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Large-scale NHS commissioning models require new partnership approach from pharma
Steve How, Paul Midgley and Sue Thomas, of Wilmington Healthcare, explore how pharma should respond to the NHS’s move towards more collaborative, joined up working
Introduction
As the NHS focuses on
larger scale commissioning, a number of Clinical Commissioning
Groups (CCGs) have recently merged or begun to share chief executives and
boards. Some of the mergers have been entered into voluntarily to help cut
costs and ultimately pave the way for the introduction of Accountable or Integrated
Care System (ACS/ICS) models; while others have been enforced to replace
failing CCGs.
In tandem with this, there have also been changes in the way that GP
surgeries are run with many of them now working collaboratively in networks or
hubs as outlined in the Next Steps on the
Five Year Forward View, published last year. Some GP practices are also
being run by trusts, rather than GPs.
CCG mergers
are a prelude to ICSs/ACSs
The newly merged CCGs are expected to be able to manage their population
budgets more effectively by pooling their resources. This, in turn, will
prepare for the introduction of ICSs/ACSs, which will see commissioning taking
place on an even larger scale, with one provider or group of providers
responsible for all the
healthcare needs of a defined population.
Working more collaboratively and cohesively will involve complex
agreements between the parties, particularly in areas where successful CCGs
have to take on the debts of failing ones. Controversially, it will also
generate significant savings through a reduction in back office staff, with
some areas being operated by a single commissioning team.
In total, NHS England has
given the green light for 18 CCGs to merge to create six new organisations in April
2018.
GP surgeries
join forces
In tandem with CCG mergers, GP practices
are also being encouraged
to combine forces and some are now working in ‘hubs’ or networks. This is
because a combined patient population of at least 30,000-50,000 people enables staff to come together as a complete
community – drawn from GP surgeries, community, mental health and acute trusts,
social care and the voluntary sector – to focus on local population needs and
provide care closer to patients’ homes.
There are various routes
to achieving this that are now underway and cover the majority of practices
across England; they include federations, ‘super-surgeries’, NAPC’s primary
care homes, and ‘multispecialty community providers’.
Interestingly, we are also seeing some GP practices being run by trusts rather
than GPs.
How will these
changes affect pharma?
Pharma needs to keep abreast of the rapidly evolving models
of NHS service delivery in different locations, as well as changes in prescribers.
For example, nurses are becoming increasingly involved in prescribing, while
some GPs are becoming less autonomous in this regard as a result of structural
and management changes in primary care, and a desire for many newly qualified
GPs to take on part time, salaried roles.
Increased financial and workforce pressures mean that care
management is becoming more evidence-based and protocol driven. We are also
seeing more ‘social prescribing’ with GPs referring patients to charities and
other non-clinical organisations to help tackle problems such as obesity,
depression and loneliness.
Delivering
optimal patient journeys – like those already defined by NHS RightCare for various
conditions – is key. Pharma needs to think across the
whole pathway to define where its medicines fit, how they can save money and
how they can be prescribed by different people.
With fewer decision points for prescribing, the days when
pharma needed big sales forces have gone. So too has the simplistic approach of
solely focusing on the benefits of a product and how it is priced against
competitors.
Instead, pharma needs to focus on partnership working to
enable it to become more embedded and integrated into the NHS. This style of
working requires a high degree of resourcefulness, as well as curiosity, about
what is happening within the NHS in specific locations, and what are the
implications across the whole pathway and population. For example, drugs
managing nocturnal urinary frequency in the frail and elderly may have a significant
impact on the Falls Services.
Market access and sales staff can glean useful insights into
local NHS developments by attending relevant board meetings, which they are
legally allowed to do - since these meetings are open to the public - provided
they do not discuss or promote their brand in any way. They could also undertake a high level of
specialist training in their therapy area so that they can engage at a peer to
peer level.
Conclusion
Collaboration is the name of the game as financial and staffing
pressures force CCGs and GP practices to work in new and innovative ways by
pooling their resources, assuming joint responsibility for finances and engaging
with new partners to take a more holistic approach to disease prevention and
management.
To succeed in this new, collaborative environment, pharma
must work in partnership with the NHS to define how its products can help the organisation
cut costs and add value across an entire care pathway. This involves a new and
resourceful approach that will see pharma representatives being willing and
able to gather as much information as possible about how local NHS and social
care providers are operating as well as becoming true experts in their own therapy
area.
Ends
Paul
Midgley is Director of NHS insight, Steve How is Business Development Director
and Sue Thomas is CEO of the Commissioning Excellence Directorate, all at
Wilmington Healthcare. For information on Wilmington Healthcare, log on to www.wilmingtonhealthcare.com
Contact
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United Kingdom
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