Regaining control

The pace of change that has been set out is dizzying: the industry has just two years to switch the pattern of its relationships and GP commissioners who will shadow Primary Care Trusts (PCTs) will be doing so in less than a year.

The White Paper covers a broad range of topics and will require some weeks of careful studying, but the tight timeframe means industry will have to act quickly to influence the outcome of the consultations, which close in October.

The reforms are both radical and conservative, in effect similar to but further reaching than the previous administration could have hoped to achieve. The White Paper frees up market access, increasing patient choice and influence, establishing new roles for the regulators, extending GP commissioning and, crucially, rolling back the state's involvement.

With a drive for efficiency savings of £20bn by 2014 there is less money to go round and a variety of different groups will be holding the purse strings. Nevertheless, some of the key players will no longer be on the policy stage. Strategic Health Authorities (SHAs) and PCTs will cease to exist by 2013, replaced by around 500 consortia drawn from about 35,000 GPs. This time, unlike Labour's practice-based commissioners, GPs will be dealing with real money (to the tune of £80bn) and will be overseen by the new NHS Commissioning Board.

Reactions and implications
Reactions to the reforms have been mixed. For example, the NHS is no longer the preferred provider, meaning better market access. But the introduction of the cancer fund, while good news for those affected, is potentially divisive in the present economic climate and is likely to create a long queue of those keen to redress the balance in favour of patients in other disease areas who are as entitled to NHS care as those with cancer.

Additionally, unless the reforms are well managed, the postcode lottery horror stories much discussed in the lead-up to the election may be replaced by equally unpalatable tales of GP lotteries, according to Jon McLeod, Weber Shandwick's UK chairman of corporate communications and public affairs.

These points demonstrate the paradoxes that arise from attempting to reconcile national politics with the equitable access tenets of the NHS. This dilemma has proved toxic to past governments, with previous ministers unable to resist stepping in. It remains to be seen whether Health Secretary Andrew Lansley will follow suit when the political pressure at constituency level is on.

McLeod, broadly in favour of the strategic direction, sounds a note of caution. "Any rational person can see the advantages of devolving control and seeing that patients get the best care for the lowest cost," he said. "But the response of GPs is going to be extremely variable, as is their opportunity to rise to the challenge.

"GPs may not be well placed to negotiate with the acute providers' larger and experienced procurement departments. What is clear though is that GPs will become even more important to the pharma industry as power brokers, particularly those GPs running quite large consortia, which are companies in effect. Marketers need to understand where the pressure points are, particularly around patient choice."

How to proceed
Marketers must now gather and use more local intelligence. 'Talent spotting' those GPs set to become lead commissioners or knowing which PCT commissioners are likely to transition to consortia will be essential. This point is universally accepted: in the wake of its recent workshop 'Accessing the market with clinical commissioning', Medical Management Services (MMS) has produced an impact analysis of the White Paper for pharma, which predicts it's these individuals who will prove most innovative and more likely to commission packages of care. Such innovators are also likely to attract those patients wanting to change their GP because of concerns with performance.

These developments make patient-facing communication even more strategically important. When talking to GPs, pharma representatives must now be eloquent in the economic as well as the clinical narrative of product communication. They also need to be confident about how the offering contributes to outcomes rather than targets, as well as how it meets National Institute for Health and Clinical Excellence (NICE) guidance. A recent survey showed 43 per cent of GPs expected to take more notice of NICE guidance moving forward.

"Marketers have to be extremely sensitive how they demonstrate their product aligns to patient choice. So yes, efficacy is important and price, but they also have to consider issues like method of delivery, demonstrating the propensity of the patient to comply with treatment, the interrelation between different treatments and treatment context. The mix of proof points will subtly shift," said McLeod.

Pricing will become more sensitive to efficacy, with the eventual introduction of value-based pricing, and pharma will have to demonstrate clear advantages to justify higher prices for its innovative products. The MMS impact analysis suggests head-to-head clinical trials will become more important, and survey results also show that only 4 per cent of GPs think they are more likely to adopt new therapies as a result of the reforms.

Pharma has a substantial bank of in-house experience and expertise to facilitate GP commissioning and create new offerings. "Innovation might include pharma companies working with GPs and GP consortia to examine populations within the consortia area to determine local needs," said McLeod.