Joint working: Three legs are better than one

Paul Tunnah

pharmaphorum

The UK PM Society has been taking a keen interest in the topic of “joint working” recently, recognising that the landscape for those involved in pharmaceutical marketing is changing quite significantly. While the term joint working may be more UK centric, the concept and changes it represents are being echoed in many regions of the world, the fundamental shift away from didactic push selling of medicines toward working in partnership with healthcare providers in order to achieve mutually beneficial outcomes.

So earlier this month it was interesting to attend a half-day meeting organised by the PM Society entitled “Delivering mutual benefit from NHS and pharma partnerships – grasping the opportunities”, particularly at a time when the UK government has announced such radical changes to the structure of the NHS through its recent White Paper. For those who have not been following this market so closely, the 152 primary care trusts (PCTs) responsible for the management of local healthcare across England will be abolished, with control of prescribing decisions instead being governed by a number of GP consortia – the exact number yet to be determined with estimates ranging from less than 100 to over 500.

"...effective joint working being analogous to the three-legged stool that only functions as a whole where all three groups operate supportively together."

However, beyond pharma and the healthcare providers there is an obvious third group of stakeholders who are inherent and critical to this equation – the patients. Hence, the analogy many have drawn of effective joint working being analogous to the three-legged stool that only functions as a whole where all three groups operate supportively together. It is this three-legged stool that describes the “win-win-win” scenario where each party gets what they want out of it.

The challenge, of course, is that in practice each “leg” of the stool comes with its own agenda and objectives, which may not at face value be compatible. So how can we make joint working actually succeed and become more than just another buzz term?

Roy Lilley, a well known and vocal writer, broadcaster and commentator on healthcare issues, chaired proceedings during two sessions exploring joint working from all angles. For those who don’t know Roy, he is not only a lucid speaker but also not afraid to ask the hard questions in the interests of getting to the heart of the matter – more on that later!

So what’s in it for the healthcare providers and patients?

During the first session, Sarah Philips, who heads the Ipsos MORI Health division, outlined how over 70% of the public surveyed view the NHS as crucial and that the government must do everything possible to maintain it. Furthermore, there is strong support for more control being handed back to the front-line physicians, with 68% agreeing that reducing bureaucracy through such a move would be a good thing. This would suggest overall support for the government’s White Paper and the future use of GP consortia.

But here’s the challenge – moving the power back to the doctor also puts them back in the firing line when the patient does not agree with that decision. Bear in mind that doctors are now dealing with better-educated patients, who are often coming with their own view of what the appropriate treatment should be and you have an explosive combination. It is therein that an opportunity arises for joint working, in terms of providing support and training for physicians and nurses in dealing with such scenarios, who have flagged such input as high on their wish list.

Dr Chris Packham, Director of Public Health at Nottingham City PCT and Dr Neal Maskrey, Director of Evidence-Based Therapeutics at the National Prescribing Centre then elaborated on the perspective from the healthcare providers. Dr Packham is one of those whose role will sadly be rendered redundant by the abolition of the PCTs, but he has been actively involved in collaborative projects with pharma and both he and Dr Maskrey have worked as GPs so are close to the patient perspective.

"...doctors are now dealing with better-educated patients, who are often coming with their own view of what the appropriate treatment should be..."

The Nottingham PCT has been involved in a number of partnership initiatives focussed around public health, such as the ‘Happy Hearts’ campaign to encourage high-risk patients to come in for cardiovascular health screening. It is these kinds of campaigns that were highlighted as being potentially difficult for GP consortia to manage moving forwards, with essential strategic planning and project management skills in short supply and something pharma is highly skilled in. Dr Maskrey also reinforced this point, highlighting that GPs are typically used to working autonomously, rather than being involved in joint project decisions (another challenge when dealing with the increasingly educated patient!). This can only serve to exacerbate the differences currently seen in treatment protocols across different PCTs once the GP consortia are in place, unless cross-consortia support is provided – an area where again pharma could play a role.

How can pharma best contribute?

The afternoon session featured two representatives from the industry – Andrew Davis, who recently returned to pharma as Sales Director at Lundbeck, and Andrew Roberts, Head of Partnerships at AstraZeneca.

However, before they shared their thoughts the the ever-vocal and engaging Omar Ali (Formulary Development Pharmacist at the Surrey &amp, Sussex NHS Trust), who works closely with the UK drug pricing watchdog the National Institute for Health and Clinical Effectiveness (NICE), presented some home-truths to the industry. The advent of value-based pricing means that unless medicines are developed to present real clinical evidence to show long-term cost-savings over existing treatments they simply will not be recommended for use. But critically, this is not just about cost of drug at the point of prescription, but also whether use of that drug results in lower associated costs once the patient is taking it, e.g. does it really work better? The message to pharma is clear – familiarise yourself with the NHS Outcomes Framework and be ready to offer innovative pricing mechanisms that encourage use of the right medicines both at and beyond point of prescription (the suggestion being that prescribers should also be incentivised on the forward outcomes).

And so to the industry perspective. Andrew Roberts proudly spoke of the joint working initiatives being conducted by AstraZeneca, with 15 programmes already underway in the UK. However, he also highlighted what he perceived to be the difference between true joint working and merely collaboration, with the focus for the former being on the patient and working to mutually agreed objectives, rather than simply helping each other meet separate objectives. A challenge therefore for pharma – you may think you are doing joint working but are you actually working to agreed and mutual objectives for the benefit of the patient?

True joint working can indeed be likened to that most cohesive (one hopes!), but sometimes challenging, of relationships – a marriage. Andrew Davis drew analogies here to how trust and communication are as inherently critical to joint working as they are to any marriage, in addition to wanting to move in the same direction. He acknowledged that the industry has much work to do in order to regain trust from the healthcare providers and patients, that the positive discussion around joint working must be accompanied by a real change in operational practice. He reinforced his point with a challenge that, despite much talk of collaboration and engagement, a majority of the typical pharma marketing budget remains focussed on the unidirectional selling mechanisms such as the detail aid armed rep.

"Therefore, the predominant challenge remaining is for pharma to determine what it gets in return..."

Overall, some good discussion around current initiatives and how mutual objectives can be assured – so surely a bright future for joint working? Well, here’s that killer question from Roy Lilley that I alluded to earlier - what’s in it for pharma?

Clearly, better trust and access to healthcare stakeholders and patients will yield benefits to the industry over the longer term. However, to justify the investment required to sustain such joint working initiatives in the shorter term I suspect Chief Executives, under pressure from shareholders, will want to measure a positive commercial impact in a much clearer and immediate way. No one had an easy answer to that one.

Are we sitting comfortably?

In conclusion, if we go back to our three-legged stool representing the win-win-win scenario, it’s still looking a bit wobbly. Clearly, the commercial experience and resources available to pharma could yield significant benefits to the healthcare providers and patients when utilised in the right way for joint working. Therefore, the predominant challenge remaining is for pharma to determine what it gets in return – this does not have to be anything as simplistic as increased brand prescriptions, but it has to be something tangible and measurable to ensure continued investment in such initiatives.

This is a challenge that is not insurmountable and one has to applaud those companies who are leading the way here, sometimes a leap of faith is what is needed – provided at some point it can be justified.

So let’s hope that third leg gets tightened up for the benefit of everyone.

The PM Society video of proceedings from the day can be viewed here

About the author:

Paul Tunnah is Founder and Managing Director of pharmaphorum, the online information, discussion and networking site for pharma executives. For queries he can be reached through the site contact form.

For queries relating to the PM Society please visit www.pmsociety.org.uk or contact Helen Lawn on +44 (0) 1892 525141 or email helen@helenlawn.co.uk.

What’s in it for pharma in joint working initiatives?