A new ABPI president; a new take on health, productivity, and partnerships – ABPI Conference part two

Market Access
A new ABPI president

As the Association of the British Pharmaceutical Industry (ABPI) announces that Susan Rienow, UK managing director and country president of Pfizer, is formally taking on the role of president of the ABPI, it seems fitting to hark back to the organisation’s Annual Conference last month.

As president, Rienow – who previously served as vice president of the ABPI and co-chair of its Vaccine Group – will be tasked with, among her other responsibilities, the key priorities of agreeing a sustainable successor to VPAS, as well as securing better access to innovative medicines and vaccines for patients on the NHS. And such topics, among others, were keenly debated at the ABPI’s conference.

Improving the health and productivity of the whole of the UK

During the afternoon, a panel discussion was held with Simon Newton (GM UK & Ireland at Jazz Pharmaceuticals and ABPI Board Member and vice chair of the Small Companies Forum), Sharmila Nebhrajani (chairman of NICE), Sarah Woolnough (chief executive officer at Asthma + Lung UK), Sally Lewis (director of the Welsh Value and Health Centre, and a practising GP), and David Lowe (clinical director of the Scottish Health Innovation Partnership and emergency medicine consultant at NHS Greater Glasgow & Clyde).

What Simon Newton channelled his focus on was the sadly ever-present question of access: that pharmaceuticals need to be made available for the whole of the UK. A large part of the problem is the time between marketing authorisation and availability on the NHS, and poor access to new medicines results in poorer outcomes for patients across the country, he said. This does not serve patients, which is the entire point of all industry roles. Instead, decisions about medicines, he urged, must be made a lot more quickly and efficiently and implemented within health systems.

Openness, transparency, and accessing primary care

Sharmila Nebhrajani, meanwhile, noted that within a single year, NICE typically has an objective for 120 technology appraisal (TA) decisions, but this is normally between 98 and 100. The backlog, she said, comes from decision-making – increasing the capacity for NICE to make quick decisions in line with the needs of innovative medicines, thereby matching processes with the risk and complexity of the model(s) under consideration, is crucial. As yet, however, there has been no change to suit the changes elsewhere.

This, in turn, requires an open and transparent consultation programme, said Nebhrajani. This would entail a streamlined approach, taking molecules of similar disease pathways together, minimising 44 weeks to 20 weeks, with well-structured evidence, an obvious clinical need, and a ‘benign clinical environment’ permitting a decision to be made outside of the normal committee process. After all, she said, 40% of appraisals at NICE come from ten disease areas. On the guidelines side, it would in part help the adoption curve by reorganising guidelines by topic suites – HTA decisions, clinical guidelines, quality standards – with a common vocabulary and economic modelling.

Newton was buoyed by the premise of this and asked Sarah Woolnough to provide the patient perspective. Stating that, as a charity, Asthma + Lung UK hears real-life examples frequently, taking 30,000 calls on its helpline each year – Woolnough noted that the single, biggest theme that comes across is the difficulty patients experience in accessing primary care. And in lung health, there has been a particular problem post-pandemic, as spirometry – the formal diagnostic test for lung health – isn’t being delivered in primary care, and if a patient isn’t given the right diagnosis from the start, then the gold-standard of care further downstream just won’t eventuate.

Woolnough provided the further example of three and a half hours sat at a severe asthma clinic in Barts Health NHS Trust – the “NHS at its very best”, she said, promising life-altering asthma biologic drugs to people suffering. However, the wait to get there has, for some, been about a year.

Nevertheless, Woolnough allowed that because the health service is “running so hot”, there often isn’t the ‘headspace’ for changes to be enacted or embedded in new treatment regimens. Capacity must be freed up somewhere in order to “get people through the system swifter”, she said. And partnership is what can help in that regard. Having spent 15 years at Cancer Research UK before her present role at Asthma + Lung UK, Woolnough stated that it is data that will enable the analytics to drive better adoption of best practice guidelines.

To paint a clearer picture, Woolnough explained that in lung health a patient is seven times more likely to die from their disease if from the lowest income communities. There remain stark inequalities. In this respect, charities and industry must work together, she said, to drive positive change and spread the opportunity that exists to take part in research and clinical trials. Championing research is a route to access for deprived communities.

Old models of care, readdressing the inverse care law, and navigating SHIP

At this point, Newton invited Sally Lewis, who recently published on sharing health systems across the world, to provide her thoughts on a value-based healthcare approach. At base, Lewis made it very clear that the healthcare system as it stands in terms of healthcare delivery was a system designed to meet very different population needs than those that exist today. So, essentially, she said, people are presently being put into old models of care, and this is failing to work both for patients and for those working in healthcare. Valuing health, rather than HTAs, is the approach that’s needed; changing delivery of healthcare so that it is easier to adopt new medicines. Looking at all the key stages of the pathway – prevention, diagnosis, intervention, follow-up – it’s about patient outcomes essentially, not clinician outcomes.

Data must fundamentally be sorted out from being a “dusty clinical report” once a year to being an ongoing process all of the time, marrying up clinical outcome data with patient data – and by valuing health, that can be driven, she said. Additionally, when digitally communicating with patients, that same technology can be used to support their care, as well.

Touching upon equity in the adoption of new medicines, Lewis made mention of Julian Tudor Hart’s 1971 paper on the inverse care law and how, in fact, the situation is now worse than it was then. Lewis urged that the inverse care law, therefore, be readdressed and access to medicine finally improved. That, she said, is the wishlist.

Finally, Newton asked David Lowe what his thoughts were on the Scottish Informatics Programme (SHIP) to foster partnership between bodies in collating, managing, disseminating, and analysing anonymised Electronic Patient Records (EPRs) and, indeed, what the ingredients of a successful partnership are. Lowe replied that, in Scotland, there has been investment in test beds and a broader understanding developed of the shared purpose of academic and industry colleagues, including an investment in “the capability of people”. He himself a clinical academic, he told how the problem is onboarding and getting through 5,000 patients from diagnostics to long-term condition management: there is a necessary time investment, and such partnership is crucial.

All things considered, it will be interesting to see how Susan Rienow steers matters.