Pharma must adapt to embrace the opportunities of a new-look NHS

Fundamental changes to the way the NHS is structured and funded are afoot – and pharma needs to adapt to this new way of working.

A new focus on “place” and the introduction of medicines registers are among the proposals in a new government white paper on the future of NHS England.

Such changes may have a seismic impact on market access, and organisations must align their own structures to meet those of a new-look health service, says David Thorne, Director of NHS Insights and Interaction at market access consultancy Mtech Access.

“There will be a fundamental change to the NHS organisational structure, funding flows, decision making and practical ways of working,” he says.

“Industry really needs to get close to the people who are going to lead and design this change. And for the most part, this will not be the clinicians, the people pharma traditionally has relationships with.

Instead, organisations will need to swap top-down market access strategies for a more locally led approach, based on the particular area’s needs and objectives, Thorne believes.

It means every commercial organisation engaged with the NHS needs to plan a response to these changes, which have a formal “go live” date of April 2022 with transition expected to start immediately.

Continued direction of travel

Integrating care: Next steps to building strong and effective integrated care systems across England, was published to relatively little fanfare last month. Yet it sweeps away many of the key aspects of the 2012 Lansley reforms and changes many of the systems that have been central to NHS/pharma interactions since the 1990s.

That said, no one who is familiar with the NHS’ general direction of travel would be surprised by the proposals, Thorne tells pharmaphorum.

“Many people are saying this has come from nowhere… but most of the content has been signalled for the last several years,” he says.

The white paper, write its authors, “builds on the route map set out in the NHS Long Term Plan” and “signals a renewed ambition” for supporting greater collaboration between partners in health and care systems.

It calls for stronger partnerships between the NHS, local authorities, and other groups in local “places”, and asks healthcare provider organisations to create “collaborative arrangements that allow them to operate at scale”.

The white paper also talks about the need to develop strategic commissioning with a focus on population health, as well as the role of data and digital in putting “the citizen at the heart of their own care”.

The vision recognises that different areas have different health concerns. Solutions, then, will be tailored to the locality, with decisions being taken at the level relevant to the situation.

Thinking place

It represents a huge opportunity for pharma in many ways, but does require some modernisation to allow teams to map their offering to local need.

Said Thorne: “Of course Liverpool should have a different diabetes strategy to rural East Anglia. Why would an area with a high Black, Asian and Minority Ethnic community have the same nature of services as a small cathedral city with 30,000 students?

“The great opportunity for pharma now is to say we have got a solution for this problem at this level. But it has to stop looking for consistency.”

Many companies are attempting to adapt this by moving their attention from clinicians to the Integrated Care Systems (ICS), but Thorne says this is far too simplistic.

“People seem to be fascinated by ICS regardless of their portfolio. Where I live, for example, the ICS will cover more than 3 million people – that’s the size of Wales. Very few decisions will be taken at that level.

“Within that ICS will be four places, each with a population up to 850,000. This is where the bulk of healthcare will be experienced by patients. If you are a woman having a baby or a man worried about prostate cancer, your care will be delivered at place level,” he said, adding that each place will comprise a number of primary care networks (PCN).

Companies need to understand each product’s “value proposition” and whether decisions fit at ICS, place, or primary care network level, he went on.

Despite this, he said, very few pharma companies were mapping out the “places”.

Medicines registries

One surprise within the white paper was the introduction of the concept of medicines registries, says Thorne.

“In 58 pages, the only mention of medicines is in the context of these new registries. They are covered in a very short, very pregnant paragraph and my instinct is that this will be very significant,” he says.

While the document is scant on the details of what these medicines registries might be, Thorne believes they signal a move towards preferred supplier arrangements based on value-based pricing. He asked if industry was ready for that.

“For years, pharma has said it would love prices to be based on outcomes. They say that their drug, for example, can get a brick layer back to work quicker and that offsets other costs.

“But do they have the evidence for that? Can they prove that their drug is more effective at getting someone back to work than treatment from the physio, for instance?”

Preparation would involve a revolution in outcomes collection throughout the pathway, from development to market access.

“I think it’s a matter of be careful of what you wish for,” Thorne says, highlighting that this part of the white paper seems to apply to the whole of the UK.

Opportunities abound

Ultimately, a more population health-driven NHS means pharma stands to benefit from targeting its solutions to local strategies. But success will depend on the sector’s ability to pivot its approach, devolve decisions, and match its own structure to that of the new-look health service.

“There are great opportunities. I would love to be a key account manager with knowledge of my product and my area, as long as I had the permission and encouragement of my company to tweak the approach to meet the local population.

“If people can grasp the nettle of this, it will be brilliant for pharma,” says Thorne.

About the author

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.