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Large-scale NHS commissioning models require new partnership approach from pharma

Steve How, Paul Midgley and Sue Thomas, of Wilmington Healthcare, explore how pharma should respond to the NHS’s move towards more collaborative, joined up working


As the NHS focuses on larger scale commissioning, a number of Clinical Commissioning Groups (CCGs) have recently merged or begun to share chief executives and boards. Some of the mergers have been entered into voluntarily to help cut costs and ultimately pave the way for the introduction of Accountable or Integrated Care System (ACS/ICS) models; while others have been enforced to replace failing CCGs.

In tandem with this, there have also been changes in the way that GP surgeries are run with many of them now working collaboratively in networks or hubs as outlined in the Next Steps on the Five Year Forward View, published last year. Some GP practices are also being run by trusts, rather than GPs.

CCG mergers are a prelude to ICSs/ACSs

The newly merged CCGs are expected to be able to manage their population budgets more effectively by pooling their resources. This, in turn, will prepare for the introduction of ICSs/ACSs, which will see commissioning taking place on an even larger scale, with one provider or group of providers responsible for all the healthcare needs of a defined population.

Working more collaboratively and cohesively will involve complex agreements between the parties, particularly in areas where successful CCGs have to take on the debts of failing ones. Controversially, it will also generate significant savings through a reduction in back office staff, with some areas being operated by a single commissioning team.  

In total, NHS England has given the green light for 18 CCGs to merge to create six new organisations in April 2018.

GP surgeries join forces

In tandem with CCG mergers, GP practices are also being encouraged to combine forces and some are now working in ‘hubs’ or networks. This is because a combined patient population of at least 30,000-50,000 people enables staff to come together as a complete community – drawn from GP surgeries, community, mental health and acute trusts, social care and the voluntary sector – to focus on local population needs and provide care closer to patients’ homes.

There are various routes to achieving this that are now underway and cover the majority of practices across England; they include federations, ‘super-surgeries’, NAPC’s primary care homes, and ‘multispecialty community providers’. Interestingly, we are also seeing some GP practices being run by trusts rather than GPs.

How will these changes affect pharma?

Pharma needs to keep abreast of the rapidly evolving models of NHS service delivery in different locations, as well as changes in prescribers. For example, nurses are becoming increasingly involved in prescribing, while some GPs are becoming less autonomous in this regard as a result of structural and management changes in primary care, and a desire for many newly qualified GPs to take on part time, salaried roles.  

Increased financial and workforce pressures mean that care management is becoming more evidence-based and protocol driven. We are also seeing more ‘social prescribing’ with GPs referring patients to charities and other non-clinical organisations to help tackle problems such as obesity, depression and loneliness.  

Delivering optimal patient journeys – like those already defined by NHS RightCare for various conditions – is key. Pharma needs to think across the whole pathway to define where its medicines fit, how they can save money and how they can be prescribed by different people.

With fewer decision points for prescribing, the days when pharma needed big sales forces have gone. So too has the simplistic approach of solely focusing on the benefits of a product and how it is priced against competitors.  

Instead, pharma needs to focus on partnership working to enable it to become more embedded and integrated into the NHS. This style of working requires a high degree of resourcefulness, as well as curiosity, about what is happening within the NHS in specific locations, and what are the implications across the whole pathway and population. For example, drugs managing nocturnal urinary frequency in the frail and elderly may have a significant impact on the Falls Services.  

Market access and sales staff can glean useful insights into local NHS developments by attending relevant board meetings, which they are legally allowed to do - since these meetings are open to the public - provided they do not discuss or promote their brand in any way.  They could also undertake a high level of specialist training in their therapy area so that they can engage at a peer to peer level.


Collaboration is the name of the game as financial and staffing pressures force CCGs and GP practices to work in new and innovative ways by pooling their resources, assuming joint responsibility for finances and engaging with new partners to take a more holistic approach to disease prevention and management.  

To succeed in this new, collaborative environment, pharma must work in partnership with the NHS to define how its products can help the organisation cut costs and add value across an entire care pathway. This involves a new and resourceful approach that will see pharma representatives being willing and able to gather as much information as possible about how local NHS and social care providers are operating as well as becoming true experts in their own therapy area.


Paul Midgley is Director of NHS insight, Steve How is Business Development Director and Sue Thomas is CEO of the Commissioning Excellence Directorate, all at Wilmington Healthcare. For information on Wilmington Healthcare, log on to

1st February 2018


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