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Waving not drowning: tackling NHS reform

Published on 18/09/06 at 04:28pm

New NHS initiatives, restructuring plans and government health policies seem to be announced and introduced on a never-ending basis, with practice-based commissioning (PBC) just the latest in a very long line of initiatives.

Pharma is quick to jump on these changes to start planning how to meet what is seen as a continuous bombardment of new challenges, but there is a danger of over-reaction by the industry to individual initiatives. This leads to several problems: how do we decide how relevant each of these changes is in relation to the successful marketing of our products; how do we keep abreast of and interpret these complex policies and initiatives as well as doing our jobs; how do we forecast the relevance of our businesses to each of these changes; and who are the people we should be talking to?

In reality, pharma needs to look at the bigger, more long-term picture, instead of simply reacting to individual headlines and initiatives in the NHS. This more strategic and considered approach has never been more called-for, with the advent of what, at first, seems to be a completely new structure to deliver primary care (or at least a reinvention of a previous structure).  

So, what should we be doing to make our marketing as effective as possible within the ever-changing NHS?

Meet the challenge

The biggest challenge to pharmaceutical marketers is to look beyond the individual policies that are initiated, to avoid immediately latching onto them as the next big thing, and then try to identify the drivers behind each of them and, consequently, the real changes that will roll out from these initiatives. These individual policy changes and initiatives need to be seen as part of the much bigger and longer-term picture of change within the NHS.

Rather than getting weighed down with understanding each policy in minute detail, which can be both time consuming and confusing for most marketers, the most important thing we need to understand is the direction of travel of the NHS, the main goals of which are to improve quality and efficiency within the NHS system and contain costs. These are the central goals that are being facilitated in many of the changes within the overall system.

For some time, the NHS has been moving towards the creation of a more businesslike image. Policies and reforms, such as NICE guidance, the GMS contract and PBC, support the overall ethos of the NHS as an efficient business, providing quality care in a cost-effective way, with the power base shifting from individual practitioners to a strategic business model.

These changes are not solely politically led; at the centre of them all is the patient. It is these empowered patients who will help drive policies forwards because of their desire to be involved in decision making and their preference to have their care managed in their own community.

Pharma, therefore, needs to clearly understand the motivations behind these changes and how the different policies are all manoeuvring the NHS towards this ideal model. There are core levers which help drive this direction of travel, but it should be remembered that different policies will quite often influence more than one lever.

The capacity for the NHS to treat increasing numbers of patients is one of the key levers. In an ideal world, everyone who needed treatment would be able to have it when and where they needed it. Policies which help to increase the capacity of the NHS include giving greater power to pharmacists and nurses, which shifts the total responsibility for prescribing away from the GP. This makes more financial sense; it allows expensive GP resources to be targeted on the more complex and skilled diagnosis of patients, while still achieving treatment goals.  In theory, higher patient numbers can, therefore, be managed.

Improving quality while saving money

Quality of care and, of course, the safety of patients is of paramount importance.  Payment by results (PBR) is a policy example which helps to highlight the important issues in hospitals to ensure they have the right focus. The pharmacy contract also ensures the quality and safety of prescribing by another group of healthcare professionals, working together to achieve this goal.

One of the main service redesigns for the NHS is to move the management of patients from secondary into primary care wherever possible. This should not only improve quality of care (patients prefer to be treated in the community), but should also provide cost savings. Examples of initiatives to support this key lever are practice-based commissioning (PBC), the GMS contract and GPs with special interest.   

Electronic patient record systems, the improvement of disease coding and the use of private companies to tender for certain services traditionally provided within the NHS system are all ways which are being explored to maximise efficiency, quality and cost containment. These new, innovative ways of working support the overall move towards viewing the NHS as a business.

Even seemingly conflicting policies, however, work completely hand-in-hand with each other e.g. PBC and PBR. On the one hand, PBC encourages treatment of patients in the community, rather than in hospitals, with GPs providing services that were traditionally only available in secondary care by hospital specialists. On the other hand, PBR has been set up to encourage hospitals to provide better quality and efficiency within a set tariff price. With patients potentially able to choose where they have their treatments and the more successful hospitals receiving financial incentives for treating more patients, PBR encourages good hospitals to increase their capacity and funding.  

These seemingly competitive policies need to counterbalance each other. The simpler services should be moved out of hospitals into the community, releasing more time and money for hospitals to deal with more serious conditions. The PCT should provide the overall framework for the balance of these services within given geographical areas and the competitiveness between primary and secondary care will drive up the quality and efficiency of the services each can offer.  Patients benefit from these improvements in terms of availability and quality of services, and the choice of where to receive them.

It is, therefore, essential that both pharma companies and brand teams move away from looking at the individual policies and begin to look at the overriding direction of travel. Initiatives and policies do not stand on their own, but are part of the overall bigger plan for reform, to improve standards within the NHS.

Embracing change

Pharma now needs to view and act on the changes within the health service at both a corporate and a brand level in order to be successful in the long-term.  

Corporately, we need to build business-to-business case models as the NHS becomes more business minded. Simply talking to individual prescribers and the new influencers and stakeholders who influence prescribing about individual products is not going to work in the future.  

Many companies are still battling to understand what the interaction should be with these new and different customers. Large companies such as Pfizer, GSK and Sanofi-Aventis, have all recognised the indisputable fact that selling single products to individuals is no longer the way forward.

Consequently, all these companies have built organisational structures which recognise other types of influencers (knowing they cannot simply translate the traditional sales force model).

Looking outside pharma, the most logical and appropriate business-to-business model that pharma could utilise appears to be one which is account-based, and a total account management approach may be the flexible model that the pharma industry needs to consider in order to be successful.

Takeda UK is an example of a company which has recognised this and changed its model. Its innovative approach was to use a regional account director (RAD) model, where the RADs have regional budgets which can be adapted and changed according to their NHS accounts. One account might be all about tendering the total portfolio of products, while another may be about commissioning nurses or employing a much more traditional sales force.

Takeda has challenged the traditional way of looking at things. In the short-term, it is difficult to conclude if this approach has been successful; however, in the long-term, the results are of great interest to the pharma industry.

Brand teamwork

A brand team approach is still extremely important. Brand managers are the people who best understand the various brands and therapeutic areas within a company. We need to understand the challenges of our individual brands in the NHS context: what are the key issues, the opportunities, and where are the big blockages to prescribing?  

When new policies are launched, we need to think rationally about where they fit within what the NHS is trying to achieve overall and then understand the potential impact on our brand and therapeutic area. If we can understand where these policies create opportunities and blockages within our patient flow, we can then target the priority areas for success by identifying the major challenges, the influencers (individuals, organisations or policies) and what we need to do to drive our business forward.  

For example, we may have identified through our patient flow that of the total number of patients presenting with a particular disease in primary care, only 30% get a clinical diagnosis from their doctor. If this is key to making our brand successful, then it is more important to understand all the issues, influencers and blockages at this point in our patient flow, than understand the complexities and changes within the overall NHS.  

The ability to understand these key drivers and their implications should allow you to be more effective with your time and focus on the things that are critical to the success of your brand.  This may affect your whole marketing, planning and implementation process. So, for example, when building a segmentation model, we can no longer concentrate solely on our customers' treatment needs, we also need to consider the impact of other influencers, stakeholders (or policies) on their prescribing decisions.

Only then can we consider how to develop our value proposition and the offering to each of the relevant stakeholder segments so that it meets their needs and priorities. This also helps achieve objectives, rather than just promoting the brand and its messages in the traditional way.  

Thinking outside the box

So, where could this potentially go in the future, what could it look like and what do we need to do to have a successful future for our brands?

First, we need to ensure that we do not simply react to the headlines, but should be watching the long-term view. We must remember that the policy names may change, but the direction of travel is going to remain. So, let's take a step back and consider which NHS changes are relevant to our brands; which can we work with to give our brand leverage?

A patient-centred NHS is set to remain and the goals for improving efficiency, quality and cost containment will continue to be at the core of the changes. Pharma needs to think broadly and be open-minded towards what might happen within the NHS in the not-so-distant future; e.g. patients carrying credits in order to access different parts of the NHS, or outsourcing more NHS services to private companies.

Of course, healthcare professionals will continue to be of paramount importance, but their prescribing freedom might be reduced. Doctors will diagnose and make recommendations, but nurses and pharmacists will become more involved in the prescribing process and the ongoing care of patients.  

Consolidation and mergers are happening in the pharma industry and the same is happening in the NHS - think of the recent reduction in the number of PCTs. This could continue, which will mean far fewer accounts for us to see. In this case, tendering and building a business case for our whole portfolio of products might be the way forward.  

To sum up, to move forward we need to think outside the box of traditional salesforce-based marketing. Acting on and embracing the changes relevant to our business as creatively as possible, could be the key to guaranteeing the future success for our companies and for our brands.


Jon Bircher is a consultant at The MSI Consultancy. He can be contacted at

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