and get higher returns. But if we know what we should be doing, the question we have to ask ourselves is why we are not translating that into action. This is a world that has been completely stubborn to a lot of senior leadership cajoling. It makes absolute business sense for us to try to work on this agenda. But if that’s the view from the top of the office, why are we not able to get it into place? We need to get this drilled down into our organizations so that at middle management level we’ve got the right behaviours, the right degree of honesty and trust, the right amount of confidence and courage to work with each other in a different way. That’s the journey.”

Farrar said that the journey called for new skillsets and increased emphasis on training. “How do people making the decisions get trained? How do they understand the nature of the business when they look at it from the industry or on the NHS side? How do we understand and walk in each other’s shoes? That’s where we have got to put attention and energy.”

Industry perspectives

From an industry perspective, the view from the top was similarly positive. Senior figures from some of the industry’s largest companies presented examples of their experiences in joint working and, in the process, became powerful advocates of the opportunity to partner. Patrick Hopkinson, Director, Portfolio and Partnership Marketing, GSK said: “This is an incredible opportunity to bring together great people, resources and skills for the benefits of patients. Partnership working can transform the relationship the industry has with the NHS, but it needs to be more than a nice sentiment, it needs to be a strategic imperative.”

Alan Barge, VP and Head of Oncology and Infection TA, Astra Zeneca, said that all the ingredients for success were there, and that the industry could provide the glue to hold it all together. Using alcohol as a metaphor, he said: “Between us, in academia, the NHS and the industry, we have a full six-pack. We have everything we need to develop innovative, ground-breaking treatments for cancer, to deliver them to patients and to make them cost-effective. But somehow, it sometimes seems we are missing the plastic ‘thingemy’ that holds it all together. My vision is to be the plastic thingemy, so that ultimately we have a full six-pack that holds together. In the UK, we have all of the components. Our challenge is to make it happen.”

One of the biggest challenges, however, is to improve trust in the industry. Richard Blackburn, Managing Director, Pfizer UK, said that there are varying levels of trust between different parts of the NHS and the industry, but that improving this was a major objective. He presented a slide that included a sticker one of his colleagues had seen on the door of a medical school. The sticker encouraged students to ‘say no’ to drug reps. (See figure) (INSERT SLIDE).

“This is the sort of thing you normally see associated with stopping smoking or internet predatory. Can it really be the view that our future prescribers have of the people they meet from our industry? I don’t think it is representative, but it does serve to remind us that there is a problem that we cannot afford to ignore.”

Blackburn highlighted a handful of initiatives designed to tackle the issue of trust, outputs from the ABPI Trust Imperative Board. Promotional items were cited as a negative force. “The ubiquitous pens, pads and other giveaways have become a stick that our industry critics beat us with. They represent the kind of relationship where we hope that the significant value that we bring to our customers will somehow be remembered as a result of the relatively cheap item we have left with them. The time has come for us to put an end to that practice. Until we do, it is just going to be something that gets in the way of us moving forward.

Blackburn drew attention to the words of the Royal College of Physicians to support the argument: “The ABPI should change its code of practice to bring an end to the practice of industry representatives giving gifts to doctors and their support staff. Acting on this single recommendation alone would do much to rebalance the relationship between medicine and industry.” In November, ABPI member companies will have the opportunity to vote on a proposal to do just that. Another vote will be taken on a proposal to declare publically all payments made by pharma companies to HCPs. The ABPI will also encourage further dialogue around the funding of medical education, meetings and training. This, said Blackburn, was a legitimate debate that encouraged divergent views. The overall aim, he said, was to improve what had become a dysfunctional relationship between NHS and pharma. “Industry is honestly trying to address that. My plea would be that our colleagues in the NHS see that and respond to it.”

One senior NHS figure, Mike Dixon, Chairman of the NHS Alliance, said that he was impressed by the ABPI’s desire to make joint working happen, rather than allow it to become a ‘hollow desire because it sounds like a good idea.’ Dixon apologized on behalf of fellow clinicians, who he said had been complicit in a plot that had led to a mistrust of pharma. But Dixon raised concern that much of the dialogue promoting the benefits of joint working was taking place between industry and ‘NHS managers’. “This conference has talked about working with leaders, and all the leaders are managers. I hope in the new world that we will see clinical leadership take a more central role in how the health service is working,” he said. “It doesn’t make sense to have the managers managing and the clinicians spending their money. The two need to meet up just as the industry and NHS needs to. In this new world, the old world of SHAs, PCTs and practices are going to give way and clinical leadership will emerge as being more important. Localism will be important, and groups of practices forming to provide and commission will increasingly be clinically led and an important point of contact for the industry. I think you need to prepare for that.”

The ABPI Conference took place in central London at the impressive conference venue, The Brewery. Dixon took Alan Barge’s alcohol metaphor to new levels, mischievously commenting that the venue selection had been designed to show that the ABPI could indeed produce a good piss-up in a brewery! The mood of the meeting was, of course, more serious as delegates consumed the challenges of the political and economic environment that faced them. But the conference dinner that followed proceedings did allow for some champagne celebration – not least for the two projects that were awarded the very first ABPI Joint Working Awards (see news on p). Further information on these, and other, joint working projects will be published in HSP’s new publication, Partnership in Practice, later this year.

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UK pharma past, present and future – ABPI launches Annual Report and plans for 2010

May 29th, 2010

The ABPI has promised that in 2010 the UK will start to move into a position of world leadership in creating, valuing and accessing healthcare innovation.

Following its recent Conference the ABPI has launched both their 2009/10 Annual Report and 2010 Strategic Plan, reviewing 2009/10, but also looking ahead to build on recent progress.

The Annual Report celebrates the ABPI’s achievements of the last year, including the launch of the Office for Life Sciences to support the interests of the life sciences industry in the UK and work with the Kennedy report to reform Healthcare Technology Assessments (HTA).

The Strategic Plan, on the other hand, lays out what the Association hopes to achieve over the next 12 months and includes promises to boost trust in the industry, extend and improve joint working between companies and the NHS and build on the momentum started by the Office for Life Sciences.

Looking back

The Annual Report looks back on what is described as “an eventful and successful” year and is optimistic about the industry’s future, but points out that the “financial and NHS climate” must be “conducive to innovation”.

The Report states: “The opportunities that lie ahead for the UK pharmaceutical and biotechnology industry in a globally dynamic environment are vast. The fast moving pace of science, if harnessed, will enable the UK to retain its position as a world leader in the life sciences industry.”

Last year saw the launch of the ABPI’s four key imperatives: Value, Innovation, Trust and Access or VITA, which have been the focus of its activities. Achievements are targeted within these areas and separated within the document to illustrate this structure.

However, in terms of overall achievements, the document focuses mainly on the ABPI’s improved relationship with healthcare providers and regulatory authorities, in particular through the progress achieved by the launch of the Office for Life Sciences.

A key achievement for the industry was the establishment of the Office for Life Sciences, which recognised that joined-up government action was required to protect the interests of the life sciences industry in the UK.

As a result of collaboration between the ABPI and the Office for Life Sciences, the Life Sciences Blueprint was published in July 2009 and Life Sciences 2010: Delivering the Blueprint in January 2010. These encompassed vital initiatives, including the patent box, the innovation pass and the Life Sciences Super Cluster, each of which considerably improved conditions and incentives for life sciences companies operating in the UK.

Other achievements for the ABPI over the last year include:

  • The Kennedy report including recommendations that will enable companies to have increased involvement in the Health Technology Assessment (HTA) process.
  • Continued collaboration between the ABPI and NHS Chief Executive David Nicholson on how the industry can support the QIPP agenda.
  • A commitment to R&D being added to the Annual Operating Framework for the NHS.
  • The NHS Constitution enshrining the right of patients to have access to NICE approved treatments.
  • The success of industry-NHS joint working projects.
  • The creation of a forum to allow industry to engage with Higher Education institutions to enhance the skills needed by the industry.

Beyond sponsorship

One key theme of this year’s Annual Report is the potential for joint working between the health service and the pharma industry and the document focuses particularly on achievements in this area.

These include the start of the ABPI’s NHS Partnership Programme to allow closer engagements between companies and the NHS, and launch of the Moving Beyond Sponsorship joint working toolkit in March 2008.

“This commitment to a shared vision and a more mature relationship between pharmaceutical companies and NHS organisations has already proved it can deliver better patient care,” the Annual Report states.

A new era

The 2010 Strategic Plan begins by describing the ABPI as offering a “compelling single voice founded on a shared understanding”.

It goes on to say: “The ABPI is a catalyst for a new era of innovation in pharmaceuticals, improving the health and wealth of the nation. In the next decade, the UK will move to a position of world leadership in creating, valuing and accessing healthcare innovation.”

The Plan divides the ABPI’s key campaign objectives for the coming year in accordance with the four VITA imperatives. The campaign objectives will be:

  • To ensure innovative medicines are valued in the UK as cost-effective solutions for preventing and treating diseases (Value).
  • To restore the UK as a world class leader in innovation by fostering excellence through key stakeholder partnerships (Innovation).
  • To create a new contract between industry and society based on integrity, honesty, knowledge, appropriate behavior, transparency, openness and trust (Trust).
  • To get the right medicine to the right patient at the right time (Access).

The document also contains the ABPI’s top level organisational objectives and how these will translate into activity for each of the imperatives.

The first of these is to maintain the momentum started by the launch of the Office for Life Sciences, and is associated with activities such as implementing the innovation pass, leveraging the QIPP opportunity, expanding joint working to a national scale, launching the Super Cluster and creating a positive environment for early clinical research.

The ABPI’s second objective is to secure commitment to HTA reform to ensure that the UK is an environment that champions innovation, which will include the publishing of guidance for companies on data collection for HTAs and the launch of a Blue Print document describing how the UK can become a global centre of excellence in this area.

The Association has also committed to implementing various behavior changes to boost the trust between the ABPI and other bodies, including new proposals within the Code of Practice to promote transparency, an annual survey conducted with stakeholders to gauge the reputation of the industry and a position paper on best practice in research data sharing to be delivered to the EFPIA by the end of 2010.

Further objectives for 2010 are to agree principles for future PPRS, improve smaller member engagement, resolve pension conflict and agree ABPI financing, modernize ABPI systems and facilities and to bring life science trade associations together.

In conclusion

The Annual Report concludes: “Great progress was made in working towards improved health outcomes for patients, working in collaboration with the NHS and creating a better investment environment for our industry. However, we still need to do more to ensure that all patients in the UK have access to new medicines and treatment with no geographical anomalies, delay or restrictions. We are looking forward to working even closer with all our stakeholders in the new political environment to achieve this.”

The 2009/10 Annual Report and 2010 Strategic Plan are available at http://www.abpi.org.uk/recent.asp.

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IMS predicts industry growth of 5-8%, but UK is given poor prognosis

May 29th, 2010

The global market for pharmaceuticals is expected to grow nearly $300 billion over the next five years, reaching $1.1 trillion in 2014, says IMS Health.

The market analysts predict a global growth rate of 5-8% during this time, due to the impact of leading products losing patent protection in developed markets, as well as strong overall growth in the world’s emerging countries.

However, the forecast is worsening for the UK market, where IMS estimates annual growth will drop from 3.2% in 2009, to 1-1.7% between 2010 and 2014.

These conclusions are included in the latest release of IMS Market Prognosis, the company’s series of strategic market forecasting publications.

Global pharma sales growth of 4-6% is expected this year, consistent with IMS’s prior forecast. In 2009, the market grew 7.0% to $837 billion, compared with a 4.8% growth rate in 2008.

“Patient demand for pharmaceuticals will remain robust, despite the ongoing effects of the economic downturn being felt in many parts of the world,” said IMS’s Murray Aitken, Senior Vice President, Healthcare Insight. “In developed markets with publicly funded healthcare plans, pressure by payers to curb drug spending growth will only intensify, but that will be more than offset by the ongoing, rapid expansion of demand in the pharmerging markets.

“Net growth over the next five years is expected to be strong – even as the industry faces the peak years of patent expiries for innovative drugs introduced 10-15 years ago and subsequent entry of lower-cost generic alternatives.”

Key drivers

In its analysis, IMS identifies several key market dynamics.

  • Pharmerging markets – IMS predicts pharmerging markets will grow at a pace of 14-17% through to 2014, while major developed markets will grow at just 3-6%. The US is expected to remain the single largest market, with 3-6% growth annually in the next five years and reaching $360-390 billion in 2014, up from $300 billion in 2009.
  • Therapy areas – Due to the wide availability of low-cost generics in many chronic therapy areas, R&D focus will switch to areas where there is significant unmet clinical need, high-cost burden of disease and innovative science that can bring new treatment options. In oncology, diabetes, multiple sclerosis and HIV, annual growth is expected to exceed 10% through to 2014 as new drugs are brought to market, patient access is expanded and funding is redirected from other areas.
  • Spending cuts – Under increased pressure to save money, countries with publicly-funded healthcare systems may seek to cut spending on medicines. Turkey, Spain, Germany and France, as well as others, have already announced plans to apply across-the-board restrictions on access or reductions in reimbursements.
  • The generic threat – Over the next five years, products with sales of more than $142 billion are expected to face generic competition in major developed markets. The impact of this shift to generics in major therapy areas such as cholesterol regulators, antipsychotics and anti-ulcerants will reduce total drug spending by about $80–100 billion worldwide through to 2014. This will particularly impact the US, where six blockbuster products are expected to hit patent expiry in 2011-2012.
  • Rigorous assessment – The number of new molecular entities launched annually over the next five years is expected to remain in the range of 30 to 35 products. However, these will be subject to more rigorous and complex assessments by payers before being accepted and reimbursed. As funding and implementation of healthcare at regional or local levels becomes more significant, the time it takes for new medicines to be made available will extend.

Aitken added: “The expected global economic recovery removes an element of uncertainty for the industry over the next five years, although the way payers address lingering budget deficits will remain an issue in many markets. Health system reforms, such as those to be implemented in the US, can spur fundamental change in the market – but the full impact may not be felt until the latter half of this decade.”

Leading up to 2020, IMS forecasts a continuing shift toward biopharmaceuticals, specialty-driven products, and changes in the mix of disease areas of interest.


IMS Market Prognosis offerings are subscription-based, strategic market forecasting publications that provide unparalleled insights into the economic and political issues affecting the pharmaceutical and healthcare industries. Based on a rigorous evaluation of the key events affecting the marketplace, IMS Market Prognosis provides a five-year forecast at the country, regional and global level.

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Pharma and the online revolution

May 29th, 2010

ExL Pharma’s recent Digital Pharma Europe Conference walked the talk of social networking. Pf reports on the event.

Is pharma entering the digital age? Is it possible for such a regulated industry to enter into the online ‘conversation’? These were the questions addressed a recent conference held in Berlin on 29-30 March, Digital Pharma Europe. This, the second Annual Digital Pharma, was held at Bayer Schering Pharma’s headquarters in Berlin, and the company’s CEO Andreas Fibig also delivered the welcome address. It was attended by 160 marketing and communication professionals from across the industry.

The overall message was that the time for pharma to fully engage in the online revolution is right now – and that the industry can’t delay in making the most of this medium as a way to deliver the highest levels of service to patients and physicians.

“The Digital Pharma global event series has a mission to provide the most cutting edge forum for the pharma industry to explore how to engage in social media and to share best practices on the most advanced eMarketing strategies and tactics,” said Jason Youner, Event Director at ExL Pharma, organisers of the event. “We strive to adopt the principles of Social Media through our events, which are rooted in openness, spontaneity, free-flowing conversation, collaboration and honesty, so we incorporate a great deal of networking, interaction and discussion.”

‘Unconference’

Digital Pharma Europe boasted to be the “very first pharma ‘unconference’ ever in Europe.” Simply, this represents a new approach to this type of event.

“The traditional format of having speakers talk at the audience for 40 minutes followed by an uninspired, brief Q&A is over,” explains Jason Yourner. “People simply do not communicate that way anymore.”

The concept is that through openness, collaboration and listening before talking, attendees learn how to bring these concepts into their communications in both theory and practice—by learning from the best practices of peers and by sharing and listening within this new format.

Attendees were also encouraged to post live tweets throughout the event, summarising the information shared, but also to communicate with other attendees and speakers etc. As a result, those unable to attend were able to follow the key messages of the conference and the importance of social media for the instant sharing of information and experience was highlighted further. The transcripted tweets from the event are available through www.wthashtag.com under ‘digpharm’.

Sharing best practice

The conference showcased speakers from across the pharma industry, social media agencies and healthcare. Notably, communications and social media representatives from Janssen-Cilag, Boehringer Ingelheim, Novartis, Merz Pharmaceuticals, AstraZeneca, Roche and Merck Serono, as well as Bayer Schering Pharma, shared their experiences of using social media within the context of the pharmaceutical industry. There were also talks from Jens Monsees, Industry Head Consumer Goods & Health Care at Google; Colin Mackay, Director of Communications at the EFPIA; and Bertalan Meskó, MD, author of Scienceroll.com and founder of Webicina.com, who provided the perspective of healthcare professionals who are pro-social media.

One of the key themes that came across was the need for pharma to engage healthcare through being human and the importance of focus on patients, rather than on sterile clinical campaigns. There was a call for the industry to ‘truly engage’ with its customers, to explore new, less passive ways of engaging, and to be willing to listen without controlling the flow of the conversation. It was pointed out that the main issue is for the industry to learn two-way strategic engagement through any channel, not just social media.

There was also discussion of how pharma companies can change their approach internally to facilitate this new type of customer engagement. One point was that social media should be central to a company’s communications department, rather than a separate job title. There was also an emphasis on internal communications between disciplines, and the need for greater internal ‘sharing’ through a more inclusive approach and the integration of training etc.

Who is pharma?

The ‘pharma personality’ concept also came forward. What is the pharma personality, what would they be like to meet at a party or as a friend? It was discussed that for corporate credibility it will be important for a pharma company to have a consistent personality through all channels. The sharing of content must be something that is driven throughout all departments of a company, but pharma companies must also communicate with one another rather than warring through legal departments.

In terms of the practical implementation of the use of social media, it was emphasised that engagement is a cycle process, and that companies must research, publish and then interact. It was also suggested that it should be down to customers to define the road map and key messages, and it will be important for companies to identify those bloggers and social media users within healthcare that are most influential.

Boehringer Ingelheim offered some tips for pharma on the use of Twitter:

1) Have a personality. Pharma needs to let go of the idea of having every tweet approved and to let the account have some personality.

2) It is important that Communications engage with the legal department over the areas they are allowed to engage in dialogue over and those that must be left to ‘corporate speak’.

3) Tweet often, but only when you have something useful to say.

4) Establish a process for the reporting of adverse events.

Commenting on the event, attendee Andrew Spong, digital conveyancer and founder of STweM (social media for scientific, technical and medical communities), said: “#digpharm exploded the myth that the social web is an adverse-event minefield, and encouraged industry participants to acknowledge that the return on connections is the new return on investment.”

Jason Yourner added why he felt the event was a success: “Digital Pharma Europe provided an exciting and dynamic arena that is in keeping with the many new ways in which people around the world communicate. Based on the feedback of the audience, Digital Pharma Europe succeeded in bringing together marketing communications executives to explore ways that they can use social media to improve their two way relationships with stakeholders.”

 

ExL Pharma will be holding the inaugural Digital Pharma West in San Francisco, CA on June 28-30, 2010. For more information and to register, visit www.exlpharma.com.

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The who’s who of Pharma 2.0

While the rest of the world debates the limits on pharma’s online interactions, who is rising above them? We take a look at the big hitters in the world of pharma social media.

In America the FDA and pharmaceutical companies are currently working towards establishing some ground rules to guide the industry’s online interactions, which are likely to have an impact internationally. A range of major US companies have submitted detailed submissions addressing the various problems that arise from pharma’s potential online communication with its customers – although these are obviously in the context of the US market where direct-to-customer (DTC) advertising is permitted with certain restrictions.

These issues include whether or not a company is responsible for comments made on its behalf by third parties or in online conversations, how the necessary prescribing and safety data can be disclosed through the web, whether companies can correct incorrect information about their drugs online, whether companies are responsible for the content of sites they provide links to and how far the industry is responsible for reviewing all adverse event information received through social media channels.

Despite these constraints, a number if pharmaceutical companies are beginning to take a prominent role in the world of social media and using various online channels to interact with the outside world. So who is currently dominating the online conversation?

Roche

Roche has made real efforts to lead the way in the use of social media platforms. Roche Diabetes Care invited 29 diabetes specialists and bloggers to a ‘Social Media Summit’ to discuss how it could better engage with and inform patients and healthcare professionals (HCPs). The company has also recently been praised by social media experts for the use of initiatives through the mirco-blogging site Twitter to encourage interaction with its ‘followers’, including a poll to decide on its profile picture. Its current 3,539 followers makes it one of the most popular pharma Twitter accounts.

Boehringer Ingelheim

Boehringer Ingelheim is another company that has made good use of Twitter, with a current total of 3,889 followers. Under the management of the company’s Director of Global Corporate Communications John Pugh, Boehringer has incorporated Twitter into its communications strategy and takes an interactive approach to its social media use, in contrast to the one-way corporate information feed offered by many companies.

Pfizer

Based on Twitter alone, Pfizer, with a current total of 6,189 followers on its ‘Pfizernews’ account, is a significant player in the social media world. The company has also launched an internal networking site for employees and is working on a site that will bring patients and clinical researchers together.

Johnson & Johnson

Unsurprisingly, pharma giant Johnson & Johnson is also at the forefront of the industry’s online representation. As well as boasting a fairly impressive 3,548 Twitter followers, the company manages its own YouTube channel that features human interest stories focused on patients, runs successful corporate blogs and owns the online community Children with Diabetes.

Novartis

Despite its 5,061 Twitter followers, Novartis is not particularly innovative in its Twitter use. However, the company has developed CML Earth, a community platform dedicated to Chronic Myeloid Leukaemia that enables interaction between patients, patient groups and healthcare professionals.

GlaxoSmithKline

GSK’s official Twitter account is GSKUS, which currently has 3,693 followers. The company aims to ensure its US blog ‘More than Medicine’ is distanced from its brands and encourages people to interact with GSK in a more informal way and openly discuss the issues facing the industry. It also runs a corporate blog for its weight loss treatment Alli.

Bayer

Although not a big user of Twitter, Bayer has been creative in using social media in other ways. Didget is Bayer’s blood glucose monitoring tool for young people with diabetes in the UK, which connects with Nintendo DS systems and rewards the user for meeting glucose targets. The tool is supported by Didget World, where children can build their own profile and network with other users. The company also sponsors MSGateway, an online community for patients with MS, and runs the Living with Haemophilia website.

It is widely agreed that the pharmaceutical industry should play a more significant role in the social networking world, both as an active participant in the conversation and as a provider of regulated and reliable information on its medicines. However, without regulations in place, the role that the industry can play in this open arena will be under question, perhaps even more so in Europe where DTC advertising is not allowed. Until official guidelines are available, it seems likely that the debate will continue.

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Do you need to be better eQIPPed?

May 29th, 2010

This acronym seems to be all-consuming for both the ABPI and the NHS at the moment. Alan Jones continues our series looking into the QIPP agenda.

As we head towards the 2011 financial meltdown in healthcare, the quality, innovation, productivity and prevention (QIPP) agenda has metamorphosed into the Quality and Productivity challenge. Over recent months in Pf, Mike Sobanja and Richard Gray have been urging companies to respond to this challenge. Here we look at the programme in a little more detail.

The QIPP workstreams

QIPP aims to ensure that the NHS delivers on quality, efficiency savings and minimising waste in a very much tighter economic climate. The agenda is quickly developing. At a national level, a number of QIPP workstreams, each with individual leads, are now in play (see Box 1). Jim Easton, National Director of the Quality and Productivity Challenge at the Department of Health, is in overall charge. The subjects of these workstreams were suggested from an ‘engagement process’ carried out last year and the topics were the ones in which people thought quality and productivity could most quickly be improved. Each workstream has a different ratio of national and local work programmes being designed. However, the initial recommendations remained in draft form in the run up to the General Election.

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Box 1: National workstreams and leads

Commissioning and pathways

Safe Care – Maxine Power, National Improvement Adviser, DH

Right Care – Sir Muir Gray, Chief Knowledge Officer of the NHS, DH

Long Term Conditions – Sir John Oldham, National Clinical Lead, Quality and Productivity, DH

Urgent Care – Sir John Oldham

End of Life Care – Sophia Christie, Chief Executive, Birmingham East and North PCT

Provider Efficiency

Back Office Efficiency and Optimal Management – Tony Spotswood, Chief Executive, Royal Bournemouth and Christchurch NHS Foundation Trust

Procurement – Philippa Slinger, Chief Executive, Berkshire Healthcare NHS Foundation Trust

Clinical Support – Dr Ian Barnes, National Clinical Director of Pathology, DH

Supporting Staff Productivity – Lorraine Foley, QIPP Lead, NHS Institute

Medicines Use and Procurement – Peter Rowe, Chief Executive, Ashton, Leigh and Wigan PCT

System enablers

Primary Care Contracting and Primary Care Commissioning – Dame Barbara Hakin, Chief Executive, East Midlands SHA

Technology and Digital Vision – Christine Connelly, Chief Information Officer for Health, DH

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Of particular significance is the workstream on ‘medicines use and procurement’. I am told that this workstream is a ‘balanced package’ of measures incorporating prescribing efficiency, waste reduction, improved procurement and ways to ensure that patients gain maximum benefit from their medicines. The workstream complements, and will work with, a number of existing  programmes to improve the quality of prescribing and will introduce measures to ensure effective, value for money use of the NHS spend on drugs. The worksteam’s focus is on efficient medicines use in primary care, medicines management in secondary care and ways of supporting patients to make sure they are getting the maximum benefit from their prescription.

Further pressure on reducing drug spending is definitely on the cards (with generic substitution still in the mix). Lead Peter Rowe has said that much more has to be done to make sure patients receive the right drugs, which could help reduce future demand for services, but that companies may have to “share the risk” of increased cost. He said: “I want to focus on better value, which could be challenging for the pharma industry.” His programme will also look at better use of non-medical prescribing and self-care, involving OTC medicines instead of prescriptions.

The management of long term conditions and the ‘right care’ workstreams are also worth noting. The latter is led by Sir Muir Gray and focuses on decommissioning, referral management and better value, as well as preventing new services being commissioned and decommissioning those not providing good value. Sir Muir describes this as “stopping things starting and starting things stopping”. All the workstreams have been set the task of improving the quality of care delivered to patients but also to identify where cash savings can be made. It is expected that the NHS will be set particular timetables and be held to account for implementing any ‘must-do’ quality and efficiency improvements that come out of this work in order to try and save the £20bn or so that the DH is expecting.

Jim Easton has also appointed five leads from the NHS and the private sector to join him on the Quality and Productivity programme. They include Sir John Oldham as National Clinical Lead for Quality and Productivity and Joyce Drohan from AstraZeneca as Director of SHA Programmes. She has been busy visiting every SHA to work on their 2008 plans, written during the NHS Next Stage Review, to make sure that they now fit in with the new economic circumstances (see Box 2 and also www.ournhs.nhs.uk/?p=2014). Within each SHA, QIPP Leads have been appointed to develop a regional response to the Quality and Productivity Challenge (see Box 3).

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Box 2: Senior National QIPP Advisers

Sir John Oldham, National Clinical Lead, Quality and Productivity, DH

Joyce Drohan, Director SHA programmes

Maxine Power, National Improvement Adviser, DH

Mohamed Dewji, National Clinical Lead, Primary Care Development

Philip DaSilva, National QIPP Lead, Primary and Community Services

Box 3: SHA QIPP Leads

East Midlands – Kathy McLean, Medical Director and Anthony Kealey, Strategic Programmes Director

East of England – Katherine Vaughton, PMO Lead

London – Hannah Farrar, Director of Strategy and System management

North East – Colin McLeod, Director of QIPP Implementation

North West – Kirsten Major, Interim Director of Health System Reform

South Central – Chris Evennett, Director of Strategy and Reform and Deputy Chief Executive

South East Coast – Sue Webb, Deputy Chief Executive and Director of Clinical Quality and Workforce Development

South West – John Bewick, Director of Development and Murray Cochrane, Associate Director of Strategic Services

West Midlands – Peter Spilsbury, Director of Strategy and Regulation

Yorkshire and the Humber – Ros Roughton, Director of Strategy and System Reform

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Getting NHS engagement

As can be seen, a huge amount of work is going on, although little yet is in the public domain. But like any big reform programme, mobilising the entire NHS workforce for quality and cost improvement will be problematic. QIPP will have to be led across whole organisations and frontline staff will also have to be engaged in driving up quality whilst improving productivity and driving down costs. However, there already seems to be a barrier to progress, as a survey earlier in the year suggested that more than 40% of GPs and secondary care doctors did not know what QIPP was. In response, a booklet, The NHS quality, innovation, productivity and prevention challenge: an introduction for clinicians, has been produced. (Note the rather ‘provocative’ statement in the introduction to this document.)

Getting clinicians to think about their costs will be a real challenge. All of the case studies in this document are in the acute sector. It can only be assumed that primary and community care are coming later. It is also interesting that some Acute Trusts are beginning to challenge their consultants to spend more time delivering care. This could be an issue as the consultant contract currently allows for some 25% of time to be spent on ‘supporting professional activities’ – for example, training, research, audit. Is this now affordable when improving acute sector productivity will be the key to delivering the savings the NHS needs (60% of all costs)?

Conclusions

There is a lot going on. But can the NHS really cut costs without substantially damaging the quality of health care? The jury remains out on this. And what will happen if QIPP fails to deliver the scale of change required? The forthcoming recommendations are unlikely to be ‘optional’, with explicit measures expected to be put in place – and this is on top of the demands of the 2010/11 Operating Framework. Quality and productivity will undoubtedly be the defining issue of 2010/11 and it is therefore no coincidence that the ABPI is working so hard to ‘make connections’ here. As is mentioned repeatedly, there could be big implications and opportunities for sales and marketing teams. Are we clear what they are? Keep up to date at www.dh.gov.uk/qualityandproductivity.

Ten key take-home points

1. By the time this article is in press, the result of the general election will be known. It is unlikely that a Tory government (hung or otherwise) would put a stop to the QIPP work programmes. So still expect a blitz of reports out not long after you read this – yet another initiative to stay close to.

2. This article has identified a lot of people involved with QIPP. Are these new NHS KOLs on your radar? Will they be account managed by anyone? Healthcare managers that are comfortable working at the SHA level could find brand new opportunities for peer-to peer relationships.

3. Many companies are already developing plans on how they can assist QIPP. Are you? Working together to keep more patients out of hospital is clearly one area of common ground. Watch out for a conference in the North West at the end of June showcasing examples of QIPP joint working.

4. NHS Boards will also have a critical role to play in leading the drive for quality at the local level, as well as cost avoidance. Are you working with Boards on QIPP ‘deliverables’?

5. There is likely to be some resistance amongst clinicians to yet another ‘management scheme’ to save money. You could help clinicians navigate the turbulent waters of healthcare reform. And make sure you prepare for QIPP in primary and community care.

6. Draw up QIPP case studies in your own clinical areas for payers. Do brand teams need to become better eQIPPed too?

7. All healthcare staff will need the correct tools, techniques and support to enable them to deliver on QIPP. Where are these and what do they look like? Can you help?

8. There are a lot of other quality initiatives to keep up with, including an interesting Annual 2009/10 report from the National Quality Board, which details the other sub groups working on clinical standards in areas such as VTE prevention, stroke care and dementia.

9. The first tranche of quality accounts will be published in June and the piloting of quality accounts for primary care has already begun. This data could be used to ‘populate’ local account management plans.

10. The new CQC registration system is now in force. Detailed information is available on all the 378 NHS Trust websites and could be useful for account management purposes.

 

Alan Jones is an occasional contributor to Pf. He commentates and presents widely on the ongoing reform within the NHS and its implications for pharma and is a consultant to Wellards. An independent healthcare policy analyst, adviser and NHS trainer, he can be contacted at alan.jones28@virgin.net.

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