Practical advice and insight into opportunities in the changing NHS Landscape underpinned presentations by Carol Blount ABPI NHS Partnership Director and Mark Wilkinson of NHS North West at the inaugural meeting of the PM Society NHS Engagement Special Interest Group, 18 April 2012, at the ABPI. Paul Midgley, representing NHIS Ltd, added value in a lively panel discussion.
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Partnership working innovations at the ABPI
Carol Blount, NHS Partnership Director, ABPI
Partnership working innovations at the Department of Health
Mark Wilkinson, director life sciences innovation, interim chief officer (Darlington CCG), interim managing director (Durham Dales Easington and Sedgefield CCG)
Welcome and introduction to the PM Society NHS Partnerships Interest Group
Ivor Eisenstadt, chairman of the new PM Society NHS Partnerships Interest Group explained that the members are looking to drive best practice and examine how patient care can be improved through partnership working. A small advisory group meets regularly and PM Society members will also be able to attend a variety of events over the coming months, examining different aspects of partnership working.
The APBI recognises the importance of the Innovation of DH Health and Wealth report published December 2011, and Carol described how the ABPI has effectively input into this and continues to collaborate with relevant stakeholders in partnership working with the NHS.
There needs to be a fundamental culture change within the NHS to meet the challenges of the Nicholson report, to increase health benefits while driving cost savings by 2015. Innovation will be at the heart of this change.
Industry also faces a challenge. It needs to deliver efficiencies and encourage innovation and despite having among the lowest prices in Europe and a very efficient generics market, there is pretty slow and low uptake of innovative medicines.
This is the challenge as innovative medicines are part of the solution for improved patient outcomes. Carol gave specific examples in vaccines, HIV, cardiology and colorectal cancer. It is important to remember that productivity is one of the Ps in QIPP - the quality, innovation, productivity and prevention challenge – and that overall medicines can improve outcomes and delivery efficiency savings. Examples were given around hypertension and venous thromboembolism.
ABPI input into the Innovation, Health and Wealth report was very collaborative and a good example of partnership working at its highest level. There were three key areas of focus in the report for the ABPI, which are around removal of local duplication of value assessments, mandatory adherence to national guidance and guidelines and underpinned by performance management and metrics.
Importantly it is an ongoing collaboration, with an ABPI Implementation group overseeing around 30 actions and a number of task and finish groups at a national level; a strategic partnership between the ABPI, NHS Confederation and ABHI; and the APBI disease-specific therapy groups for member companies.
Finally, the ABPI continues to support joint-working – where, for the benefit of patients, NHS and industry organisations pool skills, experience and/ or resources for the joint development and implementation of patient-centred projects and share a commitment to successful delivery. There are over 30 joint working partnerships with the NHS delivering tangible patient benefits and Carol would be interested to hear about more of these.
New resources to support this will include a quick reference guide for NHS and pharmaceutical industry partners, due out May 2012.
Before beginning his presentation, Mark highlighted ‘interim’ in his title. It exemplifies the current turmoil in the NHS commissioning landscape and he posed the question ‘is the provider landscape the place to focus at the moment?’.
In terms of innovation and collaboration, the three key tenets are:
- Look out and not up! Most progress will be made by having a local focus
- Develop a local ‘business to business’ relationship
- Consider the’ next steps’ that we can take.
Language matters. When Mark joined AZ he discovered he was called a ‘payer’ and was genuinely surprised as it brings to mind someone sat behind a ledger reconciling payments. Then he found out he was described as implementation, the 5th hurdle, ie a snag, barrier or impediment. He had previously seen himself as a leader, a healthcare strategist, a resource manager. This matters, he believes: language matters.
In a recent survey of 400 people on NHS language medicine and technology gets a look in, but patients and care feature most.
The old paradigm sees product development (industry), value assessment (HTA bodies and regulators), and implementation (clinicians and NHS bodies) sitting separately. This is at odds with established evidence showing that the ability to collaborate is second only to creativity in terms of the skills needed for innovation. In the NHS sense, innovation requires collaboration and strong connections to both customers (patients) and suppliers (third party organisations).
In an emerging paradigm there is crossover between product development, value assessment and implementation and the interface is the critical point, where things can go wrong, drop between the cracks or misalign.
Looking broadly across the pharmaceutical industry, the global R&D spend is going up and the pipeline benefits are going down. The Tapestry Networks European Healthcare initiative has looked to bring together industry, regulators and payers to consider particularly disease areas and to define shared-value frameworks in a clinician-led process. The group oversaw a process of early consultation on medicines with a view to only developing those that satisfy regulators and meet the needs of payers. It is a powerful example of payers, regulators and industry moving away from silos towards integration.
NHS quality improvement system
Showing a diagram taken from the NHS Outcomes Framework 2012/2013, a report he recommended as excellent reading, Mark observed that there has been a huge amount of rhetoric about local-ness, but that reforms since liberating the NHS are very much about driving a systematic top-down approach to the implementation of standards.
In many ways this is a pro-industry agenda, because it is about working out what works, doing it once and then driving it down through the NHS. It is a very structured system and if the commissioning outcomes framework works, then commissioners will be held to account on whether services are delivered according to NICE quality outcomes.
CCGs will also now have to go through an authorisation process, demonstrating that what they do is going to be consistent and provider payment mechanisms will be harnessed to ensure that standards are universal.
Innovation Health and Wealth
This sets out 30 or so recommendations under six broad areas. The aim is to reduce variation and strengthen compliance. How this will be achieved is still to be defined, but topics such as benchmarking will have increasing importance.
The key areas are around
- Reducing variation and strengthening compliance - understanding whether patient-related variation is good or bad. There is a need to retain the patient-related and lose the professional-related variation.
- Creating a system for innovation delivery – it is a complex landscape even for people within the NHS and small companies can struggle to navigate it. There is a desire to simplify.
- Incentives and investment, which covers several groups, one of which is aligning tariffs to support innovation.
- Developing our people
- High Impact innovations – for example, the NHS is starting to mandate particular innovations ‘from the top down’, for exampleoesophagealdoppler monitoring, and in future there are likely to be many more of these.
Quoting Mike Farrar, Mark explained that it does highlight one of the principle challenges facing people in the NHS. Farrar says “GPs will micro commission very well,” but in fact this poses questions and in Mark’s personal view there is a sense that a lot of people at the top of the NHS think probably not. So there is a lot of engagement at a local level and on the other hand a top down approach looking more like a system we have had in the past: a fascinating process.
Before moving on to talk about reps, Mark alerted the audience to nhsmanagers.net advising ‘sign up now!’ it gives a digest of information coming out of the NHS that can start to move industry through awareness into the territory of trust.
Building trust is about contact, collaboration, clarity, confidence and communication. There is still some way to go with joint working.
- Contact – success will be when you have a plethora of NHS speakers to speak at your meetings. Currently there is a small cohort including Mark - we have to have more contact and within industry personnel at all levels need to have the right sort of contact with ‘payers’.
- Clarity – what is the benefit. Need to be clear about what is in it for the NHS and for industry, not just over who is picking up the tab.
- Communication –must be full, open andtransparent. Shout about successes and celebrate them. Understand you are in the private sector, but would help to highlight successes to build confidence in the NHS that this sort of thing is legitimate and acceptable and only then will collaboration come.
Eight industry case studies – it actually needs to be a local approach
Mark was involved in reviewing eight current case studies recently. He observed
- There may be a missed opportunity in local discussion on issues, dialogue or an exchange of letters between a pharmaceutical/ other company and a local commissioner
- Also, Mark does not agree with the ABPI’s perspective that there is a slow uptake of reviewed medicines. Yes, the NHS is slow to take up cost-effective medicines, but Mark does not believe that uptake is low overall. Certainly there is a lack of information on the uptake of NICE reviewed medicines
- Through discussion we shared and improved our knowledge.
Innovation and collaboration requires what is akin to a business to business relationship. The foundation is in understanding needs, doing what you say, solving NHS problems, ensuring access and personal contact to develop relationships.
Then through shared value exchange and understanding, and contact at all levels and functions trust, co-working, shared vision and integrity will be achieved.
Importantly, this is a local agenda not something that will work from the top down. And it may be as much about skills sharing and exchange as products and services.
A good example is a Roche programme where they have seconded people to work within the NHS to deliver a piece around benchmarking medicines. St Helens PBC and GSK have worked together in a COPD project where GSK brought skills and audit software. It brings benefits for GSK and the commissioners have benefited from a fall in admissions.
There are few examples of joint working that point to such good or specific measurable outcomes and Mark would be keen to see more.
- Wellards will be freely available to the NHS
- Need to avoid naïve transplantationism, assuming that something which has worked in Barnsley will be suitable in another part of the country. Evidence shows that where joint working is a success it is typically built on local relationships and need, and…
- It is wider than joint working (there needs to be an accurate descriptor to reflect this)
- Broadly, the agenda is around value-based pricing.
A good place to start for a potentially shared collaborative agenda is the Kings Fund – 10 priorities for commissioners.
Other opportunities might come around CCG authorisation – MSD has a programme to support CCGs that is valuable, meeting genuine NHS need for the c200 CCGs aiming to set up.
In summing up there are three key tenets for successful collaborative working with the NHS: looking out not up, developing local business to business relations and thinking about the next steps’ we’ can all take together.
Panel discussion highlights
Transparency and honesty are the key steps in developing a collaborative working relationship. After that the CCGs are very open to the skills companies have to offer.
Joint working is not just about the pharmaceutical industry, but about all potential non-NHS partners, for example organisations such as Healthcare At Home and third sector partners. Looking at opportunities with all these different stakeholders could provide the best mutually beneficial solutions.
CCG/ contacts ‘interim’ status – it is a challenge as is the risk of ‘brain drain’ from the commissioning organisations during the transition. However, we are moving towards the end of the time of uncertainty.
CCGs will require case studies on joint working as part of the authorisation process to show that they are starting to deliver – this provides an immediate opportunity.
Pharmaceutical companies - compliance can be a barrier to joint working. However, Carol advised that feedback from the ABPI taskforce suggests that it really is worth putting in the work up front on how you might want to do something and if you set appropriate objectives and badge it right many things are achievable. The APBI Joint Working Guide may help to overcome this significant challenge, the next step will be a series of masterclasses using the quick start handbook as a framework. Ideally, it should be good to get marketing and legal together on these.
In addition, pharmaceutical companies may need to move away from providing products to being seen to provide service solutions that meet health needs. The answer is to provide outcomes not tablets – if the tablet is the feature, the outcome is the benefit and if a commissioner can buy in outcomes then there is less of a philosophical problem around the provider being a pharmaceutical company as long as it is working in partnership with another organisation that has a track record in delivery.
NHS – there is no standard way of dealing with it, every local health entity needs local focus. Companies will need better and more empowered market access teams. The issue of localisation is a big challenge for global companies – they are not structured this way. Further, they should be mindful of the seniority of CCG points of contact and the need to mirror this in their local contacts/ market access team.
Innovation Health and Wealth - there is awareness in the NHS, but there appears to be little penetration at a grass roots level in terms of putting actions into place.
Carol Blount is the NHS Partnership Director at the ABPI and leads a team of four regional-based ABPI Partnership Managers.
Carol joined the ABPI in June 2010 with more than 20 years’ senior level leadership experience within the UK pharmaceutical industry. Carol’s experience includes leadership of strategic innovation and change, business development and brand marketing. In her new role, Carol is responsible for developing partnership working with the NHS and working with the DH and NHS to support access and uptake of innovative medicines to ultimately improve patient outcomes. Carol led the ABPI input to the Innovation Health and Wealth (IHW) Report and is currently coordinating industry input to the IHW implementation plan. Carol is also responsible for Joint Working, ABPI Therapy Groups, QIPP and International and National uptake metrics.
Carol previously worked for Bayer and more recently for AstraZeneca where she developed her sales and marketing experience, becoming Head of Innovation prior to joining ABPI. Carol has successfully led a number of initiatives including joint working projects with industry and PCTs.
Graduating from Bath University in Applied Biology, Carol began her career as a medical sales representative in the pharmaceutical industry.
Mark Wilkinson, NHS Innovations
Mark Wilkinson is the Director charged with promoting life sciences innovation in the UK’s National Health Service. He is an NHS leader with 10 years’ experience as an executive member of various NHS boards (including five years as a Primary Care Trust Chief Executive).More recently, he has worked for AstraZeneca with roles in Global Marketing and Global Government Affairs.
The NHS has established a Life Sciences Innovation Delivery Board to increase the uptake of cost effective medicines and medical technologies, and to improve the strategic relationship between the life sciences sector and the NHS. Mark leads a small unit supporting the work of the Board, as well as being a full member of it.
Mark has recently graduated from McGill University in Canada with a Masters Degree in Health Leadership.
Ivor Eisenstadt, PM Society & MGP
Having spent over 13 years in the pharmaceutical industry Ivor is now managing director of MGP, a specialist publisher dedicated to improving patients’ lives by promoting best practice in healthcare. Journals include Guidelines, Guidelines in Practice, Medendium and the eGuidelines.co.uk website. In addition MGP supports the NHS and the industry in translating guidance in to clinical practice through a range of partnership working initiatives, digital projects and educational workshops. Ivor is a past chairman of the Pharmaceutical Marketing Society and current chairman of the NHS Partnerships Interest Group.
Paul Midgley, NHiS
Paul Midgley spent 10 years in NHS management consultancy as a managing director of The Healthcare Partnership, and the last 4 years as Director of NHS Insight at NHiS Ltd. Paul works with NHS and supplier clients and multi-disciplinary teams across commissioner and provider organisations to redesign services and provides training and consultancy for NHS supplier companies on understanding and responding to NHS developments including QIPP, Market Access, Health Bill, NHS Environment and Account Management.
Prior to moving into consultancy, Paul spent 15 years gaining Industry experience with major pharmaceutical multinationals in a variety of managerial roles including training, people management and sales and marketing, in both primary and secondary care, specialist, and mass markets across a broad spectrum of therapy areas.