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On neutral e-ground

Can online appointment-making save failing relationships between reps and doctors?

It has been possible, for 10 years, to model the relationship between the number of medical representatives and the market share, or revenues achievable, for not just a product but a portfolio of products promoted by a fieldforce. Such models have also helped us to understand the effect of co-marketing and co-promotion.

By 1999, various observers had started to comment on the phenomenon of reduced access to doctors in an environment where sales teams were getting bigger, more numerous and supplemented by contract hire salesforces.

ISIS Research, which operated the 'Jigsaw' panel of GPs, published a paper in February 2003 that revealed how access had diminished: 'Monthly detailing numbers fell by 25 per cent between the end of 1999 and the end of 2002.' GP visits fell by the same proportion and, yet, in the same period, the number of reps increased by 40 per cent, from 5,000 to 7,000!

You might ask what the relationship is between these two variables. Were the reps hired to compensate for the falling details, or were the falling details caused by the increase in reps? Personally, I am fairly confident that it is the latter.

The 'ARMS' Race
Competitiveness between pharma's sales and marketing departments intensified through the 1990s and into the new millennium. With salesforces constantly growing, the phenomenon was dubbed the 'Arms Race'.

Pharma's fieldforce strategies in the US were blamed for unduly influencing UK fieldforce sizes. The battle for the doctor's attention by a multiplicity of reps in the US was replicated here, and the same thing happened - too many reps calling resulted in doors closing.

Wall Street watchers went on the record observing the huge fieldforces apparently driving sales revenues, but also fearing an ever increasing competitiveness in which no company would be brave enough to `right-size' its salesforce.


On February 10, 2005, GlaxoSmithKline's JP Garnier noted that if sanity can be restored and the `Arms Race' starts to slow down, it will be good for the industry.

He added that we do not need such large salesforces to do the job; we need them because the competition is trying to increase its noise levels.

The following day, Pfizer announced a major re-structuring of its sales efforts, which was trailed by comments and action from Bristol-Myers Squibb and MSD.

AstraZeneca's Tom McKillop was then quoted as saying that there is, perhaps, a saturation of sales and marketing effect.

Wyeth CEO, Bob Essner, joined in by stating: I think we have to be very careful about thinking about the number of people in the field and making sure Wyeth builds relationships with our customers through our representatives.

This signalling between companies took place last year, but have salesforces reduced in size? The answer is YES - albeit marginally at the macro level.

NHS primary care
The NHS has been changing too. Since April 2004, the vast majority of GPs have had to deal with the 'new' contract, but actually it is mostly the practice managers who had to deal with it. In fact, everyone in a primary care practice has been, and still is, affected by the new contract, which is now in its third year.

It has more than doubled practices' administration loads, necessitated new and improved workflow processes and, of course, also made GPs considerably richer! Nevertheless, more patients are being seen, and more quickly.

Ultimately, practice managers and Primary Care Trust (PCT) staff have had to focus on this along with, in many cases, eradicating activities and processes in practices that do not focus on the patient. Unfortunately for pharma fieldforces, it is often the medical reps that are omitted from today's primary care processes.

All too often, primary care staff have commented on the fact that there are too many reps queuing up for appointments, occupying too many spaces in the waiting room, or congesting the phone system as they try to set up their appointments. GPs may object to the multiplicity of reps promoting the same product to them (thus devaluing the doctor's time).

It is perhaps unsurprising that when a manager takes action against this, the first solution they think of is to close the practice to drug representatives. Unfortunately, this is what has been happening and it is a continuing trend.


An e-solution?
Since the introduction of electronic diary services, such as mediary for example, which allow practices to organise rep appointments online, it has been noted that those which had previously closed the door to reps re-opened (and some stayed open in the first instance), as the online service diminishes the need for reps to call.

The closing practice phenomenon is most marked in certain regions. At the time of the new contract in April 2004, most practices in greater London would not see reps. In Scotland, the North East and East Anglia, the number of closing practices was marked.

Some primary care practices with patient access issues have welcomed online diary facilities. For them, allowing reps to collect their appointments online is as natural as patients doing the same. The practices that have been increasingly critical of the number of reps and their frequent interventions in the primary care process now have a solution. No more queuing, or phoning, or driving for miles by the reps, and when one does come to the surgery they have exclusivity for their `networking'.

With mediary, healthcare practices set up their electronic diary to their existing 'rules', or policy, as regards seeing drug reps. Healthcare professionals still decide when and how often to see reps, but the rest is automated, as the diary automatically makes appointments available at the right time and frequency.

When a rep looks online for appointments in a certain practice they can only see the appointments to which they are entitled, and no-one else's. They then select those they wish to take, often with a choice of dates. The only bill is the time spent online - similar to a mobile phone call and about the same price.

Instead of practices just closing the doors, to reps the whole process is taken out of the patient management workflow. Yet, the concept of collecting appointments from practices online seems to have phased some pharma managers, who appear to feel that this is a change they are not yet ready for. They seem to think that such a service can cause an obstacle between practice and rep, yet they appear not to appreciate that, without this technology, GP practices will probably stop seeing their reps completely.

Some managers might even go so far as to suggest that this service may not be within the spirit of the PMCPA-ABPI Code of Practice, when, in contrast, it has been designed rigorously to ensure compliance. The management board at mediary provided total transparency to advisors comprising a former DoH Head, former Health Minister and three industry CEOs.

Approximately two-thirds of practices actually make appointments for reps to see customers. The remaining 33 per cent either do not see reps, or they see them speculatively without appointment. An average territory should have around 100 practices of which, according to mediary's market research, up to 30 will adopt the online appointment-making system over the next two years.

Mediary also offers tools to integrate with CRM, such as the ability to make appointments online via a 'button' on the system, and read online reports of definite appointments booked for the future. This is an obvious aid to territory and customer relationship planning, especially regarding new products, new campaigns, and co-promotion planning.

Online appointment-making offers the benefit of improved relationships with customers who are happy to see the pharma industry's drug reps during the time they decide to put aside for them, and not when such interventions are an inconvenience.

The author
Ian Kennedy (MBA) is CEO at mediary. He served formerly as chief of GlaxoSmithKline's 'Health Data Management' business

2nd September 2008


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