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How can pharma support NHS service change?
Steve How, Paul Midgley and Oli Hudson, of the Wilmington Healthcare Consulting Team, find some answers in NHS England guidance for commissioners
Introduction
NHS
England’s ‘Planning, assuring and delivering
service change for patients’, which was updated in March, provides a good
practice guide for commissioners on the NHS England assurance process for major
service changes and reconfiguration.
Many elements
of it, particularly the need for clinical engagement and approval, and strong
clinical evidence, can also be applied to lower levels of change, such as the
introduction of new drugs to improve care pathways.
Clinician involvement in service change
According
to the document, the Government’s four tests of service change are: strong
public and patient engagement; consistency with current and prospective need
for patient choice; clear clinical evidence base; and support for proposals
from clinical commissioners.
The
guidance makes it clear that front line clinicians affected by proposed changes
should be involved. It says clinicians should ‘determine and drive the case for
change, based on the best available evidence’.
It also
states: “Clinicians are powerful advocates and play an important role in
communicating the benefits of change to a wider community.” For complex change, it suggests that
commissioners should consider seeking Clinical Senate advice.
Although
clinical engagement currently happens at a micro
level,
with some commissioners taking leads from particular clinicians, it often gets overlooked
in transformational change involving multiple pathways and transformations. This
can, of course, lead to major problems further down the line if clinicians disagree
with it.
However,
although it makes sense for the staff involved in implementing service change
to be the people who ‘drive’ the original concept, front line clinicians and
clinical commissioners tend to have very different priorities.
Consequently,
clinicians often find it hard to make the case for a transformative product or
service because they do not understand the wider commissioning priorities and
are not able to couch their case for change in the right terms.
Equally,
commissioners can find it hard to win clinicians’ hearts and minds on change.
Why is assurance important for pharma?
If
transformation is happening within a service and it is affecting a relevant
product or disease and therapy area, pharma needs to understand the levels of
assurance required and ensure that local transformation agencies are aware of
them too.
To engage
with key stakeholders, pharma should highlight the relevance of its product in
the context of transformational change and show how it will enhance care
pathways in terms that will resonate with different audiences involved in
assurance.
Strong
evidence-based material will be essential for these conversations.
Pharma should ensure its proposals align with
current NHS best practice, such as NHS RightCare, which has defined optimal
patient journeys for various conditions.
If pharma
feels that assurance processes have not been followed, for example, with
regards to clinician involvement, it could challenge commissioners about their
clinical evidence base and the people they have consulted.
It could
also help clinicians who are concerned about service change, and feel they have
not been fully consulted, to gain a wider consensus of opinion among other
groups of clinicians and establish an evidence base.
Engaging with clinicians and other key
stakeholders
The fact
that clinicians are central to service change provides a golden opportunity for
industry to make its case for potentially transformative products and services.
Pharma
can educate clinicians about transformational change that is happening in their
area, the implications of it and why a potentially transformative new product
or service is needed from the clinician’s perspective.
It can
also enable clinicians to ‘drive’ service change by helping them to understand
transformation from the perspective of a commissioner who is likely to take a
much wider view on the improvements and cost-savings that change can bring to
other parts of the NHS, such as A&E.
Once
clinicians are on board, pharma should identify and engage with those involved
in commissioning and service transformation. Pharma should then define the
needs of those different groups and develop messaging for them. It could also support and help transformation leads, particularly at the micro
level, in getting wider consultation and ensuring that new products and
services are signed off at the right level and that clinicians fully understand
the need for change and are supportive of it.
Conclusion
The
assurance processes laid out by NHS England for commissioners provide useful
insights for pharma on why it should tailor its own approach to transformation
in line with NHS best practice, and the level and type of engagement required
to gain the necessary assurance.
This
engagement should range from educating a clinician about a product, or service
and helping them to drive change by understanding the wider transformation
picture, to liaising with commissioners and transformation leads to prove how a
proposal will be truly transformational.
Ends
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
Contact
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Address:
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United Kingdom
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