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Early stages

Joint working between the NHS and pharma is still embryonic but shows real potential

An ultrasound picture of a foetus in the wombI once asked a highly experienced marketer how he would define marketing and he rattled off a most striking definition on the theme of satisfying customer needs at a profit. Duly impressed at the time, I have since found myself somewhat unsatisfied with this rather narrow view and have tried, instead, to reach a broader conclusion about the true nature of our engaging discipline.

Among the many tortuous definitions of marketing to be found, the one that gets closest and fastest to the heart of the matter is that by Philip Kotler: "Marketing is a social and managerial process by which individuals and groups obtain what they want and need through creating, offering and exchanging [value] with others."

It is this transactional aspect of marketing that should excite marketers most, especially those working in our industry. The exchange of value opens up so many possibilities for us as we try to define what our next offering for these 'evolving customers' should be.

For an exchange with our customers to work effectively we must, of course, first understand what it is that they truly value. Because the elusive specification of this 'value' has changed with the passing of the years, many of us find ourselves somewhat at sea.

The NHS is currently facing its biggest ever financial challenge and anticipating a whole new raft of organisational streamlining and redundancies. It hardly seems that the new organisational structure of October 2006 has bedded down fully; chief execs have come and gone, community services have been in and then out again, and World Class Commissioning has barely begun to deliver the improvements anticipated.

So what does all this mean for the NHS, the industry and the exchange of value?

It has been recognised for some time that gaining access to decision makers on the purchasing side is the key to influencing prescribing in the new world. However, in the current climate, persuading the right person to give you five minutes is quite a challenge and even then, it isn't guaranteed that you will be able to hit the right notes to begin a successful dialogue.

The key to success is to:
• Identify the right person and get a meeting with them
• Understand the 'value' of what you are able to offer
• Enable them to understand the value of what you have to offer
• Arrange a follow up to discuss specific issues and move forward.

Getting to the right person
So how do you identify the key players in this new game?

Firstly, it is vital to understand how services are structured in your therapy area and in your locality, as the approach will vary considerably from one locality to the next. Is this a service that is commissioned by GPs (that is, under practice based commissioning [PBC] arrangements) or is it commissioned by the PCT? Who are the providers: Acute Trust, or community services? Is it a mix of both? Are they paid under the Payment by Results Tariff or by local agreement?

Detailed knowledge of how and by whom services are delivered, how patients access the system and who leads the commissioning process will help you to determine the key points of influence in the cycle and reveal who makes the decisions at each point.

What you may discover is that those providing and commissioning the services are not entirely clear themselves about how the entire service is configured; that is, the complete shape of the patient journey, or what actually happens once a patient sets out on that journey.

It is unlikely that you will find a single individual who truly understands the entire care pathway, all its possible branches and how each of the elements is commissioned and paid for. At this stage, you will probably identify more than one person you should talk to.

So having worked out who you need to see, how are you going to persuade them to see you? When you make the all-important call you may have just a couple of minutes to convince a customer that it is worth their while to set aside the time for you.

It is therefore vital to sell the 'why' message in that first few minutes in order to get their interest. So what are the hooks?
• Think about the role of the person that you are going to see — what are the priorities for them and what are the pressures that they are facing?
• Remember that if they don't believe that you understand their needs they will find it hard to believe that you have anything to offer.
• Be open — you are looking for a win-win here. Building trust with the customer is important in developing lasting relationships. 

It is important to realise that working with the payer audience is not a one-visit job. It takes time to build an understanding of the specific local issues needed to develop mutually beneficial joint working programmes. It is also important to see as many stakeholders as possible.

Understanding the issues from a single perspective may support one customer while simultaneously alienating another. Be aware of the danger of getting lured onto someone's bandwagon and don't get drawn into taking sides on a contentious local debate. It is definitely in your best interests to work with both sides to facilitate better overall communication.

Speaking the right language is important, but demonstrating a good understanding is not simply about using the latest terminology. Policy initiatives come and go with remarkable rapidity in the NHS and referring to out of date programmes can have a negative impact on your credibility.

So tell the customer what you have to offer — they won't know otherwise — but before that, make sure you listen (really listen) to what they have to say. It is very easy to spot someone so keen on offering what they want to sell that they forget to listen to their customer's needs.

It is unlikely that a single visit will uncover sufficient information for you to discuss the detail of your offering, so you will need to agree to come back at a future date with ideas about how you could work together to address specific local challenges. This will also give you an opportunity to draw on any relevant experience that your colleagues may have. Phone around, find out what others are up to — you may even be able to facilitate a joint working project across more than one locality, aiding better resource management for your customers.

Ready-made solutions rarely fit the exact needs of a customer, so be prepared to listen to what they say, then use the tools you have to develop a locally sensitive solution.

The benefits of joint working
So you can identify the key players and the value you can offer them, but it is equally important to have a sense of what value exchange you have in mind. In other words: what's in it for the industry?

Promoting pharmaceutical products to an organisation that must balance its books in-year, particularly if the adoption of that product would have a significant cost impact compared with generics or NICE-recommended alternatives, is a tricky business.

Marketing a drug, or therapeutic intervention of any sort, is unfortunately no longer merely about demonstrating efficacy and better health outcomes for patients. It's also about demonstrating cost effectiveness; most importantly, it's about cost effectiveness in the short term.

The NHS is very good at addressing many different aspects of delivering healthcare for a wide population, but what it is perhaps not so good at is taking a holistic approach to service planning and development. The NHS organisation is built in silos and while there would appear to be a wide recognition within the service that a joined-up approach to service provision is essential, the target-based financial and performance management system makes this extremely difficult for individual managers and commissioners.

This is an area in which the industry can truly offer real value, by helping to facilitate joint working programmes across care settings and organisational boundaries. Key areas for this include:
• Facilitating communication across real or perceived barriers within the system
• Helping to streamline services and reduce wastage to free up resources
• Supporting providers to market their services to commissioners and other budget holders.

What's in it for me?
Working with customers to address local challenges places you in an ideal position to help them see the potential of your particular therapy for specific patients when they are working to ensure that a high quality and cost effective service is commissioned or provided.

One of the clear benefits of joint working is the creation of a positive environment for the sales team. A streamlined and well-managed service is a far more positive and receptive environment for a sales representative than a chaotic and confused one.

As an ambassador for your organisation you are also positioning the company as an ethical and responsible partner.

The good news is that both the Department of Health (DH) and the Association of the British Pharmaceutical Industry (ABPI) are actively promoting the benefits of joint working between the NHS and the pharmaceutical industry.

If you haven't already done so then take a look at the DH/ABPI Joint Working Toolkit. While it doesn't provide all the answers and is certainly not an off-the-shelf solution, it clearly represents a positive endorsement of the principles of this approach.

Developing programmes at a national level for use within target localities can be cost-effective. It is important, however, to remember the key to successful engagement with customers is firstly to listen and understand their needs, pressures and priorities, then, and only then, to consider what you can offer them, while being flexible and adaptable and adopting a solutions-based approach.

Remember that successful marketing is all about an exchange of value — if you can be open about what you hope may be in it for you, you'll start off on a sound footing of mutual trust and will be well on the road to a long lasting and mutually beneficial relationship.

The Authors
Jonathan Dancer is managing director and Victoria Cook is senior consultant at red kite consulting group

To comment on this article, email

13th May 2010


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