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Industry braced for new upheaval in primary care

Published on 08/09/05 at 12:19pm


Likely reductions in the number of PCTs could prove disruptive to pharmaceutical companies - but the development of another NHS reform could reinvigorate the role of medical reps.

Despite promises of no further large-scale NHS reconfiguration, the government has announced a review of PCT and Strategic Health Authority functions, which looks certain to slash numbers of both organisations, and alter their roles once again.

One NHS executive close to policy making predicts numbers will be cut to around 180 PCTs, a reduction of nearly 50% from the current total of 303.

The review of PCTs will be led by SHAs, who have been invited to create a more patient-led NHS which will include developing a greater variety of community-based services from a range of providers.

SHAs have until October 2006 to create these next generation PCTs, which must also deliver at least a 15% reduction in management and administrative costs.

The SHAs have, however, been given little time to put together their initial plans for the reconfiguration - just three months from its official announcement in late July to the deadline in October 2005.

Martin Anderson, director of commercial affairs at the ABPI said the changes will mean uncertainty for the industry - with the emergence of the new PCT models region by region a crucial factor.

"If a pharmaceutical company has a good relationship with a PCT which then merges with two other PCTs which are distrustful of pharma, then it could prove highly disruptive."

Anderson said a small but significant minority of trusts are closed shops to pharmaceutical companies, despite the best efforts of industry to forge mutually beneficial relationships.

But Anderson is generally optimistic  newly configured trusts could have improved capabilities and, in some cases, a more enlightened approach to prescribing new medicines.

"We know there are varying degrees to which current PCTs work with the pharma industry. We hope mergers will focus on sharing best practice and we believe this could be good for establishing better working relationships throughout primary care," said Anderson.

The changes are just the latest reshuffle in a health service which has been in a perpetual state of change since Labour came to power in 1997, and before.

Pharmaceutical companies have struggled to keep up with the changing face of the NHS and its constantly shifting priorities.

In July 2004, the UK's biggest pharma company Pfizer unveiled its new salesforce structure, re-constructed around the current PCT boundaries and introducing account managers to manage relationships with decision-makers in these areas.

Pfizer had anticipated the PCT mergers which now seem inevitable, and had built in flexibility to its model, but it and other companies will have to fundamentally re-evaluate their targeting once again.

Ironically, one policy which had not been anticipated was first floated in the same month as Pfizer announced its changes, but has now emerged as one of the main engines for change in the NHS.

Practice-based commissioning, (a modified revival of the Conservative's GP fundholding system), is now centre stage in the NHS agenda, and the government is determined to see the model adopted universally.

This is a significant shift in policy even from April this year, when take-up of Practice-based commissioning (PBC) was voluntary. Now the government says it wants PCTs to make sure there is 100% coverage by December 2006 at the latest.

It says individual practices will have the option to take on commissioning to a greater or lesser extent depending on their wishes and capabilities, but believes the policy is the best way to bring about a patient-centred service.

The initiative puts a great deal of decision-making power into the hands of GPs and other primary care professionals, reversing a swing away from them when PCTs were first launched.

The notable decision of Takeda in 2004 to dispense with its sales reps was partly based on the apparent diminishing importance of GPs - but their role now seems to be moving in an entirely new direction.

One industry expert predicts commissioning GPs will be increasingly interested in health economics and how a particular drug can save GP practices money.

He forecasts that pharma companies will have to introduce specialised functions, training its nurses and medical reps in health economics, as commissioning GPs demand information beyond the clinical value of drugs.

"The industry has always had difficulty in differentiating its message between PCTs and GPs," he said.

"Commissioning GPs will press pharma into shifting its message away from the clinical side towards the economic value of drugs," he added.

The current structure of SHAs will also be reviewed in a major public consultation on the future direction of primary care, the deadline for a decision on the strategic bodies to be November 2005. Not all stakeholders are convinced the NHS needs another major reorganisation. Niall Dickson, chief executive of think tank the King's Fund said the changes could 'derail' the reform agenda.

"It's well established that organisations entering periods of restructuring become less effective. Reorganisations are a clumsy reform tool and seldom deliver the promised goals they were set out to achieve," he said.  

"While we agree there is further scope for savings to be ploughed back into front-line services, this is the wrong time to impose structural change." 

He said PCTs also needed greater support in their commissioning role which required a much more coherent vision than the one provided by the government.

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