Living together

Through joint working initiatives pharma can aid the NHS in delivering on tough demands that it cannot meet alone

There was an advert on television in the '90s for an insurance company, in which Mark Williams - famed most recently for his performance as Arthur Weasley in the Harry Potter films - strings an arm around his screen wife and, with a slightly over-zealous squeeze, tells the viewers in a thick brummie accent that whatever happens, 'we wunna be together'. The company was trading, through this now classic line, on its aspiration to be a good partner with its customers and to support closer working between them.

Earlier this year, the then commercial director at the Department of Health, Ken Anderson, stated that: The 21st Century should become the era in which this partnership delivers greater capacity, true choice for patients and, ultimately, a world class standard in quality and efficiency in healthcare provision. Perhaps the current period will come to mark the moment when joint working was proven as the mantra for success in healthcare. With a decade or more of partnership planning between pharma and the NHS starting to bud, new and closer partnerships are heralded by the foremost thinkers as the best way to ensure that delivery of healthcare and medicines becomes more efficient, more responsive and more relevant to how lives are lived today.

Joint working initiatives will not only bring the NHS and industry closer together in the short term, but promise to deliver on commercial goals over longer periods. Why, then, is now the right time to restructure working relationships, and how should pharma go about being a 'proper partner'?

Timing is key
There are those who feel that, while the 21st Century is still young, the very term 'partnership' is a misnomer when applied to joint enterprises between pharma companies and the health service, in that it suggests equality; and that pharma has, in some parts, barely achieved the status of 'trusted supplier'.

We are starting to see a shift in the criteria for drug choice from a focus on just efficacy and safety, to an additional emphasis on cost-effectiveness and risk management, explains Alasdair Mackintosh, head of the European life sciences practice at Archstone Consulting. This is the fundamental shift to which pharma companies need to adapt, and NHS liaison teams, with the support of their organisations, need to develop and deliver strong propositions addressing these factors.

He points to evidence of a clear appetite at Primary Care Trust (PCT) level to engage with pharma companies on innovative solutions driven by local healthcare priorities. Pharma companies need to think beyond the detailing model and start to engage with the 'movers and shakers' in the NHS on a more valuable deployment of resources. In this market, those who innovate will be rewarded.

Relationships between pharma firms and NHS organisations sit on a sliding scale, from 'traditional/transactional' through to new 'long-term disease management partnerships', and the current drive away from the former - towards the latter - is undeniably gaining momentum. All blueprints for the future of Britain's healthcare apparently call for this to happen.

Angela Macfarlane, of specialist NHS liaison firm HGS Consultancy, believes that the time is right for pharma to strike up joint working agreements because the health service requires new skill- and knowledge-bases in order to achieve on its objectives ñ skills and knowledge which it lacks, yet which pharma companies have developed, polished and relied upon for years.

The NHS knows that it must deliver on ever-increasing targets and demands, and one of the big opportunities now is the recognition by the NHS that it cannot deliver on its own, she states. I've been working on this since the mid-90s and I've always said that 'partnership' in healthcare was a bit like the relationship between Charles and Diana: completely unequal, with two parties wanting different things from it.

Now, however, the NHS is working much more closely with a lot of different sectors and that is where the alignment opportunity lies for pharma. We need to ask, what is the NHS' agenda? What is its driver? What is the target, and how can we help the NHS, under joint working initiatives, to meet that?

The NHS is in the throes of some of the most fundamental reforms in its history and the UK's pharma industry is experiencing increasing commercial pressure: this coincidental timing of two key factors in business has created an environment ready to nurture joint working, says Mike Herepath, former NHS partnership director for a large pharma company.

There has been a lot of talk about collaborative working and partnerships, which has already proved itself as a valuable means of business-to-business engagement with these increasingly powerful NHS organisational customers. There's a realisation by pharma that the old transactional model is becoming less effective, and therefore companies have to think about how best to use the medicines they already have, notes Herepath. Generally speaking, UK pharma appreciates the need to try to do things differently, and that the need is growing with increasing pressure.

Being a partner
Differentiation through an improved corporate profile, closer and longer-term customer relationships, access to highly valuable customer intelligence and real opportunities to help ensure appropriate usage of medicines are all potential benefits for pharma, to be gained by engaging in new joint working initiatives.

Overall, however, there is some hesitancy to commit, as these new ways of working make early adopters nervous and unsure, particularly during periods of stricter spending restraint and keener focus on return on investments. Partnership working is new and, hence, represents change and uncertainty. Companies are stepping into the unknown, says Herepath.

There are, however, initiatives underway which seek to prepare the ground for reciprocally-aligned joint working initiatives, in accordance with the directives presented by the Ministerial Industrial Strategy Group's (MISG) Long Term Leadership Strategy Partnership Working Group.

Close to the centre and the debates, Martin Anderson, director of NHS policy and partnerships at the Association of the British Pharmaceutical Industry (ABPI), told Pharmaceutical Marketing of several key prospective developments that are expected to facilitate in pharma becoming a true partner in healthcare delivery.There are three key initiatives, he notes. Firstly, there is going to be some guidance from the Department of Health (DoH) to the NHS on joint working with the pharmaceutical industry. It has been expected for some months now and, while delays have been one of our frustrations, I have seen a draft which looks to be useful and helpful. There are people in the NHS who do not understand or fully appreciate the nature of our [pharma's] policy on joint working, so this guidance should help to give them confidence to be able to engage in joint working more than they do currently. We hope that it's going to be very positive.

The second initiative is a web-based toolkit, currently being piloted with a sample of prospective users in the NHS, which will provide guidance for pharma and the health service alike around joint working governance and frameworks, as well as advice on methodologies and examples of where joint working has been mutually productive. It is a joint ABPI-DoH guide on what/or what not to do related to the professional codes of practice. The ABPI is also eliciting input into (and endorsement of) it from the NHS Confederation, NHS Alliance and the National Association of Primary Care.

The third key area is training - developing a competency framework for pharma personnel who liaise with NHS staff on the MISG's Long-Term Leadership Strategy, explains Anderson. Research has demonstrated a wide variation of understanding, respectively, in the NHS and pharma of each other's objectives and methodologies. There could be pockets of ignorance on both sides, so we're committed to ensuring that all of our customer-facing NHS staff will achieve a 'minimum standard' in terms of a competency framework. We would hope that, through competition, the ABPI's members would want to exceed that standard. I'm sure that many already do, but we're trying to raise the bar for everybody.

Does he feel that the organisational reforms are now embedded sufficiently within the NHS that the health service is ready to talk to pharma about partnerships? There is, quite apparently, still an issue over trust, as well as signs that the NHS has not fully ironed out the creases in some of the new commissioning methodologies.

The whole NHS culture of working with private providers, whether with pharma or other enterprises, is shifting more towards collaboration and I think people are beginning to realise that. Companies see themselves increasingly as stakeholders in healthcare, rather than manufacturers and developers of medicines, and some customers have not caught up with that. I'm not saying that all companies are in this mindset either, but those at the front edge want to work with the NHS to improve overall healthcare quality and standards, because then everybody gains.

Anderson continues: "I think customers still sometimes think that all we want to do is sell more drugs, which is an accusation frequently levelled at the industry; but it is not true. It's in nobody's interest to sell drugs inappropriately. One question is, 'is pharma different from other private sector partners and, if so, why?' I don't have the answer to that - pharma provides solutions to problems, just like Microsoft or BT. However, I do think the NHS is becoming much more switched on and able to work with that kind of approach from the private sector."

There is, seemingly, still a residue in the NHS of its historic mistrust of pharma, though Anderson suspects that such misgivings held by public institutions of private companies are not contained solely within healthcare, adding that one of the best ways to overcome this barrier is simply to demonstrate good practice. We are trying to capture case studies where companies have worked successfully with NHS organisations. All relationships have potential problems, but for the NHS, working with pharma can be as easy as working with anyone else.

Come together
Surely enough this aspect will become accepted as read over the coming months and years. A wealth of key activities are emerging where a tie-up with a pharma firm can truly make a positive and direct difference to patients' experiences of the healthcare system, and the patient must be seen by all as the party with the most to gain. Examples include therapy areas which already place tough, unremitting demands on the NHS, such as cancer and asthma/COPD, plus other more acute targets such as MRSA and C. difficile infection control/prevention.

Asthma/COPD is an area where pharma's skills can be hugely valuable to the health service in terms of service redesign and target hitting, notes HGS Consulting's Macfarlane. Adding value in asthma is all about avoiding unplanned hospital admissions. Each time somebody goes into hospital, the bill for the PCT is massive because unplanned admissions end up staying in much longer than they might otherwise need to if their asthma was better controlled. Therefore, if your company has the treatments and programmes to reduce unplanned admissions and educate practice nurses, GPs, and PCT management, such that they're getting the maximum return on investment, you're on to a winner.

She emphasises the importance that pharma speaks the right language with the NHS. It's not about saying 'use our combined inhaler because...', the message should be more about 'I've looked at your local data, I know that you're not controlling unplanned admissions and you're not hitting the 18-week wait target, and I can see the consequent impact of poorly managed asthma on your revolving door patients, so let's sit down together and try to work out a way of getting you back on track'.

Dermatology is another key area where pharma can add value in service redesign, importing its expertise and knowledge (gained directly from previous experience) and helping NHS colleagues to understand where the gaps are, how to fill them and what the difficulties might be. It is important, however, that pharma realises the long-term nature of any partnership programme. NHS organisations will be looking for minimum 12-month commitments, and longer programmes will only help relations and boost the prospects for future collaboration in additional areas.

Martin Anderson, of the ABPI, believes that what the NHS needs from pharma now more than ever is assistance in the development of robust commissioning methodologies. I think everybody recognises, looking at the NHS budget, that money is not as well spent as it could be. We need to focus on preventing the need for people to go into hospital, and then getting them better and home quicker when they're there. Commissioning is the newest and biggest game in town, and the NHS is struggling with it.

Other areas of relative pharma-strength/NHS-weakness include the provision of management skills and training, and health economics. Anderson is also keen to encourage pharma/NHS secondments. The more people who understand conditions and objectives, the easier it is for both organisations to understand why things do or do not happen for patients.

He says that the public sector is going to require additional resource to meet the demands and capacity expected of it now and in the future. I think people are recognising that now.

The Author
Rob Skelding is a freelance pharmaceutical and healthcare journalist