Providing training to the NHS: a learning curve for pharma too

pharmafile | December 18, 2007 | Feature | Sales and Marketing |  NHS, pharma, training 

It hardly needs to be said that each wave of NHS reorganisation has brought new challenges in terms of pharma marketing and sales. Where GPs once prescribed with few external checks, these days prescribing must be in line with protocols and formularies decided by networks of influence, with input from groups such as prescribing advisers, practice managers, pharmacists and nurses.

These networks can sometimes be difficult for pharma to work with, not least because the key individuals are extremely busy people who often hold down at least two jobs, and may be unenthusiastic about spending time with sales reps. Yet establishing relationships with these difficult-to-reach individuals is crucial, for under practice-based commissioning (PBC), there could effectively be a thousand different local formularies across the country for each disease area.

In circumstances like these, sales teams need every opportunity to identify the local pressure points and influencers – and so the hunt is on for new ways of building relationships.

One of the most promising ways, and one that can be conducted safely within the terms of the ABPI Code of Practice, is providing pharma-sponsored training and workshops for NHS staff.

As director of NHS education and learning at the National Health Intelligence Service (NHIS), Paul Midgley provides educational programmes aimed at both phama and the NHS, and has a lot of experience in how these initiatives can work. In helping PCTs, acute Trusts and PBC groups to develop, pharma can gain credibility and access to decision-makers at the crucial local level, he says.

"For pharma, training offers a way of getting to know people, and of learning about the networks of influence in each area. Is there a therapeutics or prescribing committee? Is there a service redesign coming up, is a protocol being written? It's only through spending time with people in a situation where they're keen to share some knowledge that you can get to understand this network."

The benefits must flow both ways, however. While building relationships and deepening local knowledge are perhaps the key benefits for pharma, real benefits for NHS staff should also be guaranteed.

Andrew Waiton, head of sales and marketing for The Excel Academy, the recently launched clinical arm of established training group Excel Comunications says: "What's being offered must tap into a recognised need. Market research clearly shows that many NHS staff dont receive management or communication skills training," he says. "Both primary and secondary care doctors do not benefit from the training that pharmaceutical company executives would take for granted."

Training is also attractive because the revised ABPI Code of Practice has introduced tougher restrictions on promotional activity. Waiton adds: "Because the ABPI Code has restricted what pharma companies can offer in other ways, many people have become much more interested in activities like training, not least because it can be a very targeted but also ethical means of NHS contact. The pharma companies have to be aware of what they can and cant do under the Code, but even the nervous companies seem to be happy with providing training."

Training on offer

Pharma-sponsored training can take many forms, and may be directed at general management skills or topics specific to the NHS. John Clare, MD of the well-known communications coaching and training company Lion's Den, does most of his work with pharma, and has been providing media and presentation skills for 15 years. He sees demand increasing in the newer, but equally as relevant, area of influencing.

A little training in this area can go a long way to achieve specific ends, says Clare, citing two examples of how this can happen. "A pharma company came to me after talking with a professional society in one of its key therapy areas. The company wanted to provide the members with some courses that were not about products – and not even about the relevant therapy area."

After some thought, the pharma company and Lion's Den agreed to offer workshops on influencing and presentation skills with this particular group.

During the workshops some great stories came up, says Clare. "We asked what kinds of decisions the doctors wanted to influence. One explained that his hospital had a pot of money that could either go on some high-tech care beds, or might be spent on a creche. There are no prizes for guessing that the specialists preferred to have the beds – and so we ran a course using examples that argued for the beds rather than a creche."

And again: "There was another example recently where we spent a morning on presentation skills with a trialist in a particular area. At lunchtime he asked us to stay on for the afternoon.

"He went on to explain that his department was in the running to be made a centre of excellence and that he was making the main presentation. Could we coach him through it? I said we'd be delighted to, and I'm glad to say that a few weeks later I had a note from him saying that his department had been awarded centre of excellence status."

At The Excel Academy, Waiton finds his most popular courses are on communications skills, including presentations, chairmanship and communicating and working with different types of personalities. However, he also runs influencing and negotiation skills workshops, leading teams and assertiveness, and reports that interviewing skills are often in demand from specialst registrars in pursuit of a consultant's post.

He argues that sponsored training initiatives can sometimes quickly repay the initial investment with benefits to patients and the NHS. "I've seen some great examples of how supporting a customer group with certain skills can lead to an excellent win-win situation. For example, a client of ours launched an expensive new product in primary care. In order to be able to use it, specialist nurses need to make a business case to their PCTs. So we worked with the client to develop some training around business case development and planning.

"The nurses who attended said that they'd never have had that sort of training from the NHS, and have now gone back to their PCTs where they will be using their new skills in a variety of ways, including making business cases for the products. The patients benefit, the nurses benefit and so does the PCT, as in the long term the products are more cost-effective."

At NHIS, Midgley finds his most popular courses and workshops are business-orientated rather than communications per se: leadership skills are seen as the most useful training activity, followed by negotiation skills, developing team working, business planning, writing business cases and understanding the Payment by Results tariff.

Midgley also reports that workshops on interpreting and understanding data covering patients movements through the NHS and the costs of treatment are very much in demand, as PBC commissioners consider which therapy areas need to be examined in which order of priority.

Skills for the new NHS

In fact, the question of how to run businesses within the NHS following its latest reorganisation provides some of the most interesting opportunities for workshops and training. Midgley quotes three examples of how industry-sponsored workshops have provided some excellent opportunities to make new friends and influence events.

"A major pharma company identified a newly merged PCT as a key area for prescribing for a COPD product – but knew its lines of communication with key decision makers were poor. Nevertheless, it also knew that there were poor or non-existent relationships across the new PCT, and that there was no interaction between the three PBC clusters within the PCT.

"The new PBC groups needed to be able to write business plans that the PCT would approve, so it made sense to get everyone into a room to develop the competence of the PBC groups. The company asked us to put together a two-day workshop on developing commissioning competencies with the aim of attracting about 20 attendees from various roles including medicines management, prescribing advisers, managers from the PCT involved in service redesign, lead GPs and practice managers from each of the PCT's three practice-based commissioning clusters, and a couple of project managers from the local acute trust.

"The company's staff didn't sit on the outside as sponsors, but participated in the course as delegates, and involved themselves in the discussions and small group work along with the NHS people.

"The programme included sessions on DH thinking on commissioning, leadership and other skills needed to develop each cluster, including commissioning and negotiation, governance and quality factors. There was also a session with a company customer who talked through a protocol they had developed that happened to mention the company's drug, along with others."

The company now has very free access to almost all of the people who attended the two-day workshop, says Midgley. "During the course, the NHS people started to see the company staff as competent and as people who were able to bring good ideas because of their networking with other people in similar roles in different parts of the country."

The sponsoring company also learned a lot about how the new organisation was shaping up, and could now be confident that the evidence they wanted to submit concerning the efficacy of their drug would be considered.

In another Trust, Midgley reports that a particular PBC group wanted to implement a service redesign that involved prescribing a particular drug in primary rather than secondary care.

The hook here was a workshop on negotiation skills: "Our role in this case was to get the PCT and PBC people to sit together in an educational forum to work on negotiation skills. We had six from the PCT and six from the PBC cluster to work together for a day on case studies in the disease area that the PBC cluster wanted to develop. One case was specifically around how the PCT would negotiate with their hospital colleagues to begin treating some patients in primary care that would previously have gone to the hospital.

"It worked out very well. The PCT people saw it simply as a day out of the office working on negotiation skills, but as well as encouraging the PCT to think about the issues involved in the negotiation, they heard the PBC group's arguments as well as improving negotiating skills across the board. Moreover, the PBC cluster people were able to spend a day with the PCT, when they had not previously been able to spend anything like that much time with them."

Even though some initial pump-priming investment was required, the PBC cluster's application was approved six months later. What's more, the local market for the drug in general practice is set to increase further as the other PBC groups in the area have agreed to adopt the same protocol.

The approach can be justified even at the level of individual practice level. Another case concerned a company which was keen to work with GP practices in a PBC cluster that was not using a particular drug, despite favourable local guidelines. So NHIS approached the local PCT board with a proposal to offer a series of training sessions for individual practices focusing on how to put together practice development plans incorporating the PCTs objectives. Midgley says the PCT was keen because it saw this as a way of making sure people in the practices really understood what they were being asked to do.

"It was quite a big investment, but it did mean company staff spent afternoons with each of the 10 key practices in the PBC group discussing current successes and future challenges, including the key areas for future development and drug needs. So the company helped to roll out the business plan of the PCT group, but also gained insight into the learning needs of the key practices and can now support further education through the year. It has cemented relationships and business understanding, and understands how prescribers work with protocols – or, in some cases, how prescribers don't work with protocols and simply ignore them."

Box: Tips for success

– Be patient and accept you won't always win: There is a chance that your target group will accept what you have to offer, but in the end won't put your product into the local guidelines. Also, although quick returns are sometimes possible, don't expect an immediate return on investment on every occasion. However, there can be measured deliverables, such as building relationships and getting products written into guidelines. If your organisation does not have the required patience, it might be better not to offer training.

– Bring in the staff: It's a great idea to bring company representatives in as delegates – so long as the subject is one where they can also benefit from the skills being taught.

– Maximise your chances: Make sure you have people in the group who are likely to advocate your product in the course of the event or in conversation.

– Bring local sales staff on board: Engage the full support of local reps and managers. Their enthusiastic involvement is essential for the success of the event, and they will be aware of target individuals interests and likely availability, and may be able to provide introductions. They can also say whether opposition to a product is so strong that a training or workshop exercise is not justified.

– Strength in depth: Customer relations are between people, so having established them, don't immediately undermine them by moving key staff. Recognising that some staff moves are probably inevitable, ensure the relationships you are building do not depend on a single person by involving several company staff members in each training event.

– Go for quality: It's painful to imagine what the fallout from a badly run course or workshop might be – it could certainly undo a lot of the good work that went into the initial organisation, and could even set you back further than you were before. There is a lot to be said for working with a training and workshop provider that can show attendees' evaluation sheets from previous events.

Gavin Atkin is a freelance medical and marketing writer and editor.

He can be contacted at gmatkin@gmail.com