Steve How, Paul Midgley and Oli Hudson, of the Wilmington Healthcare consulting team, explain how pharma should make its case for change
There is a real drive for change within the NHS to ensure its sustainability in the long-term. However, discussions and decisions about transformational change mostly take place within the highest echelons of local NHS organisations.
However, NHS England’s ‘Planning, assuring and delivering service change for patients’, which provides a good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration, states that clinical engagement and approval, and strong clinical evidence are key.
Assurance for NHS management within this paper means: is there documented evidence that the transformation process has looked at clinical best practice and engaged relevant clinical stakeholders? If not, the clinicians have a route to challenge the proposed changes.
Elements of the guide can be applied to lower levels of change, such as the introduction of new drugs to improve care pathways. This provides a powerful opportunity for pharma to activate clinicians to take a lead in service change and engage with other key stakeholders. It can also help pharma ensure that it fully understands the tests and assurance checks that should be applied to new drugs and services.
Getting the message across to clinicians
Pharma should keep clinicians abreast of transformational change that is happening in relevant disease areas and make sure its customers are consulted on it. By ensuring proposals are in line with the NHS England guidance and gathering as much clinical, and ideally real world, evidence as possible about the benefits of a new drug or service within the whole pathway, pharma can then demonstrate how it could add value to the transformation process.
Clinicians are very disease orientated, so for them the direct impact of a drug on patients, such as its ability to reduce side effects, is the overriding priority. However, commissioners are service focussed and such benefits are unlikely to be sufficient to convince commissioners to invest in a product since they are under pressure to deliver on much wider priorities, such as reducing the burden on A&E and on hospitals generally.
Pharma can help this discussion by supporting clinicians in reframing clinical benefits to highlight wider service benefits within the whole patient pathway, even outside a specific disease area. For, example, they could show the current cost and workforce implications of patients who do not tolerate current treatments and potentially need appointments and reviews, versus the cost of new treatments with better efficacy or side effect profiles.
NHS RightCare provides examples of this with its long-term condition scenarios, such as ‘Susan’s Story: Osteoporosis’, where costs are shown to be reduced by a factor of 10 if Susan is treated within an optimal care pathway.
Engaging with other key stakeholders
Having the right evidence base and framing the right messages in the right way to the right clinicians is a key step. However, pharma also needs to engage with other key stakeholders involved in transformational change and ensure that its value proposition is tailored according to local budgets and priorities as well as national ones.
Facilitating engagement between key stakeholders
This is a key area where pharma can step in and get its customers, e.g. consultants and GPs, together to help them understand NHS transformation. Pharma could also offer to help transformation leads bring relevant stakeholders, such as clinicians and multi-service providers, together to better understand change and manage pathways.
There is an opportunity for pharma to activate clinicians within service change by making them aware of what is happening in their area and ensuring they understand the benefits of a new drug or service from both their own and a wider commissioning/transformation perspective.
Pharma can also take a lead in facilitating discussions between clinicians, transformation leads, medicines management staff and other key stakeholders/opinion leaders to help them better understand each other’s needs and priorities, and to ensure that proposals really will deliver the greatest possible value to the NHS.