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Healthcare: Seamless solution

Tailored services and localised customer offerings will set the pace for the future

tailor.psdPharmaceutical companies are often perceived by the public as being 'fat cat' corporations that make money out of illness without giving anything back.

This is baffling to those who work in the industry and whose companies invest in developing medicines that cure sickness and help people to lead healthy lives. Although the pharmaceutical industryís R&D figures should speak for themselves, all too often we underplay the things that we have every reason to be proud of.

Isnít it time that the perception of
pharmaceutical companies moved away from purveyors of medicine, towards that of healthcare solutions providers?

To achieve this we need to adopt a more grown-up and less defensive approach. If we are to thrive, rather than survive in this difficult environment, we simply have to question, review and challenge what we do and how we do it.

Forward-looking companies need to work to a shared agenda with the NHS, exploring common goals, collaborating fully to achieve mutual objectives. The more we do this, the more we will see how valued medicines can really change lives and support the healthcare community.

The NHS has gone through radical changes, with a much greater drive for business discipline, greater focus across disease pathways, much more power moved from secondary to primary care and increasingly different healthcare solutions across the UK.

The health service has become more regionalised as the impact of initiatives, such as Foundation Trusts, Practice-based Commissioning and Commissioning re-structure takes effect. The pharma industry therefore needs to operate effectively at this level to provide appropriate support.

But how can pharma do this without being accused of trying to manipulate the NHS to suit their commercial needs?

Common goals

The key lies in operating with openness, honesty and building strong relationships at a local level based on mutual trust and support. In this way, firms can identify local needs and work with the decision-making authorities in defined areas.

Whatever is on the local agenda, the most important outcome is that any shared activity achieves something tangible for the patient. A measurable improvement in local services has to be the common goal.

In order to achieve goals and bring real value to the NHS, pharma companies must be flexible in their approach and understand the needs of the patient fully.

Take Scotland for example, it is well known that the incidence of coronary heart disease (CHD) is higher north of the border than in the rest of the UK. In fact Scotlandís death rate from CHD is the second highest in Western Europe.

Tackling modifiable risk factors, such as smoking, raised blood cholesterol, physical inactivity, obesity and high blood pressure is therefore a priority for Scottish primary care teams ñ particularly in deprived areas of Scotland.

Colin Sloey, director of the North Lanarkshire community health partnership, sums it up: We know that many people in Scotland have higher rates of conditions such as coronary heart disease and diabetes, yet too frequently the first time either they or the health service know they are at risk is when they need emergency care and end up in an acute hospital facility.

Giving support

NHS Lanarkshire set up the Keep Well campaign to tackle this issue head on. GPs sent people on their lists aged 45 to 64 a letter inviting them for a short health check to identify if they were at risk of heart disease or diabetes.

Although the check was carried out by the practice nurse, community nurses were on hand to advise people how best to improve their health in a way that suited them. The options included specialist advice, GP-prescribed medication or support around diet, exercise, smoking or drinking.

In order to fund the project, NHS Lanarkshire and North Lanarkshire Council not only secured money from the Scottish Executive, but also worked with two pharma companies to deliver the screening process and fund the projectís initial case finding work.

The support we received from the pharmaceutical companies was and remains independent of all decisions relating to drug choice by NHS Lanarkshire or clinicians within its locality, said Sloey.

The fact that everyone locally was involved in the project, from the primary care teams through to the local reps from the pharma companies, ensured there was transparency at all times.

From the pharma industryís point of view, projects such as Keep Well provide companies with a unique opportunity to partner with national and locally based NHS management organisations to make a measurable difference to patientsí health.

Keep Well is the type of initiative that North Lanarkshire Council is very proud to be part of, said Mary Castles, assistant chief executive of North Lanarkshire Council. It brings direct and measurable health benefits to our residents in areas where they are most needed.

Although the first thought when backing local ventures might be to provide financial support, other resources should not be forgotten. A good example of this is using healthcare professionals employed directly by pharmaceutical companies to support and enhance the work of the local NHS.

Bradford and Airedale Primary Care Trust (PCT) recently ran a campaign to raise awareness of diabetes among its South Asian community. In particular, it highlighted the importance of diabetes screening and how people can reduce their risk of developing the disease by making changes to their lifestyle.

A series of information sessions was held in the community, followed by screening for heart disease and diabetes risk factors. Those identified as being at risk were referred to the practice nurse at their own surgeries for advice, support and medication if necessary.

The PCT knew that nationally one in four adults aged over 25 from the South Asian community suffers from diabetes, yet locally this was not reflected in the number of diabetes patients registered.

A multi-lingual healthcare worker was in place to help communicate the message to the local Asian community in innovative ways, but a dilemma remained for the PCT: who was going to do the screening and what financial impact would this have?

We were initially approached by a local sales rep to see whether their company could help us ñ and I suppose our initial thought was they might be prepared to support us with money,í explained Louise Butterfield, diabetes lead in the Airedale area. But once we got talking we realised that the company had a more practical resource it could offer ñ its own team of nurses who could carry out the screening, she added.

The pharma company nurses were able to support the local NHS by carrying out the screening programme and helping to fund diagnostic materials. This not only saved the PCT money, but the valuable time of primary healthcare professionals.

Many people with diabetes have had it for between nine and 12 years before being diagnosed and many of them will have started to develop complications. However, if it is spotted early, you can greatly reduce your chances of any serious health problems, said Butterfield.

To ensure that the screening programme was as effective as possible, materials were developed in a range of different languages for the South Asian community. These are now available for use by other PCTs with similar challenges.

It is important that groups of healthcare professionals brought together strive to work to a common goal, rather than defending their own agenda. This is especially so in the grey area of interface between primary and secondary care where clear roles and responsibilities are not always defined.

Dr Jeremy Shearman, consultant gastro-enterologist at Warwick Hospital, South Warwickshire, had a positive experience in working with a pharma company. I am a member of the South Warwickshire Digestive Diseases Collaborative, which was set up to develop a multi-disciplinary approach to the care of digestive disorders and to agree on care pathways across both primary and secondary care.

The group includes representatives of management from both the local Trust and the PCT, as well as senior doctors from both primary and secondary care. As a group we were fortunate to have the support of Ronnie McLeod, a committed and experienced area sales manager from AstraZeneca, who effectively engaged all the interested parties and acted as a really energetic driver of this initiative.

We all recognised the need to update the dyspepsia guidelines. However, left to our own devices, the development of the guidelines might never have happened. We also had someone supporting us who spoke in a language we all understood, who made us all aware of the mutual benefits of the care pathway and who got the balance absolutely right in terms of professional relationships.

Ronnie acted as a catalyst encouraging us to commission and prioritise tasks, and together we were able to be part of a really productive forum from the outset. This also gave the group real credibility and the confidence to tackle more complex care pathways in the future.

I wasnít just pleasantly surprised by the level of knowledge that came from a commercial partner, I think it is fair to say that this relationship changed my views of the role of pharma companies. At the end of the day, if good medicine can be facilitated through collaboration, then I believe that this should supersede any potential commercial benefits that can be derived from such partnerships.

The pilot project has engaged with over 5,000 patients who are now receiving appropriate care and treatment packages, whether this is simply advice, lifestyle issues or active clinical treatment. Early results show increased numbers attending smoking cessation services and more people being treated to standard for high blood pressure and hyperlipidaemia.

The partnership approach ensured the capacity, skills and technology to screen high volumes of patients promptly and support their commitment to a programme of care that is making a difference to the quality of their life, health and well-being.

Making a difference

Ultimately, we can make a difference to peopleís health by giving them valued medicines and services. As a collective group of professionals, I think it is fair to say that we are passionate about what we do, so we need to be harnessing that energy and commitment by getting closer to our customers, and by realigning our offerings more closely to their needs.

Patients are at the heart of everything we do, which means that a blanket health care approach will never deliver effective solutions. More aligned and collaborative partnerships, bespoke services and localised customer offerings are some of the approaches that will set the pace for the future.

18th July 2008

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