Who is the customer in the new NHS?

pharmafile | June 2, 2011 | Feature | |  ABPI, Ben Adams, GP consortia, NHS reform, PCTs 

As the structure of the NHS is ripped down and rebuilt, the pharma industry is finding itself working in a building site without a foreman.

Many are confused as to who they should be talking to about their products – is it locally with the emerging GP consortia, or the primary care trusts of old, or centrally, with the new shadow Commissioning Board?

Such is the confusion that even Richard Barker, the outgoing Director General of the ABPI, has asked the NHS to whom pharma should sell its drugs, and the health service seems just as confused.

New landscape, new customers

The government is attempting to radically reform the health service by changing the people who are responsible for it.

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The Health and Social Care Bill is looking to tear down the current system by abolishing those responsible for the NHS budget – PCTs – and replacing them with GP-led commissioning groups.

Even though this has not yet been passed into law, it is already happening on the ground, and PCTs have now been dramatically cut back – down from 152 at their peak to just 30 by June this year, with many of them merging into ‘clusters’.

Pilot schemes of GP consortia – or ‘pathfinders’ – have taken up the slack from the abolished PCTs on a regional level and are themselves overseen centrally by a ‘shadow’ National Commissioning Board, headed up by the former chief executive of the NHS Sir David Nicholson.

The problem for pharma is that these new groups do not have any legal power to commission on their own, meaning the industry cannot yet go to them to sell their products.

It is the PCTs that are still legally in charge, but are now far fewer in number, and both the moral and future responsibility for the NHS rests with the Commissioning Board and with GPs, meaning pharma has no clear idea where to focus their efforts.

Muddied waters

It is about to get even worse for pharma as the Health Bill in its current form has been halted through its passage in the Commons and sent back for public consideration, such is the ill-feeling toward its proposals.

One of the major contentions is the intended reign of GPs as the new kings of commissioning, with many – including many GPs themselves – now favouring an ‘integrated care’ approach that allows other health professionals a say in the diffusion of the budget.

It is widely expected that the government will have to water down the role of GPs in a major concession to its Bill, allowing yet more people to be involved in the process.

But it is still moving ahead with pre-emptive changes on the ground and from 1 June, all GP consortia have the opportunity to become members of newly created PCT ‘sub-committees’.

This gets around the problem of legality by making consortia an integrated part of a PCT, allowing them to share in its authority.

This will mean that GPs can be in the driving seat to commission services, having a direct say in how the primary care budget for prescribing is spent.

Speaking at the recent ABPI conference David Thorne, chief executive of the Newcastle Bridges commissioning consortium, told pharma to ‘call him’ about their products as his consortium becomes one of the new sub-committee member from June.

He couldn’t say who else would be involved or what their responsibilities would entail however, and asked the industry to phone around to see which consortia will be signing up to the new committees. So how many are involved remains a mystery, and there is no central database telling pharma who or where these new sub-committees will be – pharma may need to budget for a larger phone bill this year.

More work to be done

At the same conference Richard Barker expressed his confusion at this continually evolving system, asking Jim Easton, the National Director for Improvement and Efficiency in the NHS, who exactly his members are suppose to be selling to.

Easton could not give a definitive answer, admitting that pharma was selling into an ‘atomised system’.

“Pharma will need to engage centrally with the Board and locally with the new clusters and, in the future, consortia, but the practical aspects of this are difficult,” he said.

John Humphrys, a BBC broadcaster and the conference’s chair told Easton the government’s programme was ‘vague’, adding that there is still a lot of work to do on making the system clearer for the industry.

This was received with a hum of consensus from the audience, who need further clarity on who they should be building relationships with now, and in the future. The industry will have to wait along with everyone else to see the concessions coming out of the Health Bill’s pause, which could dramatically change the plans once again.

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