Bridging the gap

Alan Naismith

EPIC Consultancy

After the devastating floods in Cumbria in November an analogy about bridges may seem a little tasteless, but it is very apt.

The bridge I refer to is the one formed by the pharmaceutical sales force that spans the gulf between the industry and the NHS. Sadly this bridge is crumbling, undermined by decades of erosion caused by the industry’s ‘share of voice’ sales model and bad PR from alleged use of biased and unrepresentative data. The torrent that is the Association of the British Pharmaceutical Industry (ABPI) code of practice is now pounding away at the remaining foundations, having restricted the ability of reps to offer service in the traditional way.

Over the last two to three years we have witnessed around 40% of the masonry washed away and we must now make the critical decision, avoided for so long – whether or not to prop up and repair the structure or leave it to collapse into the void below.

Resigned to the fact that it has got it horribly wrong with its prescribing customers, and with no idea of how to put things right the industry has taken the easy option, which is to surround the bridge with red tape, pretend that it is still functional, and hope that no one attempts to cross. Meanwhile they have spent years trying to find alternative ways of reaching the other side.

They have managed to build a new much smaller bridge upstream towards ‘The PCTs’ (regional primary care trusts for those readers less familiar with the UK market), a relatively new town where a crossing is perceived to be easier. But just as traffic is beginning to cross news reaches us that the main employer in the town, the NHS, is set to relocate its power base in the ancient city of ‘Local Practice’ and so this new bridge is going to be a hell of a long way for a shortcut!!

Decisions, decisions…

So the choice is clear – repair the old bridge or get set for the long journey upriver, across the bridge at ‘The PCTs’ and back down the other bank. Of course any repairs to the bridge will be subject to ABPI ‘building control’ which in itself is likely to leave most companies wondering whether such a move is even vaguely worthwhile.

It has always been convenient for politicians and Department of Health officials to blame inappropriate prescribing for NHS overspends and to cite industry behaviour and influence as the cause. Indeed, the ABPI often seems willing to accept the industry is culpable and regularly ratchets up the code of practice as a way of demonstrating its control over the companies that pay for its very existence.

Whilst these companies know that the association between sales and service is misrepresented and has never really been an issue for their customers, they blindly fall into line in the common belief that the industry can walk on water and that bridges are actually superfluous.

OK, so I am being facetious, but the message is clear. If the industry is to rebuild any kind of credibility it has to engage with its customers at local practice level. That means not just repairing the bridge but widening it to allow two-way traffic. The bridge has to be safe to use and the inhabitants of ‘Local Practice’ encouraged to use it.

Now, the one thing the industry has not considered is what happens if the NHS tries to rebuild the bridge from the other side. Far fetched? Well, perhaps not.

“Medical reps are still seen by most of their customers as intelligent, well-educated, well-trained individuals with much to offer.”

The fact is that whilst the reputation of the industry as a whole is badly tarnished, medical reps are still seen by most of their customers as intelligent, well-educated, well-trained individuals with much to offer. There is an understanding that whilst never trained to actually engage or sell, medical reps used to be quite useful and helpful and that their current situation is not of their own making.

There is a belief that pharmaceutical companies should be working with local practices to develop and expand healthcare provision to local patients. By working together it is possible to identify more patients from target groups, create the infrastructure needed to assess and treat them, ultimately using more medicines.

Health professionals are being educated to understand that of course there is no such thing as a ‘free lunch’, but the quid pro quo for pharmaceutical companies is perfectly acceptable. More patients identified, assessed and treated means more medicines are used. Everybody wins.

Doctors acknowledge the commercial needs of supporting companies and seek to make the connection between the services provided, the rep and the company providing them and the brands the company sells. The association is therefore made between service and brands, as illustrated in figure 1.

 Figure 1

Figure 1: Connecting service and brands

NHS customers are now looking at ways in which they can help medical reps to rebuild the bridge and are happy to meet them somewhere in the middle. They agree that in the right environment, in the right circumstances, they would be prepared to sit down with local reps and have a meaningful (perhaps even commercial!) discussion about how they could work together for the benefit of patients.

Just shut up and listen, OK!

All they ask is that reps come in and listen, try to understand their customers’ issues and needs, and accept that this not an opportunity to promote their products.

Of course, customers cannot be expected to forget their experiences of the industry over the preceding years and there is a huge amount of mistrust, cynicism and worry that companies and their reps won’t be able to make the transition. Nonetheless they are prepared to try.

In my work with the The EPIC Consultancy I have seen positive changes, working with local practices and Practice Based Commissioning (PBC) clusters to facilitate this process, to invite in representatives and to help them engage with GPs, practices nurses and managers. Our role is to aid the process and, yes, to ensure that everything complies with the ABPI code of practice.

For too long, local representatives have, at best, been seen merely as product vendors, and at worst, as pests. They could and should be seen as allies, there to help as part of the team.

As services are relocated from hospitals into primary care, local practitioners and PCTs are struggling to meet targets and to establish the new services that are demanded. Critical to this is the lack of infrastructure, trained staff and time.

They want help and they want it now. Time is running out. The industry has one last chance to get it right before the bridge collapses completely and the opportunity is gone for good.

Does the industry have its head in the sand?

Interestingly, when we started this project in March 2009 we expected the industry to be behind us and that it would be the NHS that needed persuading. Nine months down the line the situation is quite the reverse.

We have been astonished by the enthusiasm shown for this by the NHS and it is the pharmaceutical companies who seem slow to recognise the opportunity. For whatever reason, advances to the industry about this initiative have been shunned and it feels like trying to converse with an ostrich that has its head buried in the sand! To me, this is ignoring the opportunity to really engage with the people that matter – the health professionals themselves.

We feel we have offered the industry a clear solution, which could not be easier or more transparent.

So here is my challenge upon which I would welcome feedback:

Can the industry ultimately grasp the opportunity and do something without years of procrastination, pilot projects, regulation and bureaucracy?

Can it give its customers the professional courtesy and respect they deserve and trust the sales force to engage constructively with them, to establish new working relationships where everyone can work together for mutual benefits?

We have the solution and are happy to support any companies willing to take the first steps in establishing themselves as true allies and partners to the NHS, so please let me know your views.

The bridge is still up……for now.

About the author:

Alan Naismith is Managing Director of The EPIC Consultancy, an organisation dedicated to helping local health professionals engage with commercial partners.

For more information please email or visit

Is UK pharma moving too slowly on joint working?