World Class Commissioning: how to be partners in quality

pharmafile | January 14, 2010 | Feature | Sales and Marketing |  NHS, NHS funding, commissioning, funding, healthcare, marketing 

World Class Commissioning has been heralded as a critical mechanism to revolutionise healthcare services in the UK. Now two years since its launch, NHS leaders are demanding that now is the time for World Class Commissioning to produce results.

NHS Chief Executive David Nicholson says the health service is facing a potential budget gap of £20 billion in the first three years of the next spending round. In the lead up to the next General Election, political leaders are making brave promises to protect investment in the NHS, but in the current economic climate it seems certain that whichever party returns to power, spending growth on health services in the near future will be far lower than in the recent past. The challenge for patient care is real and World Class Commissioning (WCC) is part of the solution. So how can pharma respond to these developments, and help facilitate improvements in care while also increasing its sales?

The NHS needs to promote quality but, in times of economic peril, it must also contain cost. Speaking at a recent DH conference examining progress with WCC, David Nicholson said that commissioning would play a pivotal role in addressing the many challenges facing the NHS, helping to identify and develop strategy and putting systems and processes in place to deliver quality. But achieving success, he said, would require a redoubling of effort and a change in mindset to move the service forward. “This really is the time when commissioning needs to deliver,” he said. “Both commissioners and commissioning now need to make sure we can take forward these great visions and strategies and make them a reality for our patients and communities.”

The potential £20 billion spending gap, though an estimate, puts a sizeable figure on the scale of the challenge for the NHS. But it also provides a useful marker as to where commissioning can make a demonstrable difference – if it gets its act together. Gary Belfield, the DH’s Acting Director General for Commissioning & System Management Directorate, says that tinkering around at the edges locally will not save the service £20 billion and that best-practice needs to be shared nationally to deliver results. “This is where WCC and PCTs really need to step up and say ‘we are going to transform services,” he said. “We need to do something really different if we are going to take services forward and transform healthcare. Commissioning is in the DNA of PCTs. It is not some sort of tick-box exercise. This is about transforming the way we work. We need to be brave and bold.”

And so the gauntlet has been thrown down. The commissioning function needs to raise the bar to drive health outcomes and improve patient experiences. Commissioners need to embrace and advance radical change to succeed. They are grappling with the challenge to be fit for purpose. To support them, the pharmaceutical industry must do exactly the same.

Earlier this year, Pharmafocus published a simple guide to commissioning and looked at how marketers can engage with these new and influential customers to help meet the ambitions of WCC. It provided a roadmap for where the industry needs to engage, and outlined the many ways in which pharma can get involved with world class commissioning. But having signposted the doors through which you need to walk, and when best to walk through them, the question remains: what do you need to do next? As a marketer, is your approach fit for purpose? The DH is currently battling to ensure that commissioners up and down the country are progressing against the various competencies it outlined as being central to their success. But how competent are you, or your organisation, in developing an appropriate dialogue with these key customers? What are the key competencies that you need to demonstrate to make the most of the opportunity? Here are five critical steps that will enhance your chances of success.

Step 1: Increase your level of sophistication

There are two key areas in which the NHS commissioning function is desperately short: capacity and capability. At present, the commissioning community is sparsely populated and the relatively small number of capable commissioners is dramatically over-burdened. So if you are going to try to help the NHS, you need to be offering solutions that address both of these deficiencies. For the marketer, this means that you need to ensure that your own capacity and capability is as good as it can be – you need to be prepared.

In advance of your approach, you need to understand, whether from a single product or a portfolio perspective, where your offerings align with commissioners’ priorities. Which of the common commissioning scenarios is most appropriate for your brand? Is it service redesign, or is it PBC? Is it several of them? You need to understand where you can make that engagement, and make sure you can get your messaging right so that when you push on the door, it opens.

The solutions you prepare need to demonstrate how your product, or portfolio, can support the commissioner’s challenges of capacity and capability. What can you do to support your product that will help support them? In fact, pharmaceutical companies are incredibly well-equipped to provide valuable information for commissioners – much of which will help address their lack of capacity. For example, if you have a product in diabetes, as a company you will no doubt have undertaken a lot of research in understanding how patients are treated, who is treated and who shouldn’t be. Through this process, you will have generated an awful lot of disease expertise that actually becomes additional capacity which you can offer. Where appropriate, a budget impact model, or a comprehensively prepared, adaptable service specification that supports the redesign of a service will undoubtedly provide value to a commissioner and address the issue of capacity.

Likewise, pharma is well-positioned to help with capability issues. This might take the form of additional skilled human resource to support a commissioner – you may be able to provide a capable project manager to drive through a commissioning work stream. Alternatively, you may, for example, have identified that a particular area has prioritised a major service redesign in diabetes – and have the capability to bring in a KOL who can talk to the non-clinical commissioners about the disease area and what the issues are for payers. According to the DH, in this ‘year of delivery’, increasing engagement with clinicians is a major priority for commissioners. The key to overall success is to develop more ‘informed’ commissioners – and pharma can help provide a gateway for them to achieve this.

Proactive consideration of how your products can align with commissioners’ aims is critical to developing the sophisticated approach WCC demands.

Step 2: Empower your resource

Much of pharma is moving towards an Account Management model. The days of medical representatives carrying out the simple, sequential sell to clinicians are long gone – as we have seen, a much sophisticated engagement is now required. But if you put the resource out there to have sophisticated discussions, you have to empower them to deliver. The marketer has a crucial part to play in ensuring that field-based staff are able to walk the walk.

Lack of empowerment in representative is, sadly, not uncommon. But to capitalise on the opportunity of WCC, this cannot remain the case. A sales professional who is only able to talk about product, but is not allowed to discuss the wider disease agenda, will not be able to develop the kind of dialogue that will interest commissioners. An empowered field-based person will not only be able to ask the right questions, but will be able to act upon the answers they are given. Too often, Account Managers ask questions and gather answers, only to exit the discussion armed with a ‘wish list’ and fail to return with a solution. This is because too few of them are actually empowered or understand what it is that they can put forward.

The challenge for field-based personnel is to identify commissioners’ capacity and capability needs, and to enter into a negotiation/discussion about the level of help they may be able to provide. Identifying needs is about framing the question in the right way: why does the commissioner feel the need to redesign the service? Where is the current service falling short? What level of care are current patients getting? Where are the variations in care? Are there particular groups of patients that are missing out?

And if you have empowered resource to ask the question, you need to similarly equip them to be able to build on the answer. Negotiating the solution is about knowing what can be put on the table – in advance. For example, if your Account Manager gets into a negotiation where the commissioner is revealing that he needs a half dozen trained data analysts, there is no harm in responding that it’s not possible and offering an alternative solution. The industry should not be afraid to have the discussion.

But preparation is key, and ongoing communication between sales and marketing departments is essential to drive it. Marketers need to have agreed the options ahead of any customer engagement. If you know what your areas of strength are, and the limits of what you can go to, your customer-facing resource should be able to turn discussions around to areas where you can really help – rather than having wide-ranging discussions about problems, creating long wish-lists and then running scared.

There are numerous solutions that the industry can provide for commissioners. These include:

• Disease expertise

• Project management

• Facilitation of clinical engagement

• Data – both clinical and patient experience

• Patient education

• Access to KOLs

• Access to best-practice elsewhere in the NHS

• Market development strategy

• Outcomes-based evidence

• Communications expertise in patient and public involvement

All of these solutions are readily available and can be shared. At present, the channels to share them aren’t being created in an optimal way. Much of this boils down to a lack of empowerment. 

Step 3: Be able to match agendas

Whether in sales or marketing, the ability to match your agenda with that of the commissioner is vital. To succeed you will need a level of understanding and a high degree of influencing skills. If in nominating a solution that matches your agenda you can show how it helps provide something that a commissioner is looking for, your power to influence will increase.

There are two key areas where the need to match agendas is necessary: specification and implementation. This mirrors the two basic needs that commissioners have as their basis for success: a good specification and a robust plan to implement it.  They may need to partner with the pharma company to increase their capability to design and produce the plan so that it fits their local needs and their capacity to deliver on it. This cascades naturally from the first two competencies. If you are sophisticated in your approach and understand how your product or portfolio fits with what the NHS is looking for, and your resource is empowered to negotiate the solution you can provide, your ability to match agendas successfully will be crucial. This lies at the very core of the Account Management model. 

Step 4: Develop adaptable offerings

Once you have matched agendas, the way to move forward is to have adaptable offerings. You need quality generic templates, processes and frameworks that you can work through with a customer to customise your approach together. The art is to co-design and co-produce a blueprint for success – increasing capability and capacity.

As a marketer, therefore, you will need a good basic framework for engagement that you know is good practice and well-evidenced and can match agendas with a commissioner. From there you will need to use local data, local circumstances and local clinicians to design it and ensure it fits the bill for the specific local economy.

This is having adaptable offerings. It will comprise things like:

• A best-practice patient pathway

• Good quality generic service specifications

• Case studies of best practice, including clinical models, examples of market development and procurement options  

• Good data sets and access to data that can be interrogated at a local level

• Models for stakeholder engagement

• Project management process including frameworks for communications and mobilisation plans

Step 5: Focus on quality

Quality is the ultimate goal for WCC. The Department of Health is currently configuring the next stage of its efforts around David Nicholson’s QIPP agenda – the delivery of Quality, Innovation, Productivity and Prevention. For pharma, as agendas go, this is the one to match.

Responsibility for QIPP has been given to Jim Easton, National Director of Improvement and Efficiency, DH, who, like David Nicholson, has earmarked commissioning as a central component in achieving success. “People are coming up with incredibly consistent and entirely credible lists of things that could be done to drive up quality and drive cost down,” he says. “Most of them pivot on effective commissioning – if, like me, you interpret commissioning as ‘driving clinical change’.

He says this includes reshaping the pattern of demand to focus much more on upstream care and prevention, and away from the expensive ‘rescue’ end of care.

“It means being determined to commission those things that we know are appropriate. It includes redesigning at scale, and at pace, clinical pathways for chronic disease management and for urgent care in order to improve the experience of patients and cost and quality together.”

For the pharmaceutical industry, focusing on quality care for patients really does represent the moral high ground. If your whole approach is built around delivering that, it is very difficult for today’s NHS to argue against it – the agenda around WCC, Darzi and QIPP is moving in the same direction. By keeping the patient at the centre of your plans, and at the heart of your marketing messages, your chances of success increase dramatically.

The health service in the UK is changing, and World Class Commissioning is in the vanguard of that change. The NHS is having to alter its mindset and behave differently, and the pharma industry must follow suit. The era of joint working between NHS and industry is here, and it’s good news for pharma. As Jim Easton says, to solve its problems the health service needs co-operation, collaboration and people finding ways of solving problems together. “The idea that that’s incompatible with also stimulating the market, bringing in innovating new players – that relates to our lack of shared maturity about what a market needs. In that market environment, we can have collaboration and compelling changes to market mechanisms. We will be laying down a new challenge to the independent sector to move on from the period in which they helped us in adding growth to the system, to saying ‘how can you help us in delivering the twin aims of quality and productivity?’ There are many people in that marketplace who claim to be able to help, it’s time to put that claim to the test.

“We need innovation on how we deliver. We need the sort of innovation which is innovating in how you take great ideas and put them on the ground in a way that’s really going to make a difference.”

Easton’s words were delivered to an audience of NHS Chief Executives, Chairs and senior strategic leaders from across the health service. They could well have been written for pharma.

Andy Lee is partnerships and commissioning director, WG Consulting. Tel: 01494 470760 or Email: enquiries@wg-group.com