Joint working with the NHS: sleeping with the enemy?
Posted 26th January 2010 in Articles, General | 4 comments
Dr. Paul Stuart-Kregor
The MSI Consultancy
Much has been made of the changing nature of pharma’s customer base. No longer is the GP king or queen in the UK. Rather their medical practice is increasingly defined or constrained by decisions made away from the doctor – patient interface.
Nothing new, given we have had change in the customer environment for over 15 years from fund holding onwards.
The difference now perhaps is the strong feeling that the blockbuster business model is broken. Fewer and fewer truly novel entities are reaching the market; companies are broadening their portfolios and reducing dependence on mass market products; focus is more on specialist markets.
Combine this with the impending loss of patents on big profit generators and it is clear why there is a need for change in how pharma companies do business.
Which is potentially is where joint working with the National Health Service (NHS) could and should play a part.
This has been a long time coming, given that the Ministerial Industry Strategy Group published its Long-Term Leadership Strategy for medicines in February 2007 which suggested encouraging joint working between the NHS and pharmaceutical industry. To facilitate which the Department of Health published guidance in February 2008, interestingly under the headline ‘Moving beyond sponsorship’.
Joint working is defined in the guidance as “Situations where, for the benefit of patients, one or more pharmaceutical companies and the NHS pool skills, experience and/or resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery.” Classic win-win surely.
While there is no doubt pharma has the necessary complementary skills and experience plus the resources to support these initiatives, there are some serious barriers to overcome.
There is no doubt that the industry is viewed with suspicion and a lack of trust due to bad past experiences. In part this is due to a perceived lack of openness and transparency in pharma’s behaviour and obvious short termism or ruthless pursuit of narrow commercial aims i.e. pulling the plug before the real gain in patient based outcomes has been achieved or even worse creating the problem for the NHS to resolve (through increased audit). Forcing prepared internally developed packages on the NHS does not foster a feeling of cooperation either.
“There is no doubt that the industry is viewed with suspicion and a lack of trust due to bad past experiences.”
There also appears to be a fear of “contamination” by contact with industry, resulting perhaps in NHS personnel’s values being called into question if they are seen to fraternise with the ‘enemy’. Perhaps that is where the Association of the British Pharmaceutical Industry (ABPI) Outreach Programme fits by keeping the perceived contact with the industry one step removed.
I appreciate that both parties have to overcome inherent prejudices and that it is not always the fault of pharma that such initiatives fail, but the history is weighted against the commercial side.
Joint working demands a partnership with open and honest communication and a sense of balance of the need for and acceptance of benefits to both parties. Too often in commercial relationships there seems to be a supplier-customer mentality rather than true partners with common vision, goals and values working to achieve a common objective.
Yet that is what partnership and effective joint working should be about; working together to achieve something of mutual benefit.
So why has it taken so long for pharma to embrace this approach?
In part an element must be the need to deliver this year’s results which can prevent a longer term investment mentality. For example, Pfizer Health Solutions, a separate commercial entity built entirely out of financial return from providing services to the NHS, has been successful but is only now showing a profit in Year 4, and that for a format that had been proven in the US.
Also there is naturally inertia due to fear of the unknown – having had no experience of making this work many people do not have the necessary mental framework to help them work this through. They do not know what works and does not work or how to work effectively in developing a partnership, notwithstanding the excellent guidance provided by the published documentation.
The NHS has to save money in real terms over the next few years. They cannot do this purely through cutting waste or maximising productivity within existing systems.
What is needed is serious service redesign and pharma has the opportunity to help shape those services. While there are national standards it is all about local delivery which means each Primary Care Trust (PCT) needs to consider how to commission and execute what is needed for their locality.
Is it sleeping with the enemy? Hardly.
“Is it sleeping with the enemy? Hardly.”
CK Prahalad says that when creating products, services and experiences “we need two joint problem solvers, not one”. He calls this “important idea” the process of “co-creation”.
As marketers we appreciate the value of placing the customer at the centre of the business relationship and co-creation takes that attitude firmly into the 21st century.
The NHS has already embraced this approach by working with patients to build co-created services which satisfy customer needs and offer improved experiences.
Pharma working with the NHS to improve the quality and quantity of care is another potential example of co-creation and will ultimately result in more modern medicines being appropriately prescribed and used properly by patients, which is what both sides of the partnership are looking for.
There is no doubt there is a great opportunity for the people who have the eyes to see it and the courage to go for it.
About the author:
Paul Stuart-Kregor is a Director at The MSI Consultancy (www.msi.co.uk), based in the UK.
For enquiries please email pstuartkregor@msi.co.uk or call The MSI Consultancy on +44 (0)1252 748600.
Is joint working the future of pharma?
26th January 2010, 11:10
Thanks for the excellent article Paul. One issue it raises: Pfizer approach this on the back of a long history of blockbuster products and can, therefore, bear the cost of running an enterprise at an effective loss for four years. With the emergence of speciality markets as the lead into the future and, inevitably, specialty companies working in these markets, how can these companies justify such long term investment at the risk of potential returns in the future? I think there is a way forward involving a "joint risk" approach but in a health service with shrinking budgets is there the scope for the NHS to take these risks or will the risk inevitably be placed back on the industry?
28th January 2010, 16:55
An excellent article, Paul. You have highlighted many of the problems glossed over by the industry.
In my opinion Joint Working is a bit of a red herring. It panders to those who believe ‘service’ will somehow create effective engagement where ‘sales’ has failed. The view seems to be that joint working is a panacea that will heal the industry’s afflictions.
But, as you say, in order for any engagement to be effective there has to be a two-way dialogue, with both sides willing to form a relationship. Simply pushing joint working onto customers will not work.
In my experience, the NHS doesn’t see the industry as the enemy, but they are seen as discredited and untrustworthy. In spite of this customers are extremely willing to engage with companies that can help them develop more integrated healthcare services for their patients.
What is important is that they want at least an equal part in the engagement process. They want their needs to be understood and appreciated and they don’t want to be dictated to by overbearing companies with hidden commercial agenda.
Two things need to happen:
1. Customers need to be educated that collaborative working with the industry is a safe and ethical way forward, and they need to be empowered to open the dialogue with companies that can help. We already know that this can be done very effectively.
2. The industry needs to recognise the sales force as the interface with the NHS. Sales reps need to be trained and empowered to understand and respond effectively to the needs of their customers.
Rebuilding relationships with prescribers is actually a simple, straightforward process, but until companies face up to the real issues of customer engagement, joint working will remain little more than an aspiration and a red herring that muddies the water.
4th February 2010, 00:37
For me the article title sums it up quite nicely. Along with my comments on Alan's post re: scared of regulators, big pharma has for too long had a mindset of viewing prescribers and prescribing decision makers as the enemy, who are there to block their drugs. This has to change if they are to positively engage with the NHS, it simply is not possible to muscle your way past them like it was 10 years ago.
8th February 2010, 21:54
I think DoyleeBNC has a point here - with the increasingly limited budgets the NHS has there is a risk of pharma being used to deliver services they can't afford to deliver themselves and who cares if it is good for pharma. I'm not saying we shouldn't be doing these things but I do think pharma needs to think very carefully about what it gets out of it. Building customer relations etc. is all very well but we have to make money at some point (sorry if that's a dirty word) to be a commercial business and ultimately deliver new medicines.
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