This article was first published on the Pharma Field website on 10 March 2022.
Clinical networks are becoming an increasingly powerful force within the new NHS landscape. Oli Hudson explains what they are, why they matter and how Industry can best influence their decision-making.
The latest NHS reforms have the principle of collaboration at their core, and an important enabler for this is the role of clinical networks as a new locus of decision-making both within Integrated Care Systems (ICSs) and beyond.
In this piece, we will look at what kind of stakeholders make up these new decision-making units (DMUs), what they have influence over, and what challenges they are facing. We will also explore how Industry can engage effectively with these networks by demonstrating how it can help to support their goals.
Evolution not revolution
The first thing to note is the strategic influence of clinical networks within the NHS is not new. Clinicians have come together to discuss challenges and make recommendations at a regional or sub-regional level for decades. Some of these network arrangements were then formalised in the 2000s, while nationally-mandated strategic clinical networks were established over a decade ago across four areas: cardiovascular diseases, cancer, mental health, dementia and neurological conditions, and maternity, children and young people.
What is happening today is therefore a story of evolution not revolution. As NHS England’s ICS implementation guidance puts it, the intention now is “not to replace existing networks, [but] about aligning them within the ICS.” As such, many ICSs give clinical committees and networks a formal role in their governance structures, offering them top-of-the-table influence over decisions such as managing pathway redesign, tackling health inequalities, supporting innovation and informing the overall clinical strategy at system level.
While arrangements vary across the country, an ICS will tend to have some clinical networks that are mandated by NHS England and aligned to national clinical priorities within the NHS Long Term Plan, as well as locally-determined networks that support specific areas that the ICS has chosen to concentrate on. Many of these also work in parallel with Operational Delivery Networks, which make sure safe and effective services are maintained across each patient pathway.
A wider cast list of influencers
What sort of professionals, then, are members of these networks? The ICS implementation guidance says that clinical participation in strategic decision-making needs to be “fully inclusive”, which means the new power brokers in the NHS reach far beyond the consultant at a major teaching hospital who might have traditionally been seen as a key opinion leader (KOL) by Industry in the past.
These acute specialists, of course, remain extremely important, but they are joined by a far wider cast list of influences, including allied health professionals, pharmacists, GPs, nurses, social workers/practitioners, psychologists, healthcare scientists, midwives, dentists, optometrists, orthoptists and public health professionals, among others.
Crucially too, the power of clinical networks isn’t solely confined to ICS-level discussions. Parallel conversations and relationships are also forming at place level within Place-Based Partnerships (PBPs), and at neighbourhood level through Primary Care Networks (PCNs), all of which influence what happens within a locality and feed upwards into the big strategic decisions about pathway design made at ICS level. As a result, stakeholder mapping is increasingly becoming an exercise in three-dimensional chess in terms of understanding the key personnel, their interrelationships and relative influence up and down the chain.
Engaging clinical networks on their terms
Having completed this mapping exercise, pharma then has to show it is relevant to the goals that these networks are pursuing. So, what sort of questions will they be asking, and how can Industry play its part in helping them find the answers?
The conversation, first and foremost, must be focused on the pathway and the service. Pharma will need to be able to engage substantively on the challenges a pathway is facing and how it could be improved, as opposed to talking about the drug or product itself.
There will be particular interest in value propositions that show:
- How the workforce might be managed or redeployed to make better use of available time and resources;
- How clinical efficiencies could be found, including well-evidenced ideas around prevention, preoperative care and post-operative recovery;
- What contributions can be made to reduce the backlog and support elective recovery, for example by reducing the number of appointments necessary
- How a drug might be better used at a population health level to tackle health inequalities and support under-served populations.
All propositions will need to be costed and demonstrate quantifiable benefits. Industry will also need to show that they understand local targets as described in the ICS’s annual service plans and that they have a grasp of how health inequalities are manifesting themselves within the locality – for example, understanding which groups have been particularly badly affected and how might their outcomes be improved.
“The place of greatest need”
The enhanced role of clinical networks in NHS decision-making also changes the way Industry should think about market access strategy.
Pharma companies may find there are one or two KOLs in a major teaching hospital who have significant influence within a clinical network and at ICS level, perhaps as part of an Integrated Care Partnership feeding into system decision-making. These are obviously crucial stakeholders for influencing pathway change at sub-regional scale, and the temptation is often to go all-in on influencing them.
However, influential players working in clinical network arrangements need more than just big ideas from the top. These networks will need confidence that there is real-world evidence that the proposition works, costed delivery plans, and a clear change management approach to help embed new ways of working in practice.
For this reason, our advice to clients is often to think creatively about your approach to market access. It can often best to start small by directing engagement efforts to the place of greatest need, not the place of greatest power. You may find it is better to identify, say, a district general hospital where you can work intensively to pilot and perfect your proposition and gather the evidence base to support it. It is at this level that you can really build your case for change and start to create momentum across a clinical network.
There are also implications here for account management as the emphasis must now shift from engaging with DMUs and KOLs in individual trusts to working with a wider base of influencers across a system or multiple systems. As such, a strong Strategic Account Management solution is important to help generate a broader and more multi-dimensional engagement approach than might have been considered previously.
Conclusion
In short, clinical networks have long been part of the organisational fabric of the NHS, but the reforms are set to give them new power and prominence within ICS decision-making. Pharma urgently needs to build increasingly sophisticated market access strategies, drawing on a precise understanding of the dynamics and relationships between clinicians work in a given area or locality.
These networks are also poised to become important agents of transformation, driving through ambitious changes to pathways to support population health and make better use of ever tightening resources – and to be part of this story, Industry must show it understand their needs and can make a demonstrable contribution to their goals.
Above all, the latest generation of clinical networks encapsulate the new realities of integrated working in the NHS. Pharma must now adapt its engagement approach to mirror the more fluid and networked mode of collective decision-making that is fast becoming the new order within the NHS. This is no small challenge, and Industry must act fast to answer it.
Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. To find out more about how we can support your NHS partnerships, email info@wilmingtonhealthcare.com.