The evolution of the NHS in 2007
pharmafile | February 5, 2007 | Feature | Sales and Marketing |Â Â NHS, sales, strategyÂ
The NHS will undergo major reorganisation in 2007, just as it has in the nine preceding years of Labour's tenure. What will differ this year is the extent of the financial rigour demanded of trusts, in preparation for a slowdown in NHS funding increases after 2008.
In order to bring about faster and more fundamental reform of services, and oversee greater financial control, senior roles in the new strategic health authorities and primary care trusts are now being redesigned.
So just what are the responsibilities of the organisations and who are the new influencers likely to be? Finally, how will the changes affect the activities of the pharmaceutical industry?
The main influencer groups remain more or less the same – strategic health authorities, primary care trusts, professional executive committees, groups and local authorities, with practice-based commissioning increasing the importance of general practice. However their relative roles and responsibilities will undergo significant change.
Putting plans into action
Following reconfiguration in July 2006, there are now 10 strategic health authorities, which manage the NHS at a local level on behalf of the Secretary of State. As the name suggests, these health authorities have a strategic role, in developing plans for improving health services in their area and making sure local services are both of a high quality and performing well.
The authorities are also charged with increasing the capacity of local trusts to provide more services, and to make sure national priorities, such as improving cancer services, are integrated into local health service plans
The aim is for each SHA to develop its own management structure to meet the particular needs of the population it serves, as well as ensuring the delivery of national and local priorities. SHAs will need to focus on the performance management of PCTs and non-foundation trusts; the regulation of the local commissioning arrangements; developing local systems to improve efficiency and value for money; and ensuring adequate representation for patients and the public
For the pharmaceutical industry, the next few months will best be described as keeping a watching brief as the new SHAs start to more clearly define their leadership function within the local NHS.
But companies with products likely to be commissioned by specialised commissioners, such as HIV products, may need to be involved sooner rather than later as SHAs guide the newly formed specialised commissioning groups.
The NHS nuts and bolts
The boards of the new PCTs will be comprised of a chairman, chief executive, seven non-executive directors and up to six executive directors, who are likely to include heads of finance, commissioning, operations, performance, planning, human resources, information management and technology, and corporate affairs. The guidance also states that medical directors and directors of public health are to remain on existing arrangements and, hence, it can be assumed that these roles will also feature on the new PCT boards.
All the new PCTs will be subject to a fitness for purpose review that will look at a range of functions, including finance, strategy, quality, governance, external relations and emergency planning. A second assessment will review the commissioning capability of the PCT and will focus on a variety of areas.
In order to successfully complete these reviews, PCTs will have to focus the deployment of staff into these key areas. This means there is likely to be an increase in the number of staff focusing on the commissioning of services from a range of providers and others monitoring the quality of care delivered, such as the development and improvement of care pathways.
This will require a new skill set for those pharma industry personnel who call on PCTs. They will have to engage with commissioners and service improvement leads, and the pharma personnel will need good account management skills, and be able to see beyond individual customers or organisations to identify and build links between different parts of the local health economy.
This way, pharma's frontline can work in partnership with PCT leads to help them develop and deliver new care pathways.
Selling skills will also be needed to identify where the benefits of a product portfolio align to the needs of the PCT, which is then made aware of these. In addition, facilitation skills will also be useful to help bring together local stakeholders and support them through change in areas of mutual interest.
If pharma can communicate effectively, it will help promote the locally made changes to those most affected by them and will ensure that any contribution by pharma personnel is fully recognised as true partnership working.
The more traditional customers of pharmaceutical advisers and public health will still remain, albeit in smaller numbers, but with a more strategic view, and it is possible that a large proportion of the current pharmaceutical advice will be re-deployed down to practice-based commissioning groups/clusters.
Co-ordination and advice
New developments such as the strengthened commissioning role of PCTs and the development of practice-based commissioning will inevitably mean that the role of the professional executive committee (PEC) will also have to change.
The NHS Alliance recently identified the likely new roles of the revised PEC, which it suggests could be called the Clinical Executive. The role of the new PEC must clearly be aligned to the responsibilities of the PCT and the membership of the new PECs must represent all professional groups including nurses, allied health professionals, pharmacists and others, and should not be too GP-focused. Continuity of PEC membership will be essential to allow the new PCTs to be organisations with a memory and active from the start.
For the pharma industry, the new PECs will be a key group of customers to initially identify and understand what their role and priorities are. As PCTs take on a strengthened commissioning role, they will require strong clinical input to ensure that services are commissioned to meet the needs of their population. This input will come from the PEC, and therefore, if your products or services are able to help meet the identified needs of the local population, PEC members should be your first port of call to ensure they understand what you are able to offer.
Needs versus costs
Recent guidance from the Department of Health further clarifies the support PCTs are expected to give to support the development of PBC. This includes providing information and budgets, assessing public health needs, analysing cost-effectiveness of interventions, and putting in place training and development for practices.
There can be two levels of service provision against which services for a single practice population and services provided to a wider population will be considered. In addition, PCTs will be able to provide loans to develop services re-provided from secondary care settings.
This means the traditional relationship between individual practices and local representatives will still be an extremely important one within the context of PBC. Individual practices can still develop services solely for their registered population, and this may provide opportunities for partnerships with the pharmaceutical industry. In order to identify the possibilities at this level, local representatives will need to access to each practices PBC plan and review it.
At a PBC group/cluster level, there will be a PBC GP lead and they will be another key customer group to identify and engage with. PCTs will also have a lead manager charged with managing the implementation of PBC who, again, will be an important contact.
Let the people speak
In July 2006, the DoH published A Stronger Local Voice which sets out formal methods of involving patients and the public in local decisions. The Commission for Patient and Public Involvement in Health (CPPIH) and patient forums will be abolished and local involvement networks (LINKS) will be established for every local authority area with social services responsibilities. LINks are intended to strengthen and widen the way in which people's views are gathered, listened to and taken account of when health and social care services are planned, developed and commissioned.
LINKS will have specific relationships with overview and scrutiny committees (OSCs) and will have the power to refer matters to the OSCs. These will, in turn, be asked to focus on the work of the local commissioners and health and social care services and ensure they reflect the health needs of local populations. PCTs will also have a more explicit role in responding to what patients and the public have said.
This means that for the pharma industry, there is an even more complex system of influence on the services that will be commissioned. There may be opportunities for pharma to influence the local discussions by highlighting inequalities in the local services that may be impacting negatively on access to your products.
Major changes ahead
The coming year will see changes in the matrix of influence at every level of local health economy, and pharma reps need to track these changes and respond accordingly.
At a practice level, the key documents to access are local PBC plans and review them for opportunities for partnership working, either at an individual practice or PBC cluster level. At a PCT level, opportunities will exist to engage in service redesign projects that will need to include clinical treatment guidelines, and it is at this point that the opportunity to sell the benefits of your products and services will occur. To achieve this opportunity, however, input and support must be given during all parts of the service redesign to retain credibility.
The opportunities at SHA and local authority level may be less obvious, but it will still be important to watch these organisations as their sphere of influence becomes clearer over the next year or so.
A Case in Point: South West Strategic Health Authority
South West SHA has been formed from the merger of three existing smaller SHAs – Avon Gloucestershire & Wiltshire, Dorset & Somerset and South West Peninsula.
The former Dorset & Somerset SHA has taken the lead in a number of respects; its Yeovil location chosen as the new joint headquarters, and its former leader Sir Ian Carruthers (who also served as interim head for the whole NHS) appointed as chief executive.
As in other areas, South West authorities with large deficits (Avon, Gloucestershire and Wiltshire SHA) have been merged with their neighbours which were in balance (e.g. Dorset & Somerset SHA) with the hope that the more successful leaders can eliminate these inherited financial problems. Ian Tipney, former finance head at Dorset & Somerset, has been appointed as interim director of finance and commissioning at the new merged SHA.
Commissioning of specialist services is under review nationally, but is likely to be led by PCTs working as a specialist commissioning group within the region, and overseen by the SHA.
Another crucial SHA post is Director of Workforce Development, held by Thelma Holland. The new SHA needs to help PCTs and other trusts get the balance right in personnel developing staff and re-designing services while simulataneously cutting costs. Nearly 1,800 posts were lost in the South West NHS between Jan and Oct 2006 a fairly typical level for areas across England, though the actual number of redundancies was less than 150 over the same period.
Finally, arrangements will be put in place to enable leadership and advice to the SHA, as required, from senior clinicians across the South West area.
Andrew Platten, MSc, MRPharms, Dipm, MCIM is a Director at HGSConsultancy Limited, specialists in market access and NHS alignment. For more information e-mail: andrew.platten@hgsconsultancy.co.uk
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