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The perfect blend

Pharma reps of the future will need the right mix of skills combined with in-depth training to produce the goods

For pharmaceutical companies, engaging with the NHS used to be relatively straightforward. Medical sales reps touted their wares to GPs, with varying degrees of success. In today's new NHS, however, the situation is much more challenging.

Back in the 1970s, pharma sales reps were 'detail men'; they spent more time giving details to doctors about their medicines than on the hard sell. This indirect sales strategy led to doctors prescribing more and, ultimately, to greater sales.

Although the industry's practice of detailing has not changed much in 30 years, the look and role of these reps is very different now. Today's pharma reps face far greater challenges than their predecessors. They used to spend years building close relationships with doctors - today's rep can have as little as 90 seconds to make a pitch to a doctor.

Though often highly educated and skilled salespeople, pharma reps face impervious doctors, tougher guidelines on physician interactions and fierce competition from hordes of rivals. Fewer new drugs are appearing on the market for them to sell and, as drug companies face competition from generic manufacturers whenever a patent expires on their best-sellers, there is pressure on them to boost sales.

One only has to look at the complex issues facing pharma directors considering how to allocate their resources between traditional reps and the newer breed of healthcare development manager (key account managers) in the new NHS to understand that they face a confusing market.

The factors holding them back are many and complex. Strategic decisions are difficult in the varied health service environment, the approach to NHS customers must differ depending on their status and multiple strategies should be implemented in a controlled manner. Furthermore, the measurement of NHS engagement is currently subjective, or inappropriate.

Spice of life
Before we address the challenges facing pharma directors with responsibility for resource allocation between sales and NHS development, it's worth taking a quick look at the history of the relationship between pharma and the NHS; specifically, the types of sales professional that have been employed by pharma companies.

It should be noted, for instance, that the increasingly complex sales picture, outlined here, belies the fact that, for the last few years recruitment to the sales and marketing teams of pharma companies has been on the up. According to the Association of the British Pharmaceutical Industry, there are 10,000 sales reps working in Britain today, compared with 8,000 five years ago.

Despite, or perhaps because of this growth, selling pharma products has always been one of the toughest sales jobs around. The healthcare industry is a highly regulated sales environment and the primary buyers of the traditional sales rep's products - GPs and hospital doctors - are one of the most well-informed and difficult groups of consumers to influence.

They have little time, both literally and figuratively, for pharma reps, and even when the sales rep has negotiated an appointment, their next task is to convince a busy GP to change entrenched prescribing habits.

Different flavour
Prescribing is also now a more complex field. Decisions about which drugs to prescribe are being guided increasingly by the structural make-up of the local NHS. GPs are coming under increasing influence from Primary Care Trusts (PCTs) and other formal and informal networks springing up around particular disease areas. The response of the pharmaceutical industry has been to introduce healthcare development managers to work alongside the more traditional rep.

These key account managers aim to build different relationships from their sales rep counterparts. Pharmaceutical companies recognise the opportunities for product promotion through direct access to staff, and are seeking to promote further developments in training and influencing prescribers; in particular, the `new prescribers' (ie, nurses and prescribing pharmacists).

As such, healthcare development managers are required to build multiple relationships inside and outside the medical profession, with pharmacists, committees at hospitals and Primary Care Organisation (PCO) management boards. They also need different skills, such as expertise in pharmacoeconomics, to explain why their drug will save the health service money in the long term.

The reality of marketing and selling pharmaceutical products is that most sales resource is devoted to the promotion of established products. This is the area where we should expect the greatest degree of change in the future.

The NHS has become a less friendly customer in recent years, with local PCOs making more decisions about which class of drug should be used to treat particular illnesses. Product price, effectiveness and added-value services will all play a part - and it is immediately clear that this kind of marketing will need different sales skills to those needed to speak to individual GPs.

Influencing skills need to be augmented by much better objective technical knowledge, and liaison teams now need to perform more marketing and support services, and think in terms of the present and potential future needs of the PCO.

Healthcare development managers need to think of themselves as solution providers, rather than drug sellers: in other words, they need to be able to offer a range of value-added services. This is easy to say, however, but difficult to achieve in practice.

The pharmaceutical industry needs to do much more to engage with the NHS, but has not often been terribly good at emphasising the right sort of behaviours to do that.

The teams of NHS development or liaison managers who are usually tasked with driving the company's NHS relations forwards do have a sales agenda, but often find it difficult to translate that agenda into the right kind of behaviour. This makes sense when you look at the type of pharma professional who is likely to become a liaison or development manager. These are more often than not ex-sales reps - highly experienced people - but also people who are more used to dealing with doctors and nurses, than planners and commissioners.

Similarly, for the pharmaceutical company itself, delivering and measuring success through the deployment of NHS development teams is more complicated than managing teams of sales reps. Selling to GPs may be difficult due to the nature of the target audience, but, with a single prescriber, success is relatively straightforward to measure and, as such, it is much easier to analyse which areas of the business are performing and which are not.

It's much harder to allocate resource to, and measure the effectiveness of sales and marketing efforts when NHS development teams are focusing on building fruitful, long-term relationships, rather than just trying to hit sales targets.

Furthermore, the ethos of new prescribers muddies the waters significantly for NHS development teams. Decision-making processes are more complex and the range of influencers is much wider. So how do you measure success?

The right ingredients
It's not just a question of hitting objectives - even setting the right objectives is a significant challenge in itself. Pharmaceutical companies that want to employ effective liaison teams need to spend a great deal of time and effort defining what those teams should do and how they should do it. A business development plan needs to have a very tight focus on reporting to give the team any chance of delivering against measurable objectives.

Setting objectives and tracking performance against these is crucial to the success of the healthcare team's efforts, but it seems that, in many pharma companies, NHS development managers do not always have the support they need to do the job they're trying to do. Recruiters to these types of roles are often not explicit enough about the job and what it involves.

Delivering at a healthcare team level depends on operating effectively in a b2b environment, rather than the b2c environment of selling to one GP at a time, which sales reps are used to. NHS development managers also now have to cope with the challenging task of selling to numerous local customers. There will be an increasing opportunity for them to bring offerings to customers that build upon their own expertise of business and business models - information handling, supply chain management, performance management and so on. The NHS is going to be hungry for those techniques which it has often previously ignored.

Never has it been more clear that pharma companies need to devote more of their sales budget to engaging with local organisations and networks that make up the local health economy of the individual GP. The healthcare development team, recruited and managed effectively, will provide the platform to sales success in the NHS of 2007 and beyond.

If your aim is to develop your pharma salesforce to meet these new challenges, you need to win their hearts and minds, otherwise, they won't change their behaviour, they won't buy into the development programme and, just days after the training platform you have chosen to roll out has ended, they will revert to their previous behaviour.

Effective sales training works on the principle that you cannot create changes in performance simply by changing the process - you have to change the team's behaviour.

To motivate the salesforce, pharma providers should employ objective assessments to awaken personal ambition. Statistical analysis can show where salespeople are weak, which areas need to be improved and what steps need to be taken to ensure that each salesperson, sales team and business unit meets or exceeds the targets set for them.

Indeed, there is a direct correlation between the development of sales skills and increased revenues and commission. Training teams should also look to work with the sales manager, showing them what the sales team is capable of and supplying objective, concrete evidence that can be used to challenge their salespeople to improve performance.

The author
Russell Ward is chief executive officer at Silent Edge (

2nd September 2008


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