Signs of change

He refers to the new model emerging in the UK which sees traditional product-promoting sales reps, and even super-reps, being retrained and reformed into more holistic account managers who have a much deeper understanding and appreciation of their buyers' desires. These are people, chosen because they have demonstrated good early adoption and buy-in of new processes, whose main objective is to work with healthcare professionals in a practice, or group of practices, to help them achieve their clinical and budgetary goals. It's not about closing the next three sales, it's about educating the entire range of healthcare professionals in how your offering will enhance theirs, on several levels.

Providing tangible, long-term benefits to your customers is fine. However, the NHS is changing and it knows what it needs. Pharma's latest customers - no longer necessarily the country's doctors of course - are under increasing pressure to deliver gains and results in the short-term; they have targets to hit.

The time for pharma to supply what its buyers are asking for - not a tilted interpretation of their requests, but a candid partnering effort - is only one field away. A low fence jump and both parties will be grazing the same pastures, and will, therefore, need to respect each other's needs and wishes more so than in history.

Comprehensive consultations
Some sales departments have been considering for a while the prospect of augmenting the 'old-style' frequency and coverage model, whereby a sales representative gets clued up on the pros and cons of a specific product and fervently imparts this knowledge to prescribers, by developing and deploying account managers. The way in which medicines will be marketed and 'sold' will be different to what has been standard practice for the past two decades, perhaps with a greater emphasis on the science and on helping physicians to understand how to get the bestout of using certain products or ranges.

Notably, this new 'medicines and support consultation' will more overtly emphasise the health economic benefits on offer and will highlight a number of supplementary support services offered by the vending manufacturer.

Healthcare performance is being measured increasingly against defined targets, and to meet these it is important that all healthcare providers within primary care practices work together. So it is not surprising that pharma's representatives need to have more of an account-based approach, as opposed to an individual physician approach, says Colin Hannah, managing director of Innovex UK.

This sentiment is echoed by the words of Dudley Ferguson, managing director of Astellas Pharma UK, who believes that pharma's biggest challenge is to realign its priorities and stare change directly in the face. For too long pharma has been in its comfort zone, and we haven't wanted to change. He adds that the industry has no choice now but to develop the way it talks to its customers, on a plane that shows discerning and empathy above and beyond, in large part, peddling a product.

Powerful market drivers
Chiefly, two factors in the marketplace are behind the reformatting of pharma salesforces in this way: government-led cost containment initiatives, plus a change in the contents of pipelines of many of the big pharma operations, from plentiful, widely used medicines to niche and more specialist products.

In the first instance, we've seen processes implemented by authorities seeking to, in some respects, homogenise prescribing by supporting the use of the most cost-effective medicines, whether branded or generic, in particular disease areas. The NHS is now geared up to ensure that patients receive the appropriate quality of healthcare at an acceptable cost. The work of the National Institute for Health and Clinical Excellence (NICE) is a key advocate of that goal.

The pressure on healthcare costs will inevitably lead to further constraints on pharma expenditure, through one mechanism or another. Hence, a more 'holistic' approach to selling will be required if firms are to sustain growth, comments Gary Killington, business unit director SFE, at In2Focus, a contract sales organisation.

Each PCT is increasingly becoming a market in its own right.

Secondly, with nichebusters, rather than blockbusters, now talk of the town, pharma companies are shifting their attention progressively towards the speciality sector where medicines are typically differentiated more visibly and command higher prices.

Hand-in-hand with this, the requirement for a large primary care-focused salesforce is, to a degree, diminishing. Many nichebusters will be prescribed through secondary care, creating instead a greater need for more specialist sales efforts covering distinct and specialist prescriber groups.

The key questions are whether companies need as many reps, and how they can right-size the salesforce and ensure they have the appropriate roles in place, says Nev Skelton, group vice president, salesforce effectiveness, IMS Health.

Instead of having 10 products in the portfolio, for example, with 10 or more individual sales reps detailing the doctor with 10 different brands, there will now be perhaps one or two, possibly therapy area-focused, who go and talk about the needs of a specific practice.

He confirms: We're going to see companies move away froman individual product-focused salesforce to one that's going to have multiple skills and multiple products in its portfolio.

Pharma's new skill sets
Key to this is developing partnership-focused communications, rather than product-focused sales rep sessions. It's more about shared agendas, the empathetic appreciation of respective interests and goals, and wholesomely mutual and fruitful relationships. And if that sounds vaguely convivial, it's probably due to the fact this progression in salesforce duty is still relatively early-stage with some shake down miles needed.

What is quite clear though is that account managers will require a much more thorough understanding of their company's medicine offerings, above and beyond being savvy on just one or two products, and how they might 'add value' - and read that twice because the thought-leaders in this area all say it's key in developing your marketing and sales messages - for a practice, practice-based commissioning group or hospital.

The process should be: understand your customer's needs by seeing the world through their eyes; think about how you would tackle their challenges and then consider what you would want to hear from pharmaceutical account managers when discussing products and support services that will help you achieve your goals and hit your targets; align your offering alongside this.

Needless to say, account managers will need to be better trained than traditional product reps; they will operate on a much higher register in terms of business and team building skills.

IMS Health's Skelton notes too that pharma reward systems are going to start including qualitative measures - are we individually adding value to that account? Does a particular practice believe it's getting value from us? Are we seen to be reactive and providing the right information, helping them to treat their patients?

People are, in general, reassured by 'sellers' who know the value of their offering, believes Chris Morgan, of marketing and salesforce consultancy ZS Associates, noting that in building relationships the perception of value is key.

Deliver as much value as you like, but make sure the customer sees it. He says that as well as delivering NHS-focused solutions, you need to communicate the value of your offering or people will take it for granted. Our [pharma's] historical behaviour has given us a credibility issue so it's important that we don't just 'value shift' - ie, rather than make it generally 'better for everyone', we should focus on a target and help those who can recognise the value we add. The question is, has pharma got the imagination and persuasiveness to convince Primary Care Trusts (PCTs) of the value added throughout the chain?

The mass of influencers holding stakes in this new world of healthcare partnership includes individual GPs, nurses, pharmacists, PCTs, strategic health authorities, practice-based commissioning groups, NICE and others too. This throws up several additional challenges, however, not least because decisions made at PCT/hospital/practice-based commissioning levels are often poorly communicated internally, which means that it might not be enough for account managers to have forged partnerships with decision makersat one level in the NHS if that link is notconveyed down to those on the frontline, who also hold prescribing power.

Given this, the only realistic way to manage this, explains marketing solutions provider Dendrite, is to charge a team of people with discovering who belongs to each group, their respective level of influence, understanding their (sometimes conflicting) goals and know how best to position pharma firms and their products, to ensure they're prescribed in line with the overall marketing strategy.

The new breed of account managers needs to be skilled and trained in understanding that these groups will have different strategies and approaches to achieving their goals. Therefore, their own local tactics will need to adapt depending on what their specific client's needs are, comments Tiberio Catania, regional account director, at Dendrite Europe.

We are being tasked with identifying the networks that exist within the NHS, but the biggest problem is that these structures are new and evolving. Therefore, pharma firms which are quick off the mark to identify and strike up relationships with them will gain a competitive advantage and be in a better position to find where the 'win-win' is.

IMS Health's Skelton adds: As a rep, I may have a different message for the doctor than the nurse. Even around an individual product, the messages I'm giving to someone within a particular account must be varied. I have to know who I am talking to and have a good sense of their respective interests. Treatments such as smoking cessation and diabetes follow-ups are increasingly dealt with by practice nurses rather than doctors. Therefore, the rep may need a specific message for practice nurses about helping with patients' lifestyle changes, whereas for doctors they might give a different kind of message, about why the drug is more cost effective than another in the marketplace.

Defining the new epoch
This personal, multi-layered approach is where smaller companies could take the mantle, seizing an opportunity to get in early and take advantage of the inherent sluggishness that will initially impede bigger companies coming to terms with the sheer scale of the changes they will need to implement in creating a salesforce appropriate for the next new epoch.

Pfizer has revealed that its senior sales management will in the future be much closer to its customers, though the firm admitted recently that it is as yet unsure of exactly what the hailed 'win-win' relationship with the NHS will actually look like.

Director of sales operations, Phillip Watts, has given assurance that Pfizer is not giving up on selling through its primary care rep network. He added though that the firm had been guilty, like many others, of not having always listened to its customers and that looking forward account management is the way to go in the UK as it is the very best way to have excellent relationships.

Given the content of so many presentations during the EyeforPharma SFE summit, it seems to be accepted widely that the industry's next challenge is to redefine itself as a bespoke partner of the NHS, however it remains to be seen what specific form this hailed 'win-win' arrangement will ultimately take. Several pilot programmes are underway, but few companies have yet braved revealing their tactics. Most agree however that the next 12 months will see the start of something new and progressive in salesforce effectiveness. Our customers are people who need to be listened to and respected. It's not rocket science, but it is easy to say and difficult to do, Watts notes.

It was Mahatma Gandhi, by the way, in paragraph number one; admired best for making the world as people wished it to be.