Steve How, Paul Midgley and Oli Hudson, of the Wilmington Healthcare Consulting Team, find some answers in NHS England guidance for commissioners
NHS England’s ‘Planning, assuring and delivering service change for patients’, which was updated in March, provides a good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration.
Many elements of it, particularly the need for clinical engagement and approval, and strong clinical evidence, can also be applied to lower levels of change, such as the introduction of new drugs to improve care pathways.
Clinician involvement in service change
According to the document, the Government’s four tests of service change are: strong public and patient engagement; consistency with current and prospective need for patient choice; clear clinical evidence base; and support for proposals from clinical commissioners.
The guidance makes it clear that front line clinicians affected by proposed changes should be involved. It says clinicians should ‘determine and drive the case for change, based on the best available evidence’.
It also states: “Clinicians are powerful advocates and play an important role in communicating the benefits of change to a wider community.” For complex change, it suggests that commissioners should consider seeking Clinical Senate advice.
Although clinical engagement currently happens at a micro level, with some commissioners taking leads from particular clinicians, it often gets overlooked in transformational change involving multiple pathways and transformations. This can, of course, lead to major problems further down the line if clinicians disagree with it.
However, although it makes sense for the staff involved in implementing service change to be the people who ‘drive’ the original concept, front-line clinicians and clinical commissioners tend to have very different priorities.
Consequently, clinicians often find it hard to make the case for a transformative product or service because they do not understand the wider commissioning priorities and are not able to couch their case for change in the right terms.
Equally, commissioners can find it hard to win clinicians’ hearts and minds on change.
Why is assurance important for pharma?
If transformation is happening within a service and it is affecting a relevant product or disease and therapy area, pharma needs to understand the levels of assurance required and ensure that local transformation agencies are aware of them too.
To engage with key stakeholders, pharma should highlight the relevance of its product in the context of transformational change and show how it will enhance care pathways in terms that will resonate with different audiences involved in assurance.
Strong evidence-based material will be essential for these conversations.
Pharma should ensure its proposals align with current NHS best practice, such as NHS RightCare, which has defined optimal patient journeys for various conditions.
If pharma feels that assurance processes have not been followed, for example, with regards to clinician involvement, it could challenge commissioners about their clinical evidence base and the people they have consulted.
It could also help clinicians who are concerned about service change, and feel they have not been fully consulted, to gain a wider consensus of opinion among other groups of clinicians and establish an evidence base.
Engaging with clinicians and other key stakeholders
The fact that clinicians are central to service change provides a golden opportunity for industry to make its case for potentially transformative products and services.
Pharma can educate clinicians about transformational change that is happening in their area, the implications of it and why a potentially transformative new product or service is needed from the clinician’s perspective.
It can also enable clinicians to ‘drive’ service change by helping them to understand transformation from the perspective of a commissioner who is likely to take a much wider view on the improvements and cost-savings that change can bring to other parts of the NHS, such as A&E.
Once clinicians are on board, pharma should identify and engage with those involved in commissioning and service transformation. Pharma should then define the needs of those different groups and develop messaging for them. It could also support and help transformation leads, particularly at the micro level, in getting wider consultation and ensuring that new products and services are signed off at the right level and that clinicians fully understand the need for change and are supportive of it.
The assurance processes laid out by NHS England for commissioners provide useful insights for pharma on why it should tailor its own approach to transformation in line with NHS best practice, and the level and type of engagement required to gain the necessary assurance.
This engagement should range from educating a clinician about a product, or service and helping them to drive change by understanding the wider transformation picture, to liaising with commissioners and transformation leads to prove how a proposal will be truly transformational.