Responding to NHS Change 1: Big Pharma needs to know more

While the UK's Prime Minister Gordon Brown was putting the NHS firmly at the centre of the Labour Party conference held in Bournemouth this week, the pharmaceutical industry was brushing up on its knowledge of current changes in the NHS in the City of London.

The conference, entitled Responding to NHS Change, organised by Eye for Pharma, is a two-day meeting, covering topics ranging from How to Build Healthy Partnerships within the NHS to The Implications of Practice Based Commissioning (PBC).

Chaired by Colin Wight, CEO of strategic healthcare business consultancy GalbraithWight, the meeting began with a summary of the current status of the NHS and the changes being wrought within the system.

Wight focused on the Labour conference and the likelihood of cuts being made by Brown and the possible slowdown in NHS funding from April 2008. He also touched on market access and the impact of health technology assessments (HTAs), while mentioning the challenges faced by pharmaceutical companies with regards to PBC (practice based commissioning).

Wight concluded his introduction by saying that the NHS's focus on cost could be a positive thing, as the service would eventually be able to balance its books, avoid 'bean counting' and change the current system of "healthcare rationing".

What's wrong and what's right
John Proctor, head of the Pfizer Health Solutions team within Pfizer UK, made some predictions about how the NHS might develop over the next few years. Proctor admitted, however, that the rate of change itself might make what he was saying out of date soon.

Proctor noted the discrepancies between the recommendation of the Wanless Report update to increase funding and the proposed funding cuts that may begin next year. He applauded the fact that recruitment was functioning better within the NHS and that national standards of health were better.

However, he pointed out that most of the NHS funding had been spent on augmenting salaries, rather than healthcare provision. Proctor went on to reveal that 2007 spending was GBP 96bn, but added that in 2022, spending would need to be GBP 186bn to maintain the same level of service.

Proctor echoed Wight's comments that when the NHS reaches financial stability, then braver decisions could be made over choice and access. The mistrust between healthcare providers and the government/ NHS must be broken down, he added.

"The NHS must move from 'sick' care to 'health' care," said Proctor. "How do we get people to lead healthier lives? Where and how patients are treated is more important now than who is treated. This must change. Patient centred care and concordance must replace the current thinking."

He went on to quote the EU Commission's vice-president, Gunter Verheugen: "We will not succeed in tackling healthcare, if we constantly see it as a burden."

Proctor set the tone for the rest of the day: how can the pharmaceutical industry help the NHS keep its costs down? What services and skills can the industry as commercially focused entities offer the NHS? What about the current business model must change?

Finding your way through change
Jason Bryant, director of the pharmaceutical business unit at Binley's Pharma, took the audience through the "uncertain waters" of the NHS. He stressed that poor intelligence could destroy relationships between the pharmaceutical industry and Primary Care Trusts (PCTs).

Bryant outlined how the healthcare industry and NHS shared similar goals and possible future directions to improve relationships:

* sharing the responsibility of being providers of healthcare
* building trust between the industry and the NHS
* make proposed changes happen
* play a leading role in helping the NHS reduce its costs
* offering to share skills
* people make health choices everyday; how to implement this in healthcare

Bryant also cited the example of the In-Control programme, a scheme which allows people in receipt of social care services to manage their own budgets and control their own interventions. A possible model, therefore, would be to allow patients to manage their own healthcare budgets, with support from doctors and other key workers.

Also, with the cost cutting exercises concentrating on switching from branded to generic drugs, how can the pharmaceutical industry persuade PCTs and the NHS as a whole to use the money saved to reinvest in branded drugs? From a pharmaceutical marketing angle, Bryant said that the industry needed to reconfigure and educate its sales forces to understand fully the local healthcare needs of PCTs. Education and communication were currently lacking in the relationships between the industry and the NHS, he warned.

Patent-expired prescribing
Noel Staunton, director of i3 Consultancy, expanded on patent-expired prescribing. Firstly, he questioned the safety aspects of switching patients between drugs.

He then introduced the Better Care Better Value (BCBV) indicators, which were similar in essence to the proposed changes to the PPRS proposed by the Office of Fair Trading (OFT). The indicators are primarily aimed at PCTs and acute hospital providers (AHTs) and vary from region to region.

A number of speakers did not believe that PPRS would change, as it would be too expensive to implement and be damaging to the pharmaceutical industry. However, BCBV criteria were already working on a grass roots level, had national justification and were making big savings. Staunton added that the Department of Health had said no to the Office of Fair Trading before, when the proposed deregulation of community pharmacies was refused.

Once BCBVs are laid down, what can pharma do to limit the damage to the branded portfolios? Staunton recommended the following:

* dampen PCTs enthusiasm for the BCBV targets, for example switching from Plavix to aspirin, by providing clinical evidence that the switch can cause medical problems
* assist PCTs to reach targets, without switching from a branded product
* approach PCTs in a different way - offer expertise and other resources, but do not pretend that you are doing this for altruistic reasons.

PCBs here to stay
Lastly, Peter Dunkley, head of healthcare development and strategic planning for sanofi pasteur UK, outlined the importance of practice-based commissioning (PCB). PCB forces GP businesses to become hard-nosed commercial ventures with financial incentives to improve the services provided to patients: if you improve the service, you increase the numbers of patients wanting to join. Each new patient sees the practice's income increase. Dunkley concluded that PCB was here to stay.

He advised pharmaceutical companies to consider the following when approaching PCBs:

* What can my products do?
* Who should be getting them?

A new approach is needed. Are we sending the right people in to do the job?

Dunkley counselled: "know your PCBs and know their top three priorities. There needs to be a mutual benefit and this fact should be acknowledged. There needs to be a separate business plan developed by the pharmaceutical company for each institution you visit and a clear message relayed to them regarding the kinds of skills you can offer. A tailored approach must be adopted, if relationship building is to thrive. Persistence in this respect would pay off in the long run."

In summary, the changes within the NHS will force the industry to change the ways in which they do business. Building mutual trust, supporting groups who want to work together, striving to change attitudes and vastly improving communication seemed to be the most important vehicles for change.

Everyone in a healthcare company from board to the sales force must understand who they are dealing with, or business will suffer. That means understanding how the changes are operating nationally, but more importantly how different PCTs have different local health needs. It is no longer a case of 'one size fits all'.