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The NHS' new patient-driven choice agenda requires detailed, highly targeted information analysis

A car overloaded with boxes on its roofThe patient-driven choice agenda of health minister Lord Darzi denotes a significant shift in strategy for NHS change. Calling for a more patient- and outcome-centred approach, Darzi's announcement has heralded a move away from the prescriptive, top down system of management to one that empowers local health economies. Economies are now able to adopt recommendations that reflect their own economic, demographic and disease requirements, at their own pace; a strategy that should result in the delivery of more relevant community services.

The new requirement for stronger local differences within the NHS not only creates a need for pharma to develop greater insight and understanding into the different strategies and behaviours of each local health economy, it paves the way for patients and patient groups to have more influence on prescribing practices. Patient groups have already demonstrated significant power in recent years; their lobbying of local press, for instance, played an important role in achieving prescribing policy shifts within both Strategic Health Authorities (SHA) and Primary Care Trusts (PCT).

This shift towards a patient-led choice agenda is good news for pharma companies that have been responding to NHS changes by slowly adapting their sales and marketing strategies towards a highly tailored local messaging approach. 

Softly, softly
In recent years the pharma industry has recognised the need to make fundamental structural changes. The majority of pharma companies have conceded that they are deriving less and less value from the traditional high volume field force approach.

Driven by financial incentives, over 70 per cent of GPs now prescribe in line with PCT guidelines. Furthermore, the financial incentives associated with QOF (quality and outcomes framework) points have encouraged GPs to welcome information from pharmaceutical companies that addresses the long-term care issues associated with managing diseases such as hypertension and diabetes.

Lord Darziís softly, softly approach to NHS change is far less prescriptive and does not have associated financial rewards. Instead, it aims to accentuate local differences in the implementation of care pathways and patient care, creating highly divergent strategies across England and Wales.

The introduction of key account managers (KAMs) and the targeting of senior NHS managers and key opinion leaders is a positive step that reflects the changing influencers within the NHS. However, to succeed in this new environment, and successfully tailor messaging across the NHS, pharma must achieve a greater depth of understanding and the insight required to track adoption of the patient agenda at a local level.

More tailoring
One of the main implications of Lord Darziís new NHS agenda is the need for pharma companies to tailor communication to the eight areas of care: maternity and new born care; childrenís health; planned care; mental health; staying healthy; long term conditions; acute care and end-of-life care. Pharma companies that can dovetail messages to this agenda will be well placed to support KAMs as they track the evolution of each local health economy.

Recognising that such tailoring requires reliable NHS information, it has becoming standard practice for pharma companies to provide reps with online access to new data sources such as PCT board minutes. While this may give reps some indication of behavioural trends within each local health economy, it is not enough to ensure relevant messaging. Simply providing online access to a blanket information resource is as useful as a generic Google search. This information is complex and highly detailed and, without clear guidance and understanding, there is a very real danger that individuals will draw the wrong conclusions or no conclusions at all.

Information overload
Tracking and monitoring the local adoption of disease care pathways will enable pharma companies to support community-based initiatives. Furthermore, understanding the progress of the new polyclinics will deliver valuable insight into services being delivered. This will have a growing influence on the delivery of patient-centric services.

There is no doubt that for pharma to meet the diverse operational requirements of doing business with the NHS, ranging from tailoring messages that reflect local strategies to determining the overall structure of the field force, information is key. But the breadth of information required is potentially overwhelming.

To be of value, information must be provided in a way that makes sense and can be easily understood by decision makers, KAMs and reps.

Detailed analysis of multiple information sources can provide insight into how PCTs are working, and what their key goals, objectives and relationships with organisations within their remit are. Access to a range of information, from ethnicity to disease incidence, is essential for ensuring that the pharmaceutical companyís strategy targets the needs and expectations of each PCT and local health economy.

A rep cannot be expected to carry out the detailed, highly targeted information analysis required. As pharma companies rush to provide diverse information sources to the field force, the risks associated with poor understanding are very real. Without strong management control and central visibility of local rep behaviour and performance, inconsistent messaging may develop, which can  fundamentally undermine corporate objectives.

It is essential to combine the information sources now available with extensive experience and an understanding of the NHS and its ongoing changes. Only when this happens will the information be tailored to proactively support the diverse requirements of the field force, as well as provide the central visibility required to ensure messaging consistency across the organisation.

Positive outlook
Pharma recognises the need for key account management and targeted information, particularly in support of the GP. However, the new focus towards a stronger community-based local health economy, with emphasis firmly on the quality of patient experience and positive patient outcomes, creates a need for a greater understanding of the differences across the NHS.

Developing a one-size-fits-all strategy that targets every PCT will not work. Given the vast amount of NHS information now available to pharma companies, rapidly attaining the depth of insight required at a highly granular level is a massive challenge and one that pharma cannot afford to underestimate. Organisations need to work with an information provider that has local NHS knowledge and the experience to interpret this mass of information and deliver quantifiable value.

By delivering information that has already been analysed to reflect a pharma companyís key objectives, and tailoring it to support each local health economy, the abundance of information now available can be used constructively to transform the effectiveness of pharma sales and marketing strategies.

The Authors
David Round and Duncan Alexander, Cegedim Dendrite

15th May 2008

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