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How can pharma engage with the top performing STPs?

The recent announcement by Health Secretary Jeremy Hunt on which Sustainability and Transformation Partnerships (STPs) would benefit from a share of the £325m capital funding allocated in the Spring Budget, was a defining moment for the NHS.

It clearly demonstrated that having challenged STPs to find new and innovative ways of delivering integrated care in their localities, as envisaged in the Five Year Forward View (5YFV), the NHS is now segmenting them, based on their initial progress.

STPs that have already demonstrated their ability to meet specific targets are being incentivised and rewarded; while STPs that are struggling are being told to make improvements.

Of the 15 STPs across the country that have been earmarked for a share of the £325m funding, the ones that are expected to receive the highest sums are Dorset (urgent care); Greater Manchester (surgery) West, North and East Cumbria (cancer care).

STPs regarded as needing the most improvement were Bristol, North Somerset and South Gloucestershire; Humber, Coast and Vale; Northamptonshire; Staffordshire; and Sussex and East Surrey. A further 14 were described as ‘making progress’.

All STPs have been graded by NHS England on specific measures relating to emergency care, elective care, general practice, mental health, cancer care, leadership and finance. They have been categorised as ‘outstanding’, ‘advanced’, ‘making progress’ and ‘needs most improvement’ on broad measures of hospital performance, patient-focused change and transformation.  

How should pharma engage with Transformation-funded STPs?

As the NHS moves towards new models of care with capitated fees and an outcome based commissioning structure within new Accountable Care Systems (ACSs), there is an increased focus on efficiency and cost, and a growing need to measure the value of drugs and services in both the short term and longer term.

The NHS can now stratify patients and evaluate outcomes in both primary care and secondary care. It can also validate the efficacy of specific drugs, thanks to the availability of systems such as ‘Eclipse Live’, which can identify real world outcomes linked to specific healthcare interventions over time.  

The 15 areas that have received Transformation funding are fertile ground for pharma companies that have innovative products, provided they can prove that these products support transformation of clinical pathways to lower cost settings.

But to achieve success in these areas, pharma must prove that it too is willing and able to change the way it operates; to be more accountable for results and to take more responsibility for improving patient outcomes.  

One way of adding value to a drug, which is becoming increasingly popular, is packaging up a value-added service as part of the contract. A key example is Homecare delivery services which enable a 20 percent VAT saving on the purchase price of a medicine, provided it is delivered to a home setting and administered there.

This incentive has encouraged a number of pharma companies to work with the NHS to set up medication delivery services, particularly for injectables and some of the biologics, enabling them to be delivered and administered at patients’ homes.

Concordance programmes should be another key area of focus, since evidence shows that between 30 and 50 percent of long term medicines are taken incorrectly. This not only results in huge costs on wasted medicines, but local real-world evidence for effectiveness may not justify investment compared to the promoted results from clinical research trials.  

Pharma could also consider guaranteeing outcomes to encourage the NHS to invest in new premium products. Very few companies are currently willing to do this because they don’t know enough about the metrics they can use for outcomes management and evaluation. Furthermore, it’s clearly a huge shift from current practice to say that if a product is not working, then the NHS does not have to pay for it. 

However, as the NHS and other healthcare organisations in highly developed health economies around the world become increasingly focussed on results, and the patient data technology becomes more ‘joined up’ some pharma companies, particularly the ‘Big Five’, are already moving into that space.


NHS England’s performance-based segmentation of STPs and recent allocation of Transformation funding to the strongest and most advanced partnerships, provides further evidence of the NHS’s commitment to improving efficiency and outcomes by doing things differently.

There is a role for pharma to play in supporting STPs, particularly those that have received Transformation funding. However, as the NHS gathers real world evidence on drugs, the pharma industry must prove how its products will improve patient outcomes and bring benefits across the care pathway in a real-world situation and through the provision of such data from clinical trials to support a real-world launch platform.


Paul Midgley is Director of NHS insight and Steve How is Business Development Director, both at Wilmington Healthcare. For information on Wilmington Healthcare, log on to

7th November 2017



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