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Adapt or perish

The pharmaceutical industry's traditional approach to sales and marketing is in need of an urgent overhaul

Pharma must change its marketing strategies to meet the needs of the new NHS

The pharmaceutical industry's traditional approach to sales and marketing is in need of an urgent overhaul.

One of the major reasons for this is that the structures of, and environment for, making decisions are changing radically within the 'new` NHS. For example, in general practice, doctors are by no means the only decision makers; nurses and dispensary managers (where relevant) have their say as well.

With the increasing influence of Primary Care Organisation-led (PCO) formularies, and GP and pharmacy contracts, there can be no doubt that the autonomy of the average doctor is on the wane.

However, for pharma companies looking to understand the decision-making dynamics of the new NHS, the picture is far from simple.

If pharma companies are to achieve any traction within PCOs, with doctors, and within the new NHS, they need to not only achieve an in-depth understanding of the dynamics of each PCO and practice, but must also demonstrate that they can help healthcare professionals to achieve the targets by which they are measured - whether those are cost-savings, targets against specific therapy areas or the general achievement of the long-term goals of the health service.

The role of the PCO
Under the GMS contracts, introduced in April 2004, PCO contracts are with a practice as a whole, rather than with an individual practitioner - a strong reason to expect prescribing choices to be made at practice level.

While some PCOs - most notably those in Scotland - expect doctors to comply to the letter with central guidelines, others have a far more relaxed approach.

Due to the increasing number of PCO mergers, which could dramatically reduce the current numbers from around 340 to possibly as few as 100, maintaining a real insight into the choices made by decision makers, key opinion leaders (KOLs) and their influence on doctors throughout the PCO will be a massive challenge.

Just who are the rising KOLs? In the new NHS, these could be anyone from the senior consultant working across a number of different hospitals to the mobile community therapist.

Certainly, GPs continue to play a fundamental role, in particular within those PCOs with a more relaxed approach to central guidelines.

Increasingly, however, nurses, pharmacists and other healthcare professionals need to be taken into consideration in pharma sales and marketing strategies.

While many companies now admit that persisting with a GP-only policy is ineffective in the new NHS, the full role of some of these 'new' players is yet to be appreciated fully.

As the informed patient becomes increasingly prevalent, it is the pharmacist's ability to deliver added value services, for example, that will gain unprecedented closeness to the patient providing the opportunity not only for improved education on new drug therapies, but also advice on therapy alternatives to enhance the overall quality of care.

To understand the changing influence - and influencers - organisations need a way of drawing insight from multiple information sources, from wholesale and prescription data, to inferred practice-based information.

By using this insight, pharmaceutical companies will be able to manage the changing NHS and gain maximum value from the sales and marketing budget.

Companies have got to get close to PCOs today, working with the full network of KOLs, jointly funding research and dovetailing product messaging with each PCO's objectives - from cost-savings to addressing specific areas of chronic disease, such as diabetes.

This is a fundamental shift from the traditional sales model, a move that requires well-trained, highly-paid key account managers to liaise with senior PCO personnel.

It requires the development of tailored, relevant business cases for every PCO, the ability to track PCO policy enforcement, and adherence to it at practice and GP level, to refine messages at every level of the NHS.

Aligning strategy
If pharma companies are to achieve any traction both within PCOs and with doctors, they need to gain an in-depth understanding of the dynamics of each PCO and practice, and develop new ways of interacting with healthcare professionals.

To become effective, as opposed to merely efficient, it is vital for pharma companies' marketing departments to know their new customer base.

In view of the rise of the practice formulary, and the new contracts between PCOs and practices, more promotion is going to have to occur at account, rather than at an individual, level.

To maintain access, pharma companies need to demonstrate that they can help healthcare professionals to achieve their targets, rather than just promote the latest wonder drug.

Just who are the people within each therapy area, for example, that drive decision-making, particularly in the creation of PCO formularies? In order to find the answer, pharma companies need to understand, in detail, the roles and objectives of each of the many individuals involved in healthcare provision.

There are a number of strategies that pharma companies can employ to ensure that they put the right information in front of the right people. The ability to map networks of KOLs requires significant research. However, the reward for this effort is much more effective targeting and segmentation.

New tack
Companies, such as Leo Pharma, have gone for a complete restructuring of the salesforce, while others have opted for its dismissal in favour of other techniques.

A collaborative approach, where the pharma company funds education or nurses, have also proved to be a successful way to reach decision makers, but may be beyond the reach of smaller firms.

Technology can also help companies evolve and execute their new marketing strategy. Reformulating targeting and segmentation is made much easier if you have the ability to map networks of influence, backed by up-to-date databases that offer the ability to create profiles and identify links between individuals.

Without doubt, the working lives of the standard pharma salesforce are going to change dramatically. Detailed collaboration and a shared focus on outcomes will still require a large number of people but, fundamentally, this will be a fieldforce rather than a salesforce; from highly-skilled, highly-paid key account managers undertaking PCO liaison to a GP-focused fieldforce delivering more relevant information that matches the evolution in patient-centric care.

With the increasing emphasis on prevention, as well as cure, the salesforce must be able to demonstrate to PCOs and doctors a drug's role both throughout the patient lifecycle and within a complete treatment programme.

There is a good opportunity for pharma companies to provide support and more detailed in-depth education and training for GPs and, increasingly, practice-based specialists.

As the influence of the PCO continues to grow and financial pressures created by the GP contract and practice-based commissioning come to bear, it will be those pharma companies that can align their drugs with the long-term goals of the health service, particularly in the management of chronic conditions, such as diabetes and high blood pressure, that will play an important role in supporting doctors in an increasingly challenging and fast-changing health service.

The Author
Gareth Thomas is managing director of Cegedim UK

2nd September 2008

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