Patient pathway activation and industry’s role in enabling access to innovation in the NHS

For many organisations endeavouring to launch a treatment in the UK, regulatory approval still carries an implicit assumption that once a treatment is proven clinically effective and deemed cost-effective, the NHS will absorb it. The logic is understandable. Years of evidence generation, regulatory scrutiny and health technology assessment culminate in a decision that confirms value for patients and the system.

In theory, the pathway already exists. Clinicians are in place, referral routes are established, and patients will naturally flow toward a better option. But the reality is more complicated, and the gap between approval and adoption is where many promising treatments quietly stall.

As IQVIA's Transformation and Strategic Development lead in the UK, Arlene Neville, observes that organisations frequently arrive with a sound clinical efficacy argument and an expectation that this alone will shift practice. Instead, they encounter "a very complicated system that often involves many sectors to manage a group of patients," she says.

Unless that complexity is understood, unpacked and sometimes fundamentally redesigned, the result is a treatment with proven value that nonetheless finds no natural home in the pathway.

Demonstrating value is increasingly understood as just one part of the work. Ensuring the conditions exist for that value to be realised in practice is becoming an equally critical discipline.

In a health system as dynamic and structurally complex as the NHS, future-proofing access means doing the hard work of pathway readiness long before a treatment reaches the patient.

Stephen Jowett, senior director and head of Value & Access Services at IQVIA, says the word that matters is activation. "Something has to actually happen," he explains. "It's not just going to happen by osmosis."

Once the focus shifts from approval to delivery, the nature of launch planning begins to change. Rather than assuming uptake will follow, organisations must understand how patients actually move through the system, including where bottlenecks sit, who owns decisions and what operational constraints shape practice. As Neville explains, activation becomes a question of system readiness.

What is patient and pathway activation?

Patient and pathway activation refers to the process of turning theoretical availability of innovative therapies and medical technologies into real-world access. It focuses on ensuring that the system is ready to adopt this treatment innovation once it has been approved, rather than assuming uptake will occur automatically.

This typically includes:

Pathway redesign
Workforce planning
Diagnostic readiness
Referral alignment
Funding flow mapping
Commissioning readiness
Patient identification.

Activation centres on system readiness and ensuring patients are able to move through the pathway and receive treatment.

“Activation … often breaks down when there's a lack of understanding around pathway ownership, operational readiness and … risk transfer,” she says. Without that understanding, demand can be generated in parts of the system that are not equipped to respond, placing pressure on diagnostics, workforce and referral routes. The result is a perception of resistance, when in reality, services are attempting to manage change within existing constraints.

The definition of a successful launch has been evolving for the IQVIA team. “Successful companies designing launches are those that design around system readiness,” Neville says. “They invest in pathway design. They align internal teams around long-term embedding and treating activation as a strategic capability. The key shift … is moving from selling products to building services in the NHS that can realistically run and sustain.”

The implication is significant. Adoption depends on whether the surrounding service model can absorb change. When that groundwork is missing, activity often intensifies after approval. “We see a lot of activity happen naively post-launch when products have stalled in that NICE reimbursement and lack of activation zone,” Neville adds.

What follows is often a cycle of reactive intervention, as organisations attempt to stimulate uptake within pathways that were never designed to support the innovation in the first place. This is often costly and unsustainable.

Designing for a moving NHS

If the activation gap is widening, it is largely because the NHS itself is changing. Care is shifting beyond traditional hospital settings, funding responsibilities are becoming more distributed, and workforce pressures are forcing services to rethink where and how patients are managed. In this environment, pathways that once supported adoption may no longer be viable.

Much of the discussion centres on the shift of care closer to home. While often framed as a move from secondary to primary care, the reality is more complex and more difficult.

“The shift is incredibly difficult because it often involves redistributing workforce without redistributing resources, authority or confidence, … and that is often met with a lot of friction,” Neville explains.

Financial flows add another layer of complexity. “The money has to follow the patient, and that is difficult to do if companies don't understand how money flows in the NHS,” Neville adds.

For Jowett, pathway activation is as much about affordability as logistics.

“The pathway activation piece isn't just making sure that the building blocks … are in the right shape. … It's actually, ‘How do you make sure that something is affordable to establish a pathway?’ That's going to take a lot of siloes to be broken down.”

These dynamics reinforce the need to design launches for the NHS that will exist when a therapy arrives, not necessarily the pathway that exists today.

The cost of waiting

Organisations often find themselves addressing structural issues reactively when pathway design is left until after approval. This can lead to short-term capacity support, temporary service models or patient support programmes (PSPs) designed to bridge gaps in delivery.

“We see companies who perhaps haven't seen activation as a strategic capability within their company,” Neville says. “Because of that, they don't put the energy into investing in pathway design. … They find themselves needing to fill a void in the NHS around capacity. They support with PSPs, putting extra resource and manpower into the NHS.” This is often costly and unsustainable.

While these interventions can improve short-term access, they rarely address underlying pathway constraints. The result is inefficient spend and delivery models that are difficult to sustain once support is withdrawn. “If that spend was aggregated and invested earlier in patient activation, they would get so much bang for buck,” she adds.

Timing therefore becomes central to how activation is approached. When planning begins late in the process, organisations are often left working around structural barriers, rather than reshaping them to meet their needs. In contrast, earlier engagement allows space to understand how services operate in practice and how pathways may need to evolve to support a more sustainable route to access.

Future-proofing access in a changing NHS

Planning for access is closely tied to understanding how pathways themselves are likely to change. That perspective also shapes how far in advance organisations begin preparing.

For Jim McArdle, lead, Patient Services, IQVIA UK, this forward-looking approach starts with horizon scanning. “One of the challenges that I often lay down to companies is the need to horizon scan and to think about the models that we're putting into play now. … Are they going to be future-fit in terms of how the NHS evolves in '27, '28, '29?” he says.

While many companies start considering launch strategy several years ahead, the most meaningful pathway design often sits closer to launch. “The Goldilocks zone is probably 12 to 18 months out in terms of thinking about how new technologies are going to land, and what impact will they have on the pathway,” McArdle explains. “That gives you enough time to start thinking, ‘What are the activities that I need to put in place?’”

From this perspective, activation becomes a shared strategic endeavour. McArdle notes, “There are three sides to consider. First, the company must think about its own impact on the pathway. Second, there is a responsibility to understand what is already happening and what the NHS adoption is likely to look like in practice. And third, what are other organisations doing within the same or adjacent space?”

The challenge is amplified when organisations move into unfamiliar therapy areas or care settings. “A company focused in general medicine, and all of a sudden, they're moving to precision medicine, they have to accelerate learning into that particular therapy area,” McArdle says. A similar shift occurs when companies move between secondary and community settings, requiring what he describes as “a quantum leap” in understanding how services operate.

Taken together, these pressures reinforce the notion that future-proofing access unfolds over time. Companies make a concerted effort to understand existing pathways and gradually reshape them in anticipation of change, rather than scrambling to adapt after launch.

This also requires a shift in mindset. “One of my biggest observations has been that what we define as ‘pathway activation’ … isn't perceived as being a problem that industry needs to solve,” Neville says.

Yet, as the NHS continues to evolve, access increasingly depends on shared ownership of that challenge and on collaboration to carefully unpack the complexity that sits between approval and patients. As highlighted by Rowland Sinker in his 2025 review into the NHS Innovation Ecosystem, “Innovation is more important than ever. Our healthcare system is changing, and it must.”

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About the authors

Arlene Neville is head of NHS engagement & transformation, IQVIA. She has spent 18 years as a senior manager in the NHS. Most recently, as a commissioner heading up the transformation and integration agenda around primary care and long-term conditions. Neville’s experience in the NHS spans public health, acute provider, and ICS, and she has worked at a regional and national level.

Stephen Jowett leads IQVIA’s teams that encompass Market Access Strategy, Pathway Transformation and V&A Analytics with a particular focus on enabling collaboration between the NHS and the life sciences industry. He has worked extensively within innovation and digital enablement in healthcare, strategy consulting and service re-design.

Jim McArdle is senior director, strategy & business development, interface clinical services, IQVIA. After qualifying as a pharmacist, McArdle worked across many sectors of pharmacy both in the UK and internationally. He has led on many projects designed to improve the lives and wellbeing of patients across primary and secondary care and recognises the value in collaborative working between the NHS and life science sector, to bring innovative solutions to health economies and to patients. McArdle has a BSc in Pharmacy from LJMU and a Master’s in Business Administration (MBA) from the University of Liverpool.

About IQVIA

IQVIA (NYSE:IQV) is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. IQVIA’s portfolio of solutions are powered by IQVIA Connected Intelligence to deliver actionable insights and services built on high-quality health data, Healthcare-grade AI, advanced analytics, the latest technologies and extensive domain expertise. IQVIA is committed to using AI responsibly, with AI-powered capabilities built on best-in-class approaches to privacy, regulatory compliance and patient safety, and delivering AI to the high standards of trust, scalability and precision demanded by the industry. With approximately 93,000 employees in over 100 countries, including experts in healthcare, life sciences, data science, technology and operational excellence, IQVIA is dedicated to accelerating the development and commercialisation of innovative medical treatments to help improve patient outcomes and population health worldwide.

IQVIA is a global leader in protecting individual patient privacy. The company uses a wide variety of privacy-enhancing technologies and safeguards to protect individual privacy while generating and analysing information on a scale that helps healthcare stakeholders identify disease patterns and correlate with the precise treatment path and therapy needed for better outcomes. IQVIA’s insights and execution capabilities help biotech, medical device and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders tap into a deeper understanding of diseases, human behaviours and scientific advances, in an effort to advance their path toward cures. To learn more, www.iqvia.com.

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