Responding to NHS Change 2: Look forwards, not backwards

During the second day of Eye for Pharma's conference, Responding to NHS Change, the emphasis turned to organisational change in the pharmaceutical industry, specifically in how to identify and partner successfully with key NHS stakeholders.

PMLive reported from the first day of the conference that the idea of mass marketing to the NHS was no longer acceptable, especially as the concept of the customer was changing. Trust issues continue to block successful relationship building between Pharma and the NHS, and this theme was expanded on the second day by Carolyn Dyson, head of strategic healthcare marketing at Altana Pharma.

The main hurdles to overcome, said Dyson, were those preventing complete transparency in Pharma's dealings with the NHS. She said that communication channels needed to be open and clear to gain long-term trust. The key to success here was the institution of programmes that emphasised collaborative communication. Only then can the industry improve its reputation and enhance NHS relationships.

What is a beneficial partnership?
Next to present was Mike Herepath, a former NHS partnership director at AstraZeneca. He said that the most misused and misunderstood term in Pharma and NHS collaborations was the idea of 'partnership', with both sides demonstrating fundamental differences in what they require in such a relationship. Using a Humanist approach, he said that a true partnership was based on overlapping needs, wants or desires.

A starting point, said Herepath, was an effective system of evaluation. In order to evaluate a partnership successfully, the value must be assessed early on. Such assessments should be based on features deemed important by both parties and, as such, is a completely subjective evaluation. There was no winning formula, he admitted.

The assessment would depend on the stakeholder's needs, values, priorities and expectations, which a pharmaceutical company must manage in real time. Most importantly, added Herepath, each side's views of 'success' must be negotiated. What's valuable to Pharma is different to the NHS.
Pharma will derive value from a partnership if a company can differentiate itself by raising its profile, allowing better access to communication channels, understanding the relationship better, gaining market and business intelligence and fostering more appropriate usage of its products.

"What is valuable to the NHS in a collaboration with Pharma? It's very different, of course," said Herepath. "The NHS will benefit if the pharmaceutical company can help it reduce costs, improve quality of care and health outcomes, achieve targets, minimise hospitalisation and raise and maintain an organisational profile. Patients benefit from improved health and well-being and better access to treatments."

Herepath concluded that in order to be as completely transparent with the NHS as possible, Pharma should contractualise partnerships, be detailed regarding evaluation, ensure the partnership agrees in terms of aims and objectives, manage the partnership as a project, assign responsibilities and fix review dates.

Marketing compliance
John Whiting, former marketing operations manager at Wyeth, presented on the changes in the legal landscape of marketing drugs to the NHS. Pharma's reputation here has been damaged by a number of high-profile lapses in marketing compliance. He said that things went wrong legally when: requirements were not specified between the two parties or communicated effectively; management did not take the requirements seriously; the system was not capable and staff were not trained effectively.

Whiting stressed that the NHS was a different customer now. Pharma should be careful to distinguish between win-win and inducement to prescribe situations. He also emphasised the importance of maintaining a clean reputation. Marketers would benefit, he said, from knowing case law examples and keep up to date with the ABPI code of practice.

The danger marketers face is that the industry was essentially self-regulating, which means that marketers should not launch a dodgy campaign just to see how things go. A marketing team should never have to start again and should also keep up to date with codes of practice.

Best practice should include the following:

* leadership at the senior level
* responsibility and awareness of legal issues throughout the organisation
* consistency and sharing across brand teams
* involve approvers at every level
* use creativity to provide clever, memorable campaigns NOT those designed to stretch the definition of lawfulness
* if in doubt, ask
* if still in doubt, don't go ahead with the campaign

Realigning sales and marketing activities
Nina Felton, country principal of IMS Health, reiterated the points raised in the conference on day one: flexibility is an alien concept for Pharma. What was needed, said Felton, was to challenge thinking and make the industry realise that the changes would bring excellent business opportunities, if Pharma took the time to consider the different types of NHS stakeholders involved in the new system.

On a national level, Felton said that the UK is split into Northern Ireland, Scotland, Wales and England, all of which are slightly different. On local levels, they are massively different. A "one size fits all" approach was no longer appropriate, she said, so the sales model must change. She added that the launch environment should now be totally different to that a mere five years ago, citing IMS data which showed that only 35 brands out of the 4,500 studied had "successful" launches against IMS criteria.

Felton revealed that only half of the companies IMS looked at had measurable performance criteria, such as evidence based materials. With health technology assessments (HTA), the NHS will demand this approach.

The NHS is also shifting from secondary into primary care. This is happening at a time when Pharma is switching from a general to a speciality portfolio of products. These two operation shifts did not align, warned Felton. The sales and marketing models that will work best would be those that maximise primary care franchises (balanced investment and co-promotion); manage mature products and specialise in a segment. Many pharmaceutical companies will need to operate two co-existing business models.

For example, over the next five years, the oncology segment will see 50 new products launched in the UK alone. The number of oncologists will not increase, however, so competition among companies to see them will increase. Also, as patients get treated earlier, this means that the homecare market will become more and more important. How will companies deal with distribution and adapt their sales model accordingly, especially as such patients will live longer.

Felton concluded that Pharma must get better at being customer-centric. The new NHS stakeholder framework cannot be guessed, it has to be understood, especially as this cannot be reliably worked out by looking at job titles. Those stakeholders important to Pharma are the commissioners, PCTs, PBCs and independent contractors. Doctors will remain important, but they are no longer the main stakeholder in the new system.

Time for change
Other speakers followed Felton's line. All concluded that the pharmaceutical industry had remained unchanged in its approach to sales and marketing for over 40 years. Blanket bombing is no longer appropriate.

Change has only really been happening in the past five years. The industry is experimenting with an expanded view of the customer and is slowly adopting new IT for marketing and sales to make the interaction between customer and the company work in real time. However, there are no real trail blazers: the conservative nature of the industry must change. The future model of dealing with the NHS, or any customer for that matter, must involve a stronger focus on evidence-based medicine supported by health economics.

What is stopping Pharma from changing? Dr Alisdair Mackintosh, head of European life sciences practice at Archstone Consulting said: "Pharma is reluctant to break with the established model because up until now it has served the industry well. Innovative ideas have been piloted, but scaling them up has proved a major challenge. The existing organisations within the industry are overly complex and are under constant pressure to deliver financially only. All this must change."

In conclusion, the three priority areas for Pharma to address in their relationship with the NHS are to redefine the customer, understand the stakeholder network and remodel the scope of sales. The future NHS is predictable. Doctors are being told what to prescribe (generics before branded next generation products), there are different criteria for selecting treatments (cost versus risk), patients are taking control of their healthcare and, as a result, healthcare provision is moving closer to the patient. In short, Pharma must redefine what sales and marketing actually is within the operational parameters of the company.