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Pharma must collaborate with UK health professionals to better meet their needs

The UK pharmaceutical industry is in the midst of an era of great challenge and also unprecedented opportunity.

How firms interact with the country's National Health Service (NHS) is subject to great upheaval as the ways in which care is delivered to patients are redesigned and the methods firms employ to keep healthcare professionals informed about the latest advances in medicines are under more intense scrutiny than ever before.

At the same time, the UK has a long and unenviable track record of slow take-up of new innovative medicines compared with the rest of Europe.

The Association of the British Pharmaceutical Industry (ABPI) aims for fundamental change in how the UK's government, pharma industry and health providers interact, in order to reverse this underachievement in delivering the best healthcare for patients while ensuring it is conducted responsibly and ethically.

Poor productivity in turning our advances in life sciences into more effective drugs for patients is damaging our society. We are already seeing new treatments coming forward in areas such as rheumatoid arthritis and cancer faster than European health systems can absorb them, with the large majority of new drugs benefiting US patients long before they are in common use here. No less than 70 per cent of the 2004 sales of medicines launched between 1999 and 2003 were in the US.

Main protagonists
There are three main players in this drama; the industry, governments and providers - and all three have to change.

Pharma is accused of being too inward looking, too defensive and too narrow in its view of what it can offer. Governments are tied to old ways of measuring healthcare performance and productivity, and are slow to realise that `mother knows best' is fast dying out as a guiding philosophy of healthcare management.

Healthcare providers at every level are bound too rigidly to short-term budget considerations over the adoption of new technologies, which offer better long-term health outcomes, and slow to reach out for new ways to manage and deliver care.

The consequence of all this is under-achievement. What we require are new rules of engagement and for each of the main players to commit to change their mindset and behaviour.

Pharma needs to re-engage itself as a partner, rather than mere supplier to the system; governments need to focus on innovation to enhance outcomes, rather than measuring activity outputs over cost inputs; and health providers need to focus on partnership to achieve sustained improvements in patients' health.

We must shape our business around the needs of governments and health providers, which means displaying a greater degree of sensitivity to their problems. We need to accelerate the move from the old style `develop and sell' to `innovate and engage.' In other words, collaboration should be at the core of our business approach.

Some green shoots of this approach are beginning to emerge through a range of promising experiments, which are breaking down scepticism on both sides.

Increasingly, pharma companies are becoming more collaborative, transparent and sensitive to their customers' needs, and ready to deliver more complete healthcare solutions. Rather than expecting demand, unrealistically, to be shaped solely by central agencies, like the National Institute for Health and Clinical Excellence, pharma is increasingly engaged with local needs and priorities.

The ABPI has set up one such initiative to improve both the quantity and quality of contact between companies and emerging NHS commissioning organisations. This will supplement, not replace, individual contact between pharma firms and local health providers, such as Primary Care Trusts (PCTs), Health Boards in Scotland and Local Health Boards in Wales.

Where relations between the NHS and industry are poor and Trusts restrict access for pharma companies, the aim is to build confidence and explore opportunities where firms can offer assistance through a collective local industry presence that best fits the aims of the Trust.

Behind the scenes
The guiding principle behind the initiative is for industry to be part of the solution, not part of the problem, for the NHS and commissioners. Among the frustrations expressed by local NHS management is a lack of understanding of their needs, with NHS pharmaceutical advisers and doctors feeling bombarded with approaches that simply do not meet their priorities.

The formation of local industry groups in priority areas will enable firms to be more responsive to local NHS management.

The ABPI is bringing together local NHS with industry groups and combining them with external consultancy expertise to manage this new initiative and provide dedicated facilitators who will arrange the meetings and ensure agreed projects are implemented, to maintain momentum.

In the first year, efforts will be focused on NHS organisations serving larger urban populations and, during the second year, broadening the target audience to include more rural NHS organisations.

It is efforts of this kind that will do most to help bring about the new relationship needed between industry and healthcare providers. However, it is vital that this relationship is seen to be transparent and ethical. It is for this reason that, following an extensive review, the ABPI further updated and strengthened its Code of Practice for the industry in 2006 (see here).

It covers every interaction between pharma and healthcare professionals and the ways in which the industry markets its products. This includes all advertising and promotional materials, the conduct of company representatives, the management of educational meetings, and limits on gifts and hospitality.

The Code and complaints made under it are overseen by an arm's-length body - the Prescription Medicines Code of Practice Authority (PMCPA). It is a condition of ABPI membership to abide by the Code in both letter and spirit, and strong support is given to it by UK-based industry, including many non-ABPI member firms.

Key changes
The new edition of the Code is the result of a fundamental review and follows a far-reaching public consultation that included the views of, among others, the British Medical Association, the Royal College of Nursing, the Royal Pharmaceutical Society of Great Britain and the Medicines and Healthcare products Regulatory Agency.

We want to ensure that more people and groups know about it, its provisions and understand how it works.

A survey undertaken during the review revealed that 48 per cent of UK doctors are unaware of its existence and only 30 per cent of those who are familiar with it know how to make a complaint.

With this in mind, the PMCPA has appointed a new communications manager to raise the profile for the Code and ensure clinicians and health authorities are fully aware of how they can use the system. Hopefully, it will also prompt them to look closely at their practices and procedures to ensure they match pharma's commitment to transparency and responsibility.

A higher level of engagement, debate and exchange of ideas between those who make medicines and the healthcare professionals who prescribe them will help improve their effectiveness for the benefit of patients and, therefore, society as a whole.

2nd September 2008

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