Close encounters with the NHS
pharmafile | August 6, 2007 | Feature | Research and Development, Sales and Marketing |Â Â NHS, healthcare, industry relations, pharmaÂ
Most marketers in the pharma industry understand the need to get alongside and talk to key people in the NHS and yet as an industry, we still haven't cracked it. Because we don't always fully understand why and how that investment in time, effort and resources can pay off, we are not always maximising the benefits of those communications channels.
Partly, of course, this is because pharma has always been driven by sales targets – in other words, short-term goals making an instant return. That has some validity, of course, given that it is a business like any other, and one which has seen its opportunities to reap return on significant investment truncated by various pressures. But there is a danger here. Thinking too much in the short-term, and not investing in building long-term relationships with key NHS customers, will have profound effects. So why isn't pharma doing it well enough yet?
Much has been written about the nature of the new NHS, and it's clear we simply have to accept that the NHS contains the bulk of our important customers in the UK. This means pharma has to build its relationships within the context of all that change, like it or not.
Understanding what is happening is the crucial first step to achieving that. As the number and types of customers grow, we must get a grip on this new plurality, and consider carefully just who the key people are that we should be talking to.
Traditionally, pharma has divided NHS customers into distinct groups of stakeholders, and targeted different messages for each group. GP teams spoke to GPs, hospital reps to hospital doctors, and for the more enlightened, NHS teams built relationships with non-prescribers. How well this separate bucket model has worked is open to debate, but what is unarguable is that in isolation, such an approach is no longer valid.
Joined-up marketing
Messages may still need to be tailored to the different audiences, but there is a fundamental requirement to understand customer needs, goals, priorities and beliefs in the context of the environment in which they are working. We can then approach the market in a joined-up manner, so all parts of the sales and marketing mix deliver a credible and consistent message. We should be considering our communications in the context of local health economies – this provides us with a more relevant perspective on what success could be like for the NHS and for pharma.
It's clearly nonsense for NHS teams to undertake market shaping or patient identification work if the sales reps continue the usual short-term policy of trying to capture as many patients as possible. Likewise, how in tune are we with the local health economy? And how much are we partnering the NHS if the hospital sales reps continue creating hospital discount schemes that clearly don't fit with the needs of the whole, local perspective?
Surely, we should be fitting our offer into the context of common health system goals? Pharma has to keep up with these, and make sure its communications are consistent across local health economies to ensure NHS needs are being met. Only then will we stand a chance of meeting our commercial objectives.
Communication with key NHS contacts will only be successful if we concentrate on customers' needs, goals and priorities. This means gaining an insight into what life is like within the NHS for these people, and, in particular, understanding the, sometimes contradictory, priorities they face. If pharma can start to understand what that feels like, and who and what are the major influencers and influences, then it will start to really understand the needs of its customers, whoever they might be.
What success looks like
The first thing to think about is exactly who the key stakeholders are and, crucially, how they fit in with each other. Alongside this, it's important to look at two things in parallel: establishing the needs, goals and priorities of stakeholders; and how these can fit with our own commercial objectives.
But, understanding what success looks like is not as simple as it perhaps once was. It's no longer about simply capturing short-term sales to meet targets against prescribers; today, it's about making sure that our long-term (commercial) objectives fit in with the needs of the whole local health economy.
Knowing what our customers' needs, goals and priorities are is the first step. We then need to establish what the desired behaviour change is and what must take place for this to happen. Once we understand that, we will know what the opportunities (and the barriers) are and, therefore, what capabilities are required to align our activity and communications.
It's no good simply looking at one part of the NHS, though. Increasingly, there is interplay between influencers, and not appreciating the impact of that interlinked influence can render our communication ineffective. Perhaps the biggest change of all in the NHS is that interlinking of influence on prescribing decisions – which means it's important to look at the whole picture.
Only with this level of understanding is it possible to think about how to build effective and consistent communications with the NHS. Success is about building genuine partnerships with specific health economies more than merely with prescribing individuals. This requires an account-based focus where we align goals, agree the appropriate patient and consistently communicate to all stakeholders.
The word partnership is defined by some NHS people in a different way to how you or I might define it. In general, NHS people view partnerships, especially with the pharma industry, as being one-sided. It is possible to find genuine partnerships, but only where all concerned are truly going for the same goal.
You simply can't claim that you are partnering the NHS if your reps are pulling sales through inappropriately. Instead, you have to create a situation where you are helping to shape the environment alongside your key NHS partners – and you will then find your reps are pulling through appropriate patients. But that means, in many cases, a fundamental change in thinking.
A shift in thinking
Just as reps are going to have to think more strategically, it's fair to say that NHS teams are going to have to start thinking more commercially. The new NHS is a world of increased transparency, so we can't and, indeed, shouldn't seek to hide why we are here as an industry. Provided we can convince our customers that our commercial objectives are in line with their own health and health economics objectives, that shouldn't be a problem, although this will require a cultural shift from both sides.
That shift in thinking requires us to consider all the appropriate stakeholders in an environment, and that means waking up and thinking about how we're viewing the customer, who they are, and what the joint objective is. And that can only happen in an atmosphere of openness and frankness, especially given that there is genuine scepticism on the NHS side, based mainly on their experiences of pharmaceutical companies pulling them in different directions in the past. (Let's not ignore the fact there is a degree of scepticism on the pharma side as well. If we don't overcome this, we have no chance of aligning ourselves with our customers' objectives.)
But we mustn't kid ourselves here: while there may be some scepticism about all business within the public sector, it reaches a peak in the way the NHS views pharma, based on previous, behaviours and relationships. Moving forward, we need to adopt a more contractual approach – perhaps the word compact, a popular concept in the public sector environment, suggesting a consensual and mutually beneficial statement of intent, is appropriate.
But these days, it's no longer simply about doctors having all the power to write prescriptions. That this needs saying in 2007 is in itself an indictment of our industry's slowness in embracing change. It's true that doctors continue to be extremely important in the equation, but many companies are still struggling to understand the fact that they have to account for the needs of all the customers that impact a prescription – although to be fair, some have radicalised their approach, and some are looking at completely different models of provision.
Finding a common goal
Of course, let's not lose sight of the fact that the pharma industry needs to pull through sales in order to survive, and indeed to provide investment for research and development for future therapies. Ultimately, the aim of building better communications and long-term relationships is needed to pull through sales, but what has changed is that those sales need to be appropriate, both for the pharma company and for local health economies (or accounts).
Having established exactly who the customer(s) is/are in the new NHS, what their needs are, and what needs to happen for them to change their behaviour, we now have to engage with these key stakeholders as soon as possible.
Building a clear and transparent relationship means putting your cards on the table about your own objectives to try to find exactly what your goals have in common. If you can genuinely work together to identify and prioritise those goals, then you are in a position to capture those appropriate patients.
The appropriate patient
I mentioned that a new thinking had to be brought about across all teams in pharma, and that includes the sales teams, who still have a role to play in all of this. Once common goals have been identified, both GP sales teams and hospital sales teams can work with individual doctors to help them identify patients who are best suited for treatment. Getting the right patient on the right drug is high on the list of the industry's objectives, just as much as it should be on the NHS's agenda.
Helping clinicians identify the appropriate patient is not dissimilar to the challenge we have always faced in pharma sales and marketing. What this different approach does is recognise the constraints and pressures facing GPs to consider the whole population needs, as well as the individual patient, which may influence the messages we may need to deliver. It requires us to maintain a consistency of approach in helping all stakeholders understand the right patient with a rationale that accounts for their clinical and role-based needs. The same marketing principles still apply here that if we do not position our brands, then our customers (or our competitors) will do it for us.
Another key advantage of this approach is that it becomes something more than selling products post-launch. If you can engage with the NHS and understand its needs, you can engage with people much earlier on in the process, and well before launch. This means you can make sure that trial designs meet actual NHS needs, which in turn, will lead to a greater chance of success of the launch itself, with your customers' needs met, and your USP based on real, rather than assumed, customer requirements.
Meeting objectives
Building effective communications and strong relationships within the NHS is not simply about adapting to a new environment – it is much more than this. It's about a significant cultural shift, for the industry and for the NHS. We need to develop relationships that allow honest and transparent debate in order to align objectives.
The NHS is rapidly identifying the patient who would be most appropriate for our brands, so we must work together, engage early and help them identify the appropriate patients that allow the NHS to hit its objectives and pharma to meet its commercial objectives. In order to do this, we require deeper insight into the needs, goals, priorities and drivers across local health economies (accounts) and consistent communication with all customers within them.
Get this right, and you can build a significant competitive superiority and what company wouldn't put that high on their list of priorities?
Jon Bircher is a Senior Consultant at The MSI Consultancy. E-mail: jbircher@msi.co.uk; or visit: www.msi.co.uk.
Related Content
A community-first future: which pathways will get us there?
In the final Gateway to Local Adoption article of 2025, Visions4Health caught up with Julian …
The Pharma Files: with Dr Ewen Cameron, Chief Executive of West Suffolk NHS Foundation Trust
Pharmafile chats with Dr Ewen Cameron, Chief Executive of West Suffolk NHS Foundation Trust, about …
Is this an Oppenheimer moment for the life sciences industry?
By Sabina Syed, Managing Director at Visions4Health In the history of science, few initiatives demonstrate …
