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PBC and partnership13/03/2007
The White Paper Our Health, Our Care, Our Say was published in January 2006. Last October, a follow-up report highlighted early progress in 60 pilot sites across England. What are the implications for the pharma industry?Currently, the latest round of Local Delivery Planning (LDP) is embedding the ambitious reform programme laid out in the White Paper into local NHS business plans at PCT and acute trust level. PBC plans for 20078 will be in place by early summer, and will reflect the tactics that groups of practices will employ to deliver many of the themes identified in LDP.It is vital, therefore, that you are aware of the key features of the White Paper in order to identify where opportunities may arise in NHS plans, to know which buttons to press when engaging with key customers, and to check that your product messages are consistent with the needs of the local market. The White Paper: four target areasThe White Paper aims to spread local best practice onto a national scale in four key areas: prevention and early intervention; choice and patient involvement; improving access and tackling inequalities; and meeting the needs of people with long-term conditions.The document is liberally sprinkled with case studies of best practice from around the UK. As the October progress report suggests, partnership working by all stakeholders in healthcare including the NHS, social care and pharma is crucial to making this agenda work. Opportunities for pharma involvement1. Prevention and early intervention places emphasis on:Increasing self-care and appropriate conditions management this links to patient education, a key area in which pharma can engage with commissioners and patients. More POM to P switches will also give patients more self-care choices. More homecare using technology e.g. monitoring of long-term conditions by the patient and/or healthcare professionals in the patients home, allowing virtual wards to be run by community teams. Tackling obesity along with predicted changes to QOF in 2008 to bolster this programme, this is a major area of public health strategy that links to many long-term conditions and provides opportunities for local and national joint working. Increasing resources and planning for prevention and early intervention this links to the use of predictive modelling, using demographic and health data. It offers pharma companies opportunities for market expansion, and enables them to work more closely with public health organisations, commissioners and patient representatives to tackle health inequalities. 2. Choice and patient involvement highlights these priorities: Increased information on, and more input into, support packages for service users and carers. Local service user input/feedback on services, to be actioned where problems are identified. Increased user satisfaction with the care package. New patient experience monitoring bodies called Local Involvement Networks (LINks) will be set up by the end of Q2 this year to gather feedback from service users. They will feed information to the local authority Overview and Scrutiny Committees (OSCs), which can challenge public funding for services found to be underperforming. It is important for pharma to tap into this aspect of patient involvement to gather support for new initiatives or safeguard existing ones. Companies involved with PBC clusters in service redesign initiatives would do well to involve their local LINks. 3. Improving access and tackling inequalities covers a range of opportunities: An increasing range of urgent care services. More GP-led minor injury units, more paramedic-based services, and a smaller number of trauma centres will all mean new customers in new settings. Joint working between health and social care communities and authorities to reduce inequalities. Do your NHS development executives have links to their local authority KOLs, who have joint Health Improvement objectives with their PCT colleagues and sit on joint Local Area Committees? These people may be influential. Easier registration with GPs and improved access and convenience. This will mean a wider range of companies running primary care practices, including private providers. Think about how your sales teams will work with these new customers, who will probably employ their own salaried prescribers. More community-based services. One aspect of this is improving community support for patients discharged from hospital: patients will be discharged earlier and need ward-style support in their own homes, providing an expanded market among community nurse and district nurse prescribers. Another aspect is shifting acute services from hospitals to the community. Service redesign is a major focus for PBC groups and PCTs trying to reduce the need for hospital admissions by expanding the Tier 2 services available in the community. Use of GPwSI and other PwSIs has been augmented, with consultants running community-based clinics, diagnostics and procedures. Specialities targeted for service redesign include dermatology, ENT and gynaecology. Instruct your representatives to keep track of new providers, and make sure your CRM system is up to date. Does your NHS data provider have up-to-date information that can be integrated into your CRM system? 4. Meeting the needs of people with longterm conditions covers some of the following priorities: Increased support for self-care and increased availability of Expert Patients and Expert Carers programmes this links to patient education, and to working with patient support groups and local expert patient tutors. The programme is being expanded tenfold with additional public funding. Any service redesign should include patient education. This is a huge opportunity for pharma to help patients understand the long-term benefits of different treatments and demand the best they can get as we are seeing currently with the public debate on treatments for Alzheimers disease. Do your local teams know who is involved in the education of target patients and KOLs with roles in local patient support groups? Does your marketing team have a strategy for reaching these customers? Users and carers to receive a choice of services as close to home as possible. Prevention of avoidable hospital admissions this is a major preoccupation of PCTs and PBC commissioning groups, with huge potential for cost savings. It links to service redesign and the use of predictive modelling, as well as community matrons and other community nursing specialists working alongside practices to manage frequent fliers outside hospital. Major initiatives to reduce emergency admissions are focusing on patients with COPD, palliative care needs, diabetes and CHD. This is another opportunity for pharma to engage in service redesign. Essential steps to takeTo engage in service development initiatives, you need to do the following:Market intelligence gathering/Analytical ability/Joint business planning The whole primary and secondary care team need to know what is on the PCTs (or each PBC clusters) service redesign agenda, understand what the data says about trends, and produce an integrated plan for working priority clusters. Networking/Influencing With key individuals in high-potential clusters or high current users. Between secondary care and primary care KOLs. Provide examples of redesigns from elsewhere. Network your KOLs with innovator KOLs from areas that have successfully redesigned a similar service. Facilitation/Partnership Set up meetings to organise, facilitate and fund at local or national level: with board/steering group stakeholders with the full service redesign group (multidisciplinary) with the full cluster group (all practices represented). Evidence for guideline/formulary inclusion Medical Information evidence pack for your product. Local/national KOL endorsement, plus copies of existing protocols. Business case, using health outcome data to prove long-term cost-effectiveness. Flexible deployment/Tailored data/Local marketing capability Once product is on guidelines, pull through by publicising guidelines in calls and at meetings, using locally-approved materials developed with customers. Give local management authority to deploy flexible resources depending on local market conditions.
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