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How can pharma engage with key stakeholders on NHS service transformation?
Steve How, Paul Midgley and Oli Hudson, of the Wilmington Healthcare consulting team, explain how pharma should make its case for change
Introduction
There is
a real drive for change within the NHS to ensure its sustainability in the
long-term. However, discussions and decisions about transformational change mostly
take place within the highest echelons of local NHS organisations.
When
transformation teams do engage with staff from other parts of the service, it
will generally be with small groups of clinical leaders; hence many ‘jobbing’ clinicians are left in
the dark about change until it occurs.
However, NHS
England’s ‘Planning, assuring and
delivering service change for patients’, which provides a good practice
guide for commissioners on the NHS England assurance process for major service
changes and reconfiguration, states that clinical engagement and approval, and
strong clinical evidence are key.
Assurance
for NHS management within this paper means: is there documented evidence that
the transformation process has looked at clinical best practice and engaged
relevant clinical stakeholders? If not, the clinicians have a route to
challenge the proposed changes.
Elements
of the guide can be applied to lower levels of change, such as the introduction
of new drugs to improve care pathways. This provides a powerful opportunity for
pharma to activate clinicians to take a lead in service change and engage with
other key stakeholders. It can also help pharma ensure that it fully understands
the tests and assurance checks that should be applied to new drugs and services.
Getting the message across to clinicians
Pharma
should keep clinicians abreast of transformational change that is happening in relevant
disease areas and make sure its customers are consulted on it. By ensuring
proposals are in line with the NHS England guidance and gathering as much
clinical, and ideally real world, evidence as possible about the benefits of a new
drug or service within the whole pathway, pharma can then demonstrate how it
could add value to the transformation process.
Clinicians
are very disease orientated, so for them the direct impact of a drug on
patients, such as its ability to reduce side effects, is the overriding
priority. However,
commissioners are service focussed and such benefits are unlikely to be
sufficient to convince commissioners to invest in a product since they are
under pressure to deliver on much wider priorities, such as reducing the burden
on A&E and on hospitals generally.
Pharma
can help this discussion by supporting clinicians in reframing clinical
benefits to highlight wider service benefits within the whole patient pathway,
even outside a specific disease area. For, example, they could show the current
cost and workforce implications of patients who do not tolerate current
treatments and potentially need appointments and reviews, versus the cost of
new treatments with better efficacy or side effect profiles.
NHS RightCare
provides examples of this with its long-term condition scenarios, such as ‘Susan’s
Story: Osteoporosis’, where costs are shown to be reduced by a factor of 10 if
Susan is treated within an optimal care pathway.
https://www.england.nhs.uk/rightcare/products/ltc/
Engaging with other key stakeholders
Having
the right evidence base and framing the right messages in the right way to the
right clinicians is a key step. However, pharma also needs to engage with other
key stakeholders involved in transformational change and ensure that its value
proposition is tailored according to local budgets and priorities as well as
national ones.
This
should involve developing messaging for the most senior NHS executives who are
potentially focussing on four to five priorities, such as reducing pressure on
A&E, the frail and elderly, or chaotic families. Industry should also
refine its proposition for transformation leads, medicines management staff and
other key opinion leaders (KOLs), who may have different drivers and
priorities.
It
should also be noted that in the 14 areas, which are early movers from STP to
ICS/ICPPs (Integrated Care Provider Partnerships), former low-mid ranking CCG
commissioners and project managers are transferring across to these new care
models. They are taking up roles such as service improvement manager within the
ICPPs; hence they are prime pharma targets as they are now working very closely
with clinical teams.
Facilitating engagement between key
stakeholders
There
is also a role for pharma to play in assisting transformation leads within the Integrated Care System,
or STP, to engage more widely
within the NHS, particularly clinicians, when planning and implementing
service change.
Networking
between transformation leads, commissioners, service development managers,
clinicians and patient representatives is vital and, if it is done well, it speeds
up conversations, enables shortcuts, and helps change to happen faster and be
shared more widely.
This is a
key area where pharma can step in and get its customers, e.g. consultants and
GPs, together to help them understand NHS transformation. Pharma could also offer
to help transformation leads bring relevant stakeholders, such as clinicians
and multi-service providers, together to better understand change and manage
pathways.
Conclusion
There is an opportunity for pharma to activate clinicians within service
change by making them aware of what is happening in their area and ensuring
they understand the benefits of a new drug or service from both their own and a
wider commissioning/transformation perspective.
Pharma
can also take a lead in facilitating discussions between clinicians,
transformation leads, medicines management staff and other key stakeholders/opinion
leaders to help them better understand each other’s needs and priorities, and to
ensure that proposals really will deliver the greatest possible value to the
NHS.
Steve How, Paul
Midgley and Oli Hudson are all part of Wilmington Healthcare’s consulting team.
For information on Wilmington Healthcare, log on to www.wilmingtonhealthcare.com
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