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The true driving force

The NHS is changing faster than ever before, but who is really driving this change?

Over the past few years, the pharma industry has begun to make long overdue changes. Fieldforces are being reduced, some by almost 20 per cent, and the number of group meetings, as opposed to details, has begun to grow. But is this shift being driven by pharma, or is it a forced response to the fundamental changes being undertaken by the NHS? If it is a market-driven change, are pharma companies ready and able to adapt?

There is no doubt that the way in which pharma companies interact with individuals across the NHS is changing. Figures from Cegedim reveal that average rep call rates dropped from four per day in 2004 to less than three per day in 2005. Since this figure is driven by a comprehensive reduction in the number of doctors prepared to see reps, this 25 per cent drop in productivity has reinforced the argument for reducing fieldforce numbers.

Similarly, an increasing number of GP practices have banned rep visits, preferring instead a group `lunch and learn' session, if they will receive reps at all. This shift is reflected in figures which reveal that the proportion of meeting-based sales activities has grown from 20 per cent in 2004 to 30 per cent in 2005, and up to 45 per cent in the first four months of 2006.

Yet just how effectively are pharma companies using this new model? Given the fact that there has been no increase in call rates to pharmacists, in spite of the new contract, and that nurse visits remain static at around 20 per cent, there are clear indications that the industry is following, rather than driving, the new market.

Surely this strategy is highly dangerous. The NHS is changing faster today than at any other time in its history: if pharma is to retain a place and deliver value in the new NHS, it needs to create far more proactive strategies to meet the needs of individuals, practices, commissioning groups and Primary Care Trusts (PCTs).

Furthermore, as GPs, nurses and pharmacists turn increasingly to the internet for medical information, there is growing recognition that e-detailing can play a strong role in reaching this audience.

Simply shifting the rep's goal from the traditional detail to a `lunch and learn', or increasing the focus on e-detailing alone, will not demonstrate the level of commitment and understanding required to attain, or retain, a foothold in the new prescribing environment. Organisations need to create an integrated multi-channel strategy that maximises the strengths and opportunities of each approach.

Relevant messaging

Pharma simply cannot expect the skills and expertise of a typical detailing rep to transfer automatically to the new environment. Creating the right `lunch and learn' format, for example, requires new tools and skills to enable reps to extend beyond the one-to-one communication towards effective management of large meetings.

Speaking and presentation skills development, and support in accessing and securing relevant opinion leaders should become a standard component of the rep armoury. These face-to-face meetings should also be used as part of an integrated sales and marketing strategy, reinforcing existing online contact and leveraging online communication to provide face-to-face response.

This changes the role of the marketing team. Rather than providing a single, consistent product message, marketing needs to be able to work with reps to modify the message to reflect the issues and needs of each specific group. Furthermore, it is important to recognise that the message is now not just about product efficacy. By combining local understanding with a willingness to help a practice or commissioning group achieve the new measurable goals defined by the government, the pharma industry can also begin to deliver quantifiable value.

More help, therefore, will be required in identifying relevant groups of people across both primary and secondary care and researching key local issues. This information should then inform the creation of tailored messaging, supported by a relevant opinion leader if required.

Better value

Indeed, with the new account management focus, the ability to understand the needs of each practice and commissioning group will be essential to ascertain market potential and prioritise
attention. Accurate, up-to-date profiling information will become a fundamental component of the new business-led role that reps will have to adopt. Without the ability to combine up-to-date prescribing information with insight into strategies of PCTs, an understanding of the evolving opinion leader network and the preferred contact or communication methods for the individuals within these networks, account managers will struggle to maximise value in what is a far more expensive sales environment.

Improved communication across these overlapping teams will become increasingly important as pharma improves profiling and tailored message delivery. In this complex environment, reps cannot be expected to manage this diverse message delivery and multi-tier opinion leadership without access to good CRM which provides immediate insight into every relevant interaction.

Proactive change

Of course, given the rise in `lunch and learn' meetings, and e-detailing, many companies may insist that this shift in strategy is already underway. But how effectively are budgets being spent today and, more critically, how confident are reps in their ability to operate in this new far more challenging sales situation?

To be frank, if the needs of doctors were being met, call rates would not be dropping. If pharma wants to keep the door open, it needs to improve customer understanding, create a relevant message and deliver it in the most appropriate way. Today, many are simply creating a half-hearted response to NHS-led directives and goals, leaving reps to manage the new model with little support.

This lacklustre and disjointed approach will result swiftly in pharma falling out of favour, leaving the salesforce with no way to make direct contact with the front line in patient care.

It will be those firms that combine account management skills with a willingness to understand local needs that will drive change and reap the rewards. Key to this is an integrated information source that ensures every interaction is recorded, monitored and measured to assess effectiveness of multi-channel approach.

The Author
Gareth Thomas is managing director at Cegedim UK

2nd September 2008

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