Paul Midgley, Sue Thomas, Steve How and Oli Hudson, of Wilmington Healthcare, explore how pharma should adapt its approach
Since the publication of the Five Year Forward View, the NHS has undergone rapid structural change. This has resulted in an increasingly complex, multi-layered healthcare system that is seeing some GPs taking on wide-ranging responsibilities in Integrated Care System (ICS) areas.
It has also resulted in a diverse range of stakeholders becoming involved in NHS service planning, with local authority officers taking on some key STP leadership roles, for example, as opposed to clinicians; and the third sector and patient groups becoming increasingly influential.
Shift in GPs’ prescribing power
Many GP surgeries now work collaboratively in networks or hubs, which may have a prescribing arrangement across a Federation, a CCG, an STP, or even across multiple STPs. Consequently, some GPs have grown more influential as they have assumed extra responsibilities following the structural changes.
In order to engage with GPs effectively, pharma needs to define the decision-making power of individual GPs. It also needs to know of any pressures that exist to prescribe in a certain way within a network or hub; what formularies they are on and the size of their local Area Prescribing Committee (APC) footprint.
Based on this knowledge, pharma then needs to segment its key GP customer groups and ensure that it is delivering the appropriate message and deploying the right level of resource to each type of GP. This should involve assigning one senior level executive to manage the relationship with a particularly influential GP.
Group consensus is key for STPs
STPs were introduced to build on the work of the Vanguards and implement a place-based care system that incorporates both health and social care. Collaborative working is key to achieving these goals.
STPs encompass a variety of stakeholders ranging from representatives of Academic Health Science Networks (AHSNs), clinicians and pharmacists to local authority officers, charities and patient groups. Indeed, many local authority officers hold key posts in STPs as well as clinicians. These stakeholders attend key decision-making meetings and group consensus is often required in many STP areas before any significant changes can be implemented.
Some of these stakeholders are new to pharma and in order to engage with them it must do more than simply sell products – it must gain their trust in its shared values and philosophy. It must also demonstrate that it has a huge amount of expertise in specific diseases and therapies, and can lend support in areas such as providing real world evidence to inform patient pathway development and optimal care.
Integrated Care Systems (ICSs)
Integrated care systems (ICSs) bring together NHS providers, commissioners and local authorities to work in partnership in improving health and care in their area. They will take the lead in planning and delivering care for their populations and providing system leadership.
Key decision-makers in ICSs will grow out of STPs, Vanguards and other new care models, such as primary and acute care systems (PACS) and multispecialty community providers (MCPs), which both seek to integrate care and improve population health. PACS and MCPs take different forms in different places but share a focus on places and populations rather than organisations.
A lot of service improvement managers currently employed by Clinical Commissioning Groups (CCGs) may transition over to work on the provider side in ICSs to ensure transformation happens, or they may work in an alliance within the ICS. A similar situation is likely to occur with middle managers in CCGs; while senior commissioning managers and executive managers may take on new roles as strategic commissioners within CCGs or STPs.
In terms of engagement, it is currently a complex and changing picture for pharma. The way services are planned will depend on factors ranging from what has happened in the past and what facilities are currently available to who is in charge, and whether it is an urban or rural location. Keeping a close watch on the developments in each locality will be key and will require cutting edge Customer Relationship Management (CRM) tools, combined with effective real time insight feeds to analyse the impact of changes.
Pharma must keep abreast of new care models that are emerging in different areas across England, be mindful of the variety of responsibilities that key customers hold and take a tailored approach to engagement across different geographical areas and with individual clinicians. Pharma must also sell its company and its philosophy to other key stakeholders and keep abreast of their activities in relevant disease and therapy areas.