New models of NHS care – new models of pharma response?

As the year comes to a close, it’s fair to say the NHS has experienced an eventful 2018.

The year saw the health service celebrate its 70th birthday, with the government declaring an end to its austerity policies in order to increase funding for the NHS in England with an £20.5bn extra by 2023/24, a 3.4% increase per year on average.

However rising demand and mounting debts across the NHS show the system is under huge pressure; this funding uplift won’t come close to solving these problems. Consequently, the system is currently undergoing a major transformation aimed at making health and social care sustainable for the longer term.

New models of care, led by Integrated Care Systems, are now seen as the way forward towards a sustainable, integrated health and social care service. So where does the pharmaceutical industry fit in to all of this? Can the sector become an active partner in helping the NHS transform itself? Speakers from the NHS and pharma at the recent PME and IQVIA roundtable agreed that pharma could play a role – indeed the NHS needs its help.

But it’s also clear that the industry must accelerate the transformation of its own business models in order to create real ‘win wins’.

Co-creation is key

Santoke Naal, Head of Market Access IQVIA, kicked off proceedings by highlighting the emergence of new models of care. "There are now 14 integrated care systems (ICSs) operating in England, as well as more devolved areas such as Greater Manchester and Surrey Heartlands."

However ICSs are just a staging post towards ‘population health systems’ focused on improving the health and well-being of a local population by addressing inequalities and using preventative measures to address the wider determinants of health.

Santoke Naal

“So how can pharma support this change in the future? Moving forward, that’s a big question, and requires some new solutions from the industry.” One golden rule is that projects need to have direct input from both parties from the start in order to be successful. “These programmes require a co-creation approach – that’s the way forward when working with the NHS,” says Santoke,

One strong local NHS programme is the Lancashire and South Cumbria sustainability and transformation partnership (STP), which has created a £44m transformation fund to improve diabetes and has a diet trial to reverse type 2 diabetes in patients.

Meanwhile, while there is a lot of gloom about market access for innovative new drugs in England, he says there have been a few notable bright spots in 2018. Most notably, fast patient access for CAR-T cell therapies, Gilead’s Yescarta and Novartis’ Kymriah, where England has been ahead of its European counterparts in making the drugs available.

“It's a real coup for the NHS and it’s gone way above our expectations," he says. "The real question now is about the bigger populations eligible for these treatments, and how that will be funded. CAR-T therapies are cost-effective for these patients, but the service redesign required is just as big a challenge.”

Accelerating integration

James Roach is Director, Accountable Care Partnership, West Essex Health and Care System. Looking ahead at the challenges for the NHS in the 2018-2022 period, he says a rapid move at scale towards new models of care is needed.

James Roach

Many of England’s acute providers are ‘technically bankrupt’, he says, requiring an accelerated move to more cost-effective population health models.

“Across the NHS we need to move away from poorly executed savings plans to ensuring we maximise the return from existing expenditure. That includes working with the pharma industry, our biggest supply chain partners, in a different way.”

West Essex is focusing on total system change: collectively pooling its resources, while shifting to a focus on outcomes and improving the service experience for its population.

The region is now adopting population health models for musculoskeletal (MSK) respiratory disease, diabetes and cardiovascular disease. Pharma companies are also urged to be proactive in seeking partnerships to the NHS.

“There's a natural tendency to hold back in the absence of very clear governance arrangements. But that means too often people [in pharma] are waiting for permission. The landscape now requires more direct conversations and more direct interventions.”

The Accelerated Access Collaborative

Ewan Barbour, Market Access and Pricing Director, Merck, presented on its multiple sclerosis treatment Mavenclad being selected to be among the first designated Rapid Uptake products on the new Accelerated Access Collaborative (ACC).

Ironically, the AAC process has been anything but accelerated, having taken four years to come to fruition. Now the scheme is getting underway, its goal is to comprehensively address any unwarranted barriers to access and uptake for the seven selected potentially transformative products.

Ewan Barbour

He said the success is based on Mavenclad’s efficacy and unique posology, which involves no more than 20 days of tablets in the first two years of treatment, with no need for further treatment in years three and four. This gives it an advantage over rival MS drugs, which need to be either administered via infusion by nurses, or require greater monitoring, for example.

This creates a “capacity credit” by potentially freeing up nurses’ time, and Barbour say this is what helped the drug gain its Rapid Uptake status.

He says the product nevertheless faces a lot of significant local uptake barriers. “That's my challenge really, to Academic Health Science Networks (AHSNs) and any other NHS organisations; we’re delighted to get this designation of a rapid uptake product, but it’s got to deliver. “It's taken four years to get to this point and it would be really disappointing if we didn't now see these products, which have been recognised as transformative, really move in the market place.”

Greater Manchester leading integration

Greater Manchester is England's most advanced integrated health system

Jay Hamilton, Associate Director Health Innovation Manchester, explained how Greater Manchester, England’s flagship of health and social care integration, is working collaboratively with industry to address shared challenges.

Echoing James Roach’s sentiment, she said: “Please don't wait to be asked, but make sure you're coming to us with innovations in your disease area which support a pathway or a system of care.”

Health Innovation Manchester is an AHSN, and Jay says the network of 15 AHSNs across England still has its work cut out to tackle lingering suspicion of pharma in some parts of the NHS. “If we don’t seek out good local NHS-industry partnerships and promote them across the system, the pace of change will be slower than it needs to be.”

She says pharma needs to make its voice heard as well.

“You need to come knocking on the door saying:“Why aren’t you saying more about this? Look how good this is, how can we get disseminate this through your NHS comms network?” This is going to have more credibility for other NHS bodies, so that’s the best route.”

Novartis’ collaborative culture

Fiona Bride

Fiona Bride, Director of Market Access Strategy, Novartis, says her company has shifted its culture to try to align as much as possible with healthcare providers, and create common goals around patient outcomes.

“It's got to go beyond the pill, it’s got to go beyond simply pathway mapping. We the industry have to think about how we take some responsibility for the workforce efficiencies as well.”

She adds that data and integration of data is another major challenge. The good news is that Novartis is already seeing joint working initiatives where data and digital innovation are reaping rewards in terms of workforce efficiencies.

Moving from selling to facilitating access and change

Paul Simpson, Head of Contract Sales and Medical Solutions, IQVIA, says the industry is beginning to engage with New Models of Care, and urges the sector to grasp the nettle of remodelling its offer around the NHS’ long-term needs.

Paul Simpson

He says IQVIA research shows rapidly changing healthcare professional (HCP) behaviour: 34% of all UK healthcare professionals reported that they had reduced time with pharma over the last five years.

This has resulted in an 18% reduction in the number of calls that the industry makes on HCPs. “I think this means HCPs see less value in those traditional interactions that we have with them,” he says.

Pharma needs to translate its understanding of these macro trends into action. That involves moving from the old way of doing things, away from selling and towards serving customer needs.

“For this new environment, we need people who understand a patient pathway and how to access it. Instead of being highly trained sales people, they need to be highly efficient facilitators, helping HCPs to get patients early access to the right medications at the right time. And to understand how to make a ‘beyond the pill’ programme a reality and help pharma meet that need by offering real added value.”