Joint working with the NHS: sleeping with the enemy?

Dr. Paul Stuart-Kregor

The MSI Consultancy

Much has been made of the changing nature of pharma’s customer base. No longer is the GP king or queen in the UK. Rather their medical practice is increasingly defined or constrained by decisions made away from the doctor – patient interface.

Nothing new, given we have had change in the customer environment for over 15 years from fund holding onwards.

The difference now perhaps is the strong feeling that the blockbuster business model is broken. Fewer and fewer truly novel entities are reaching the market, companies are broadening their portfolios and reducing dependence on mass market products, focus is more on specialist markets.

Combine this with the impending loss of patents on big profit generators and it is clear why there is a need for change in how pharma companies do business.

Which is potentially is where joint working with the National Health Service (NHS) could and should play a part.

This has been a long time coming, given that the Ministerial Industry Strategy Group published its Long-Term Leadership Strategy for medicines in February 2007 which suggested encouraging joint working between the NHS and pharmaceutical industry. To facilitate which the Department of Health published guidance in February 2008, interestingly under the headline ‘Moving beyond sponsorship’.

Joint working is defined in the guidance as “Situations where, for the benefit of patients, one or more pharmaceutical companies and the NHS pool skills, experience and/or resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery.” Classic win-win surely.

While there is no doubt pharma has the necessary complementary skills and experience plus the resources to support these initiatives, there are some serious barriers to overcome.

There is no doubt that the industry is viewed with suspicion and a lack of trust due to bad past experiences. In part this is due to a perceived lack of openness and transparency in pharma’s behaviour and obvious short termism or ruthless pursuit of narrow commercial aims i.e. pulling the plug before the real gain in patient based outcomes has been achieved or even worse creating the problem for the NHS to resolve (through increased audit). Forcing prepared internally developed packages on the NHS does not foster a feeling of cooperation either.

“There is no doubt that the industry is viewed with suspicion and a lack of trust due to bad past experiences.”

There also appears to be a fear of “contamination” by contact with industry, resulting perhaps in NHS personnel’s values being called into question if they are seen to fraternise with the ‘enemy’. Perhaps that is where the Association of the British Pharmaceutical Industry (ABPI) Outreach Programme fits by keeping the perceived contact with the industry one step removed.

I appreciate that both parties have to overcome inherent prejudices and that it is not always the fault of pharma that such initiatives fail, but the history is weighted against the commercial side.

Joint working demands a partnership with open and honest communication and a sense of balance of the need for and acceptance of benefits to both parties. Too often in commercial relationships there seems to be a supplier-customer mentality rather than true partners with common vision, goals and values working to achieve a common objective.

Yet that is what partnership and effective joint working should be about, working together to achieve something of mutual benefit.

So why has it taken so long for pharma to embrace this approach?

In part an element must be the need to deliver this year’s results which can prevent a longer term investment mentality. For example, Pfizer Health Solutions, a separate commercial entity built entirely out of financial return from providing services to the NHS, has been successful but is only now showing a profit in Year 4, and that for a format that had been proven in the US.

Also there is naturally inertia due to fear of the unknown – having had no experience of making this work many people do not have the necessary mental framework to help them work this through. They do not know what works and does not work or how to work effectively in developing a partnership, notwithstanding the excellent guidance provided by the published documentation.

The NHS has to save money in real terms over the next few years. They cannot do this purely through cutting waste or maximising productivity within existing systems.

What is needed is serious service redesign and pharma has the opportunity to help shape those services. While there are national standards it is all about local delivery which means each Primary Care Trust (PCT) needs to consider how to commission and execute what is needed for their locality.

Is it sleeping with the enemy? Hardly.

“Is it sleeping with the enemy? Hardly.”

CK Prahalad says that when creating products, services and experiences “we need two joint problem solvers, not one”. He calls this “important idea” the process of “co-creation”.

As marketers we appreciate the value of placing the customer at the centre of the business relationship and co-creation takes that attitude firmly into the 21st century.

The NHS has already embraced this approach by working with patients to build co-created services which satisfy customer needs and offer improved experiences.

Pharma working with the NHS to improve the quality and quantity of care is another potential example of co-creation and will ultimately result in more modern medicines being appropriately prescribed and used properly by patients, which is what both sides of the partnership are looking for.

There is no doubt there is a great opportunity for the people who have the eyes to see it and the courage to go for it.

About the author:

Paul Stuart-Kregor is a Director at The MSI Consultancy (, based in the UK.

For enquiries please email or call The MSI Consultancy on +44 (0)1252 748600.

Is joint working the future of pharma?