Right-sizing the salesforce
pharmafile | December 20, 2005 | Feature | Sales and Marketing |Â Â salesforceÂ
Can we form an impression about how good or ‘right’ a team is simply by the size of it? We shouldn’t be size-ist, should we? The straight answer is no – size alone tells us little. It’s like asking if the colour green is good. Well yes, if it’s a traffic light, but not so great if it’s a facial complexion.
Size does matter but only in the context of the environment in which pharma teams operate. Other features determine the worth – size, hopefully, becomes a multiplier of these, but only if the basics are in place.
What do we expect of the best teams in today’s pharmaceutical selling arena? The blend has moved from a quantity argument to the quality of what each team (and individual) can deliver to their employer and the NHS customer, in order to assure ongoing access to key decision-makers.
Are quality of expertise and delivery the converse of size? It shouldn’t be, though it does seem that if you have to equip teams with a greater depth of knowledge than before, then the time and resources allowed for training and materials development at the core of the operation will need to be greater.
This not only includes knowledge on product and therapeutic areas but also on the national and local NHS plans for delivery, if you expect your field-based personnel to be able to fulfil essentially a consultancy role to their NHS customer in moving service developments forward.
NHS customer reach determines size
We have experienced relatively stable numbers of GPs and hospital consultants in the various therapy areas over the years, so the number of medical reps required by an organisation to see (x) numbers of customer type (y), (z) times a year, to outshine the competition, has been relatively straightforward to calculate.
As the NHS has inched towards corporate behaviour it should be possible for pharma teams to rationalise and concentrate on fewer influencers, who in turn would enforce opinions/processes/decisions at the clinical coalface.
Talk to the right people and they do the work for you? This new model, first predicted several years ago, has become a business reality. Yet the only constant seems to be change – we are forever dealing with an NHS kaleidoscope of influencers, which has yet to crystallise from the most recent rotation. It’s no longer black and white and simple to profile customer segments. There are still many groups of customers, in a convoluted hierarchy out there that need to be engaged at all levels of their organisation(s) and partnered with. And that demands more than one type of customer interfacing team.
Organisational clusters in primary care
As an industry we have had to engage most of the 35,000 GPs, 10,000 practices, 302 PCTs relevant to our product and therapeutic area. If the number of PCTs is then scaled down to 100-plus super-PCTs does that mean, that on average, and with due consideration to targeting, pharma companies need a third less people in the field? Do we really believe that the numbers of influencers have or will diminish to that extent?
It will probably make less difference than the maths would predict since the number of true influencers within the NHS is constant, since the most progressive PCTs have simply absorbed the more ‘static’ organisations. This would be a helpful rationalisation exercise for marketers calculating the numbers ‘needed to meet’. The NHS is usually very consistent within the laws of physics and conserves mass by moving itself around! Though, with the desired 15% management efficiencies needed, a number of roles will be cut.
The numbers game
Practice-based commissioning (PbC), on the other hand, takes the numbers in the opposite direction with an increased number of decision-makers who should be engaged.
July 2005’s Commissioning a patient led NHS, was formed on the back of a consultation process to make the NHS more patient friendly. It dictates universal PbC by the end of 2006.
There is no doubt that PbC is necessary to engage clinicians where the PCT infrastructure had fallen short. Unleashed in hospital trusts, patient choice and Payment by Results are capable of combining to produce a ‘frenzy’ of costly hospital-based activity. PbC is then a very necessary gearing mechanism to restrain this. The functions of PbC practices are:
- The design and improvement of patient pathways
- Working in partnership with the PCT to create convenient community based services for patients
- Responsibility for a delegated budget covering acute commissioning and emergency care and to manage that budget efficiently
Fifty per cent of healthcare managers surveyed recently were clear on what the PCT commissioning role would be and thought that 50% of practices would be engaged in PbC by the end of 2006 (‘engaged’ is defined as operating at levels 2 or 3).
Level 2 is when ‘Assistants’ monitor activity and assist with care pathway development and participate in the enhanced management of groups of patients (typically very high service users).
Level 3 are the ‘Pioneers’, where practices set specific targets for the reduction in current levels of patient flow into secondary care and develop care pathways which improve utilisation of local care alternatives and receive 35% of the value of any efficiency savings.
Level 1 – when ‘Monitors’ simply audit health service usage against an agreed portfolio is arguably not so much engagement as ‘opt-out’ as far as that is permitted.
PbC will vary from basic, through to enhanced and then advanced – the pharma industry needs to track which falls into what category to make ‘engaged’ both appropriate and worthwhile. The issue is which teams will engage with the leaders in PbC and what competence size offering will be viewed as fit for the purpose. Because of its focus on service redesign, rather than simply holding the cheque book, PbC offers a very different scenario to industry than its more tactical predecessor Fundholding.
The opportunity is clearly there for industry marketers to develop supportive programmes around care pathway development, chronic disease management that will help commissioners (PbC and PCT) hit the 18-week target by unblocking those beds occupied by unnecessary admissions. The level 2 and 3 practices will need all the help they can get in service development initiatives.
If target customers for the pharma company Primary Health Care Development team become PCTs and levels 1and 2 PbC groups, then we have lost 200 customer groups (PCTs), but gained around 5,000 (PbC Pioneering/Assisting Groups).
This is further complicated by the fact that not all practices will be a single commissioning entity; they will align themselves into consortia which will once more reduce the numbers needing to be engaged by the industry.
The precise numbers are an educated guess until the organisational PCT amalgamations are confirmed, but we need to speculate because business plans are needed now, not mid-2006 when the final pattern of PCTs is fully revealed.
The number of practices engaged in PbC in any one region will vary widely according to the previous relationship with their PCT – the better the relationship the more likely the buy-in, which really is the converse of what the government intended. PbC was planned to be an antidote to recalcitrant GPs in areas where the PCTs had largely failed to engage the clinical front line.
Furthermore, the PCTs retain the right to top-slice the savings budget from the practices who do not ‘behave’ so we may see some fall-out from levels 2 and 3 from PbC if local commissioning consortia are disillusioned that their efficiency savings have been reclaimed by the PCT.
The conclusion is that it is difficult to give a generic, all-embracing view on rightsizing of a sales/development team, based on NHS infrastructure. It is a complex mosaic heavily weighted by local priority and differs according to therapy area, product characteristic and company.
However we should be guided by a few core principles:
- There will be an increased number of influencing groups in the NHS organisation (in England only – watch this space for plans on PbC in Northern Ireland!) Many will want to work with the pharma industry in a more sophisticated way, less product focused, much more centred on health improvement and service re-design.
- Some evolution is required in both training and materials to avoid the presentation to emerging customer groups being irrelevant to their goals and outcomes. It’s a great opportunity for healthcare development teams to partner the NHS on many different interfaces and those teams that don’t have the mantle of healthcare development should aim to acquire it.
- Partnership working has to be a three-way win – the pharma company must benefit, the patient must benefit and the NHS must benefit, but not necessarily in that order and it can be done at all levels in the organisation.
- Learn from the past – look at the case studies developed and published by the ABPI (Best practice in working together for patients, 2004, 2005). PbC clusters will move to corporate behaviour with their own working-with-industry-guidelines shaping them.
How will healthcare development partnership endure in the long-term? For partnership working to be sustained, companies must measure the value of the initiative to their commercial goals. We should fear for the long-term prospects of partnership working if it is for altruism alone, and while qualitative outcomes and good relationships are vital, they will fall short of convincing the finance director when more investment is required.
There is a politeness at the moment regarding the hard facts of return on investment from partnership projects which is charming but not realistic. Partnership healthcare development projects can deliver sound financial outcomes – this has not always happened because they were measured in a way that could not differentiate from traditional product promotion, were poorly applied or subject to unrealistic time frames.
Knowing how to measure partnership project outcomes is important and if the fundamentals of patient benefits and health service developments are covered, then, as a commercial organisation, a fair return should be expected. The healthcare development model, properly quantified emerges as the viable contender for the way ahead, whatever the size.
Internal fit determines size
To be effective there must be an excellent internal fit and this is more of a challenge the larger and more complex the organisation.
It requires consolidated leadership and an excellent internal communications programme surrounding the teams expectations and outcomes from the team and the platform for synergistic working. The same applies whether it is internal head count or contracted in.
The determinants of a good internal fit are quite straightforward but can be overlooked in the rush to establish a new team in the field. They include:
- Clear and shared objectives about what the aims of each team are and use of case examples to provide clarity when the margins are blurred.
- Unremitting communication about the plans/progress/success/challenges that each team faces.
- Discourage elitism and encourage mentorship.
- Rapid decision chains are a must – companies should be cautious of ‘going large’ unless a streamlined decision process exists. NHS people seek a refreshing change with their partnerships not more frustration.
- Invest time in creating a community in which the teams work and feel valued – the larger the team the more difficult this is to achieve. Pharma team leaders should ideally constantly challenge themselves and seek feedback from others about their own skills and delivery in this area.
- It’s unwise to trade bigger numbers in the field against marketing resources at the centre who can support them well and impact on the effectiveness of every individual. In the quest for greater customer responsiveness the need for different, probably more complex materials is apparent. This of course is where the right CSO partner can prove invaluable since this is where the margin truly delivers for a company.
Many variables contribute to considerations on the Right Size for a team. The changing customer operational groups and internal company fit are absolutely fundamental to these decisions, tempered by product potential, corporate portfolio and how resources can leverage from that, as well as competitor strategy.
There are many considerations for marketers to juggle. Size matters, but first the operational unit (the person) has to be well-equipped, efficient and well-connected in the pharma organisation, and above all, relevant to the NHS customer.
From there, size, when sensibly aligned to targeted customers, is the multiplier of success.
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