NHS and pharma: evidence, value and collaboration
Ashish Rishi
Cetas Kinetic Ltd
As the NHS tries to claw back a £20 billion deficit over the next four years, we will see a number of fundamental changes to the way we receive healthcare.
The new Health and Social Care Bill is now being implemented and we cannot escape it. As of the 31st October 2011 the NHS Commissioning Board became operational. Over the next 15 months Primary Care Trusts (PCTs) will disappear and the commissioning of patient services will pass to the Clinical Commissioning groups (CCGs). It will be the job of the NHS Commissioning Board to develop outline strategic imperatives.
So in this new era, is there a productive way for the NHS and pharmaceutical industry to work together? The NHS and the pharmaceutical industry have traditionally held a transactional and purchaser partnership, however, the NHS faces demanding productivity targets and has to manage increasing demand and public expectations, whereas the pharmaceutical industry has a high cost base and is struggling to create the next generation of medicines.
The ABPI has stated that the pharmaceutical industry is entering a ‘prove it works’ era that will rely on collaboration with the NHS. So it seems that it is now more important than ever for the NHS and pharmaceutical industry to collaborate to enhance healthcare outcomes in the UK.
"Demonstrating the economic value of treatment will be of most benefit now to the NHS."
Evidence
It is vital the value of a drug is continually assessed. Pharma must improve on providing data post launch of a drug with a real world value. This will allow commissioners to assess the value of the drug outside of ‘budget terms’ and look at patient care pathways and the value it will provide the CCG. On the flip, the NHS has a wealth of data that should be shared with pharma too, the combination of this data could be the key to fixing the NHS and pharma’s productivity / cost issues by:
• Improving patient care and thus outcomes
• Develop payment systems for drugs based on outcomes
• Increase the productivity of drug research.
It’s no longer about just getting clinical support for new medicines, but about ensuring that it delivers a measurable outcome that is also affordable and perceived as such by commissioners, who will have a different idea of what the outcome should be, as the evidence will impact on real budgets in real time in the real world.
Value
Once the real-life evidence is available, discussions between pharma and the NHS will move away from a clinical discussion and towards a value-based discussion. Demonstrating the economic value of treatment will be of most benefit now to the NHS and of course to pharma to demonstrate.
"...evidence will impact on real budgets in real time in the real world."
Evidence
With the new NHS, there are opportunities for a higher degree of involvement of the pharmaceutical industry to support the delivery of care by placing their drugs into the patient pathway that the commissioners will be most interested in - identification of patients, treatment and follow up, compliance and adherence. To achieve this, industry needs to put their own agendas aside and ask the questions to collect robust real-life data.
This is where the opportunity for pharma lies. It will be able to make a case about the value that it can bring to help the NHS across the whole pathway. Ultimately, leading to:
• Improving patient care and thus outcomes
• Develop payment systems for drugs based on outcomes
• Increase the productivity of drug research.
Partnership working in the real world
Initiatives between the NHS and pharma have been few and far between. However, when done together they have had an impact.
An example of good working practice is the INFORCE initiative run in Nottingham. INFORCE was an initiative to enhance the treatment of people in Nottingham with chronic obstructive pulmonary disease. INFORCE (Industry and Nottingham NHS Focus on Reducing COPD Exacerbations) saw the collaboration between Nottingham City PCT, Nottingham University Hospitals NHS Trust and the pharmaceutical industry.
The project aimed to further improve care for patients with COPD, and ultimately reduce the number of unplanned admissions to hospital. The partnership in this case was between pharma companies Astra Zeneca, Boehringer Ingelheim, GSK, Pfizer and Nycomed.
A review of the INFORCE project highlighted that there was initial wariness as to how the partnership between the NHS and pharma would work, as the NHS staff had only encountered pharma in a financial sponsorship perspective and were unsure of how pharma would add to the awareness project.
Post-project NHS staff found the involvement invaluable. Examples of added value gained from pharma involvement included:
• A national perspective on COPD and best practice
• Communication and marketing skills – particularly regarding communication with GPs
• Training materials for use with primary care staff
• Access to GPs through their existing relationships with practices
• A different approach to problem solving
• Project management skills.
This could also be a key strategy for improving health outcomes in patients.
"Pharma and NHS transparency is key to making a monolithic health system like the NHS remain a Global leader in Healthcare."
Evidence
Need for Change
Although the NHS and pharmaceutical industry do work together in a number of ways, the value of pharma to the NHS is not appreciated. There are tensions that create barriers, as factions within the NHS are suspicious to the motives of pharma - it is thought that they will exploit NHS knowledge for profit. On the other hand pharma will be keen to protect its investments in R&,D and ensure a return.
However, change is on the agenda for the NHS, pharma will also need to adapt for the new NHS landscape. Pharma will no longer need large numbers of sales reps, but the skillset will need to move to a mix of sales and a health economist rep, as pharma will see greater uptake if they align their drugs to the value agenda within the NHS.
Pharma and NHS transparency is key to making a monolithic health system like the NHS remain a global leader in healthcare.
About the author:
Ashish Rishi is owner and director of Cetas Kinetic, a business transformation company working within healthcare
Does the NHS appreciate the value of pharma?
