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Dropping the ball

With the NHS 'transition' in progress, how well is industry coping with all it has to juggle?

Juggling applesI was clearing out some old files the other week, as you do, and came across an industry journal article from 1990. I think I must have kept it because it reminded me of my first stirrings of interest in a changing NHS and implications for pharma. These were Mrs Thatcher's years and a new internal market was proposed. New ideas were on the table, including the radical notion of giving GPs pots of money for buying healthcare services. Family Practitioner Committees (FPC) were to be overhauled and turned into Family Health Services Authorities (FHSA).

The article featured an interview with Paul Bates, Leicestershire FPC general manager, and he was questioned about the growing interest by pharma in the work of the new FHSAs. He said he needed a much greater knowledge of the industry, as in the past he hadn't needed to know about pharma, but now he did. But he also said that the industry must gain a greater understanding of FHSAs. He pointed out that many he had spoken to from the industry had displayed a lack of understanding of the NHS White Papers and what the future role of the FHSA was likely to be. He also suggested that both FHSAs and pharma should move forward in partnership, based on mutual need.

The article was written such a long time ago and yet so little has changed. His comments about poor customer focus and lack of knowledge of NHS papers could so easily have been written today, particularly as new customer groups are now again springing up. But, in what most commentators are now saying are the most profound changes in the NHS since the mid-1970s, dropping major NHS balls going forward this time around is not an option.

Equity and excellence
Since last summer, folk will have gained a good understanding of the main White Paper, Equity and Excellence: Liberating the NHS. No surprises there, then. But what was a surprise was that some companies did not appear to engage in the consultation and take up the opportunity to make a submission.

With customer-centricity back on the agenda, not to have made a submission may have been a major ball dropped. Here was a major opportunity to crystallise thoughts, get engagement across the company, plot likely scenarios and make a significant contribution to the debate.

From your submissions, you would have been able to cut various proactive and reactive policy-based statements to add value to customer facing interactions. The industry has now got very used to making National Institute for Health and Clinical Excellence (NICE) and Scottish Medicines Consortium (SMC) submissions, so what a lost opportunity to produce such 'intellectual offerings'.

Unknown unknowns
And maybe other balls have also been dropped too? There has been not just one document to read but a whole suite — probably well over 500 pages of text in all in some seven other ancillary documents, with more being published all the time. Have all these documents also been examined and analysed for opportunities and threats? For some, the answer is likely to be 'no'; this resistance to forward planning seems so strange when there is such a long transition period and in the absence of exquisite planning detail.

The 'unknown unknowns' appear to be holding folk back until the crystal ball is clearer. But only a perfect storm of financial meltdown, and perhaps as a result, a political U-turn, will mean that new GP consortia payers are not ruling the roost in two years. We are where we are.

So let's have a brief look in more detail then at some of these 2011 balls.

Balls for 2011
The new commissioning structures: Not all GPs want to be involved and it is likely to be a small group of folk who will lead each consortium. Are we account managing the local medical committees to gather critical local intelligence and speeding this back to HQ? Do we have folk that can do this with the cull in primary care sales teams?

A new generation of GP leaders is likely to spring up. Do we know who these might be? Do we do NHS key opinion leadership development these days? Are we tracking which groups are emerging from Practice Based Commissioning (PBC) clusters? What do we know about the 'pathfinders' and other early adopters?

The consortia will have cash-limited prescribing resources so inappropriate prescribing costs will have to be held down.

Are we gearing up for the arrival of 200+ primary care formularies? It will be populations and not patients for these bodies. Are we thinking about their needs in terms of keeping folk out of hospital? QIPP is coming to GP-land. Are we preparing for this? And each GP Commissioning Consortia (GPCC) will have an accountable chief financial officer. Are finance managers in your new stakeholder maps?

As Primary Care Trusts (PCT) begin to implode, are we flagging up possible survivors that will be osmosed into the GPCCs? For instance, what is likely to happen to medicines management leads? Many consortia are likely to buy in services from local commissioning support groups. Some will be private companies; some will be NHS groups. Do we know who these might be? The NHS Commissioning Board will start to coalesce later this year, going live in April 2012. Are we yet trying to forecast what this body will look like and who its leaders might be? Are we going to do a SWOT? Are we forming a national key account management team to look after this new body?

The new outcomes framework: Did we analyse this document very closely? The enhanced focus on outcomes must be hugely relevant to marketing and will (and should) affect the brand proposition, which may need to be refocused. Are marketing messages being nuanced in light of this document and for all the new customer groups? This could be the most important factor as we begin to move towards payment for outcomes. One annexe lists all the possible outcome indicators and folk should definitely have a look-see here. The final Framework is due to start this April, with full implementation from April 2012. Watch out for the final document — a 'must-digest'. And outcome frameworks have also now been published for social care and public health. Have folk looked at these yet?

The new provider world: The White Paper could make radical changes to secondary care. All hospitals will be Foundation Trusts and will have more freedom than they do currently. They are to return to their original conception and will be encouraged to get into joint ventures, federations and other forms of co-operation. What impact will integrated acute and community care organisations have on local working? This could have major implications for 'real' local account management.

Monitor will be the new OfHealth, a new independent economic regulator. It will regulate prices and promote competition. The renewed commitment to 'any willing provider' could change the hospital landscape profoundly in the same way privatisation did with energy and telecoms. If Monitor succeeds in promoting competition, we could see an extensive NHS market with many more different kinds of providers; in the future, secondary care may look very different from today, with a greater proportion of NHS healthcare being provided by private or voluntary providers. Are we preparing for this possibilty? Though it has probably been ignored thus far, Monitor will become increasingly important for headquarters.

The new local democratic world: With both PCTs and SHAs being abolished, at a local level the new kid on the block will be the local council. With no local NHS body taking any strategic overview any more, it seems as if local Government will be the local 'minder' and the local authority will lead joint strategic needs assessments to ensure 'coherent and co-ordinated commissioning strategies'.

There is to be a new statutory Health & Wellbeing Board that will assess the needs of the local population. Directors of Public Health will move to local Government and will be involved in the new National Public Health Service and hold a ring-fenced health improvement budget. So all of you who have been working in the public health field (particularly around health inequalities) will have a brand new customer tribe to consider. What do folk know about local Government? Local councils have elected (political) councillors and officers and a very different culture. Pharma tends to have little or zero contact here, so what to do? Ignore or engage? If you are going to engage, think about the opening comments in this article. This may necessitate the need for a fresh look at NHS account management by the industry, one based more on local health and care economies.

The new ALB and NHS information world: The review of the Arm's Length Bodies proposes totally to cull some industry favourites, like the NHS Institute. But one rising star is likely to be the Health & Social Care Information Centre. What do we know about this organisation? Should HQ attempt to account manage it? And the Government has laid out plans for an 'information revolution'. Critical to achieving this 'revolution' is transforming the way information is collected, analysed and used by the NHS and, in line with this, the Government will step away from being the main provider of information to enable a range of separate organisations to offer such data. In essence then, more NHS information databases might be available to all and there is to be a new market in healthcare information. So how will pharma engage in this particular new world?

Juggling the balls
So there we are: the NHS world is being turned upside down once more. For pharma, new customer groups are springing up. Where will pharma engage? Will pharma be an 'onlooker' or 'player'? Will it engage in commissioning support? Is it perhaps time to revisit disease management? How will it adapt to a new focus on outcomes? What new value-added services will it develop? Will pharma finally 'walk the walk' on account management? When will pharma 'strategise' market access? And is the industry model of the last decade or so now in pieces?

Space has not allowed any discussion on value-based pricing but for sure this is one ball that will not be dropped!

There are many, many challenges to address, so please don't just mill around. Football may not be coming home but the cricket looks more hopeful, as long as all the catches are taken. Dropping balls does tend to advantage the opposition.

The Author
Alan Jones is an independent healthcare policy analyst, adviser and NHS trainer.

To comment on this article, email pm@pmlive.com

24th January 2011

From: Healthcare

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