The NHS and pharma: Let’s work together
pharmafile | August 13, 2007 | Feature | Research and Development, Sales and Marketing |Â Â NHS, healthcare, industry relations, joint working, pharmaÂ
In the last 10 years, pharma’s relationship with the NHS has undergone a transformation. For one thing, it’s difficult now to remember how, even in the mid-90s, the DH still issued occasional letters discouraging joint working between health authorities and the pharmaceutical industry.
Today, that arm’s-length approach is long forgotten in Whitehall. Policy documents, including the joint NHS-ABPI report, Developing Partnership between Industry and the NHS in the UK, and the NHS Framework for Procuring External Support for Commissioners, have dramatically changed the climate for joint working with pharma and private firms in general.
A new breed of consultant
Conditions are said to be more favourable for industry-NHS collaborations than at any time in NHS history, and a new breed of joint working consultant has begun to appear to broker the sometimes difficult relationship between pharma company and NHS Trust, such as Angela Macfarlane of HGS Consultancy. She has been as close to the changes of recent years as anyone. After a spell in pharmaceutical marketing, she ran a private hospital providing services to the NHS in the North West of England for four years.
She says: “I felt the pharmaceutical industry might be very good at communicating with doctors, pharmacists and nurses, but managers were becoming increasingly important, and communicating with them was an area in which the industry didn’t have a lot of experience.”
But how could the barriers of policy inertia and distrust be overcome? By the late 1990s, Macfarlane could see evidence that people in the then-new primary care groups were beginning to think they could work with pharma in carefully-defined ways, and eight years ago, she set up HGS Consultancy to identify where the NHS agenda fitted with those of the pharma industry. Negotiation could then take place with both sides until that fit was realised.
Trusts under pressure
One of the key reasons for the growth of joint working is the pressure on trusts to balance the books. “Managers have spent the last year seeing posts being cut, swathes being taken through nurses, and the push to reduce PCT managers by 15 per cent,” Macfarlane explains.
“These pressures have driven trusts to look at who their potential partners can be and ask how they can do things more efficiently and get extra finance or people. If there are people who want to help us, can we do that in an ethical way?”
Another key reason for a change of heart in many trusts is what she sees as the government’s privatisation by another name. “The other real driver is the government’s agenda of ‘plurality’, which allows other providers to bid for services. The clear message now to managers in the NHS is that it’s all right to work with the private sector – which includes the pharmaceutical industry.”
The projects that companies are working on with the PCTs vary widely; for example, at Birmingham East, Pfizer UK Health is contributing to the management of chronic conditions. Another PCT is known to be seeking a pharma partner to help audit for difficult-to-take drugs that are being dispensed, but may not be being taken.
When found, it then proposes to work together with the company on programmes to encourage compliance and concordance. Similarly, there are collaborative projects with industry focusing on the switch to CFC-free inhalers and in providing pharmacist training for medicine-use reviews.
Payment-by-results is an area where large gains are available, according to Macfarlane, who says there can be a perverse incentive for a hospital to admit a patient, say after they have received nebulisation, and to then send a bill to the PCT. For this reason, there can be much to gain by negotiating a care pathway that keeps costs, such as repeated post-operative consultations, under control, and this is an area where business can contribute.
Another potential area is implementing NICE technology appraisals and guidelines, says Macfarlane. “We hear about PCTs that are quite happy for pharmaceutical companies to work with them in implementing guidelines, so long as the representatives stay on-message,” she says. “For them, the issue is that where you have a set of guidelines that are really important, the industry can help because it is very good at communicating with GPs.”
A positive message
Andrew Curl is an experienced pharma industry hand: he was deputy director of the ABPI for four years, and worked for SmithKline Beecham managing operations in various parts of the world – so, it’s a sign of the times that he has decided to hitch his wagon to the cause of joint working.
Curl set up Pharma Partners in 2006 to develop partnership programmes, and one of his activities has been developing joint projects under the ABPI Outreach Programme in three areas of the NHS not known for good relations with the pharma industry: Northwest England, Southwest England and the East Midlands. While these may have been difficult areas in the past, Curl and his colleagues are now reporting that they are successfully taking a number of projects forward.
“Part of the strategy is to work with groups of companies rather than one per project. Where relations haven’t been good in the past, PCTs can still be quite keen to be involved in joint working if there’s a group of companies and a facilitator,” says Curl.
Curl hired independent NHS-pharma relationship consultant Jan Balmer to work with him and the ABPI to develop relations in the East Midlands under the Outreach Programme. Balmer contacted the areas PCT chief executives, and made appointments to see them. The reception that awaited her approach was positive: “Once I have explained the aims of the pharma industry in wanting to work in collaboration with trusts to achieve better outcomes for patients, I have yet to encounter an NHS organisation that does not want to work with the industry in some way.
“It’s very different from the traditional relationship, which was often either about the NHS going to pharma for money for projects it had already developed, or about pharma approaching the trusts with a ready-made package designed to improve drug sales.”
She identified a range of areas for joint working and helped the PCTs to develop business cases, which were then presented to the industry. Interested companies formed consortia to support the projects, and Balmer then established steering committees to guide the projects, with industry providing skills to help in implemention and evaluation.
Balmer has several projects in development, but the best developed is a two-year cardiovascular project run in conjunction with Nottingham City PCT called the Happy Heart Project, which will initially identify patients at risk of heart disease, diabetes and stroke. Once the patients are identified, GP practice-based healthcare assistants will then support them in making lifestyle choices, and where the calculated risk is greater than 20%, they will be offered appropriate medical and pharmaceutical interventions.
Pfizer and chronic diseases
One project widely recognised as one of the most advanced pharma-industry collaborations in the UK is that between Birmingham East and North PCT and Pfizer UK Health Solutions (UKPHS), involving a collaboration on telephone care in the management of patients with chronic conditions.
“The project is a commercial arrangement,” says Andrew Donald, Director of Policy and Redesign at Birmingham East. “There are three partners: the PCT, Pfizer Health Solutions and NHS Direct, and the arrangement is underpinned by a contractual framework.
UKPHS and NHS Direct provide a telephone-based care management service for people with long-term medical conditions, in response to DH policy in this area. “NHS Direct provides the telephone-based care management centre, and the UKPHS managers bring a rigour in project and programme management, and in measuring outcomes,” says Donald. “It’s very different from the added-value approach where a company offers sponsorship or runs an event.”
The initial one-year project in a deprived area provides telephone care managers, who, rather than persuading patients to change their lifestyle, instead work to create an environment where the patients begin to understand their conditions and start to develop their own personal goals.
The initial project has recently been extended and now covers 3,500 patients with chronic diseases including coronary heart disease, diabetes and heart failure, and is now about to extend further to include COPD.
“Part of what the company brings to the party is experience of offering similar services in the US, where Pfizer has worked with insurance companies,” says UKPHS head John Procter.
And according to Andrew Donald, the evidence that the project is working is building up. He concludes: “People who originally had poor health metrics are being measured with BMIs, blood pressures and cholesterols that are more acceptable, and there are also some indications that use of healthcare services on an unplanned basis is also reducing.”
Gavin Atkin is a freelance writer specialising in medical and pharmaceutical topics. For more information e-mail: gmatkin@gmail.com
Related Content
Digital mental health technologies – a valuable tool in supporting people with depression and anxiety
The potential benefits of digital mental health technology for managing depression, anxiety and stress, together …
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 …
