How can pharma engage with key decision-makers in new, collaborative NHS care models?
Paul Midgley, Sue Thomas, Steve How and Oli Hudson, of Wilmington Healthcare, explore how pharma should adapt its approach
Introduction Since the
publication of the Five Year Forward View,
the NHS has undergone rapid structural change. This has resulted in an
increasingly complex, multi-layered healthcare system that is seeing some GPs
taking on wide-ranging responsibilities in Integrated Care System (ICS) areas.
It has
also resulted in a diverse range of stakeholders becoming involved in NHS
service planning, with local authority officers taking on some key STP
leadership roles, for example, as opposed to clinicians; and the third sector
and patient groups becoming increasingly influential.
Shift in GPs’ prescribing power Many GP surgeries now work collaboratively in
networks or hubs, which
may have a prescribing arrangement across a Federation, a CCG, an STP, or even across
multiple STPs. Consequently,
some GPs have grown more influential as they have assumed extra responsibilities
following the structural changes.
In order
to engage with GPs effectively, pharma needs to define the decision-making
power of individual GPs. It also needs to know of any pressures that exist to
prescribe in a certain way within a network or hub; what formularies they are on
and the size of their local Area Prescribing Committee (APC) footprint.
Based on
this knowledge, pharma then needs to segment its key GP customer groups and
ensure that it is delivering the appropriate message and deploying the right
level of resource to each type of GP. This should involve assigning one senior
level executive to manage the relationship with a particularly influential GP.
Group consensus is key for STPs
STPs were
introduced to build on the work of the Vanguards and implement a place-based
care system that incorporates both health and social care. Collaborative
working is key to achieving these goals.
STPs
encompass a variety of stakeholders ranging from representatives of Academic Health
Science Networks (AHSNs), clinicians and pharmacists to local authority officers,
charities and patient groups. Indeed,
many local authority officers hold key posts in STPs as well as clinicians. These
stakeholders attend key decision-making meetings and group consensus is often
required in many STP areas before any significant changes can be implemented. Some of
these stakeholders are new to pharma and in order to engage with them it must
do more than simply sell products – it must gain their trust in its shared values
and philosophy. It must also demonstrate
that it has a huge amount of expertise in specific diseases and therapies, and
can lend support in areas such as providing real world evidence to inform
patient pathway development and optimal care.
Medicines
management staff within the locality may be involved in workstream planning
groups led by programme managers to design new care pathways. They are very
much involved in decision making, however, they work as part of a team,
considering the whole implications of care and cost across the pathway.
Interestingly,
the
latest NHS Planning Guidance 2018-19, indicates there may be more room for transformative
pathways, including medicines with STPs, as the system control total eases the
history of tension and disagreement over NHS trusts’ budgetary accountability
to NHS Improvement and CCGs’ budget accountability to NHS England. Integrated Care Systems (ICSs)
Integrated care systems (ICSs) bring
together NHS providers, commissioners and local authorities to work in
partnership in improving health and care in their area. They will take
the lead in planning and delivering care for their populations and providing
system leadership. Key
decision-makers in ICSs will grow out of STPs, Vanguards and other new care
models, such as primary and acute care systems (PACS) and multispecialty
community providers (MCPs), which both seek to integrate care and improve
population health. PACS and MCPs take different forms in different
places but share a focus on places and populations rather than organisations.
A lot of
service improvement managers currently employed by Clinical Commissioning Groups
(CCGs) may transition over to work on the provider side in ICSs to ensure
transformation happens, or they may work in an alliance within the ICS. A
similar situation is likely to occur with middle managers in CCGs; while senior
commissioning managers and executive managers may take on new roles as strategic
commissioners within CCGs or STPs.
In terms
of engagement, it is currently a complex and changing picture for pharma. The
way services are planned will depend on factors ranging from what has happened
in the past and what facilities are currently available to who is in charge,
and whether it is an urban or rural location. Keeping a close watch on the developments in
each locality will be key and will require cutting edge Customer Relationship
Management (CRM) tools, combined with effective real time insight feeds to
analyse the impact of changes. Conclusion
Pharma
must keep abreast of new care models that are emerging in different areas
across England, be mindful of the variety of responsibilities that key
customers hold and take a tailored approach to engagement across different
geographical areas and with individual clinicians. Pharma must also sell its
company and its philosophy to other key stakeholders and keep abreast of their
activities in relevant disease and therapy areas.
Ends
Paul Midgley is Director of NHS insight, Sue
Thomas is CEO of the Commissioning Excellence Directorate, Steve How is Business
Development Director and Oli Hudson is Content
Director, allat
Wilmington Healthcare. For information on Wilmington Healthcare, log on to www.wilmingtonhealthcare.com
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