The real priorities in the current NHS
(Published 15 December 2005)

It is easy to take a surf on the internet and look at the priorities stated in NHS policy and strategy documents. However, does this really reflect the true picture on the ground? What are the big issues for NHS customers at the moment? We raised this question with over 70 customers during the last three months. They were from a variety of roles in primary and secondary care.

Here are the top priorities, in order of importance to the customer, and some of the key comments and insights they gave.

1. Practice Based Commissioning: Practice based commissioning grew in importance and caused more frustration as time went by in 2005. The target of having 80% of practices commissioning by the end of the year has clearly been missed.
2. Payment By Results: Standardising cost per patient episode is a major concern. Patients are people, not machines. Episodes are far more unpredictable than the model acknowledges and the variation caused by individual patient complications is rapidly blowing budgets. To add to the customers worries, the standardised tariff figures are not well informed. Planning for management of additional patient costs not covered by the tariffs is complicating local flows of funds and budget monitoring is made more difficult.
3. HR Issues such as agenda for change and job insecurities as PCTs merge was foremost in many customer minds. Many managers report change fatigue and stress and a remarkable number of senior managers throughout the UK are off on long term sick. Even senior managers in general practice are reporting job insecurity and redundancies as the practice is being run as a small private business with changing staff requirements.
4. Reducing Emergency Admissions ranks as number four priority. This goal means customers are more focused than ever on aggressively managing long term conditions. The business case for funding “Walk In Centres” is supported as this model reduces visits to hospital accident and emergency units. However the changes and related problems in provision of out of hours care is causing an increase in emergency admissions. Furthermore those patients being admitted are sicker and more expensive for the hospital to treat.
5. Balancing the Budget ranked number five. Yet it seemed to be the underlying theme in all the priorities. Managers and clinicians are talking about bankruptcy strategies. This is a very new concept and is not just relevant to the hospitals and PCTs. There is discussion that poor performing practices should “loose their franchise”.
6. Contracting Services from GPs, pharmacies, hospitals, dentists and opticians and the management of these contracts is clearly also a high priority. The work load is growing as each new service profession contract commences. From the service provider perspective, managing and fulfilling the contract adds a new burden and they reported that patient care resources were being diverted to manage the contracts and of course to secure the contracts and the accompanying funds. The PCT mergers also caused concern in terms of management and contracting of services during and immediately after the merger period.

What does all this mean for pharmaceutical sales and marketing? Well an in depth analysis is highly valuable but beyond the scope of a short article. However, here are a few common themes.

There is further blurring of the primary/secondary care line and growing local variation in delivery of care and budget management. This means that good local knowledge is more important than ever for pharmaceutical sales people. This cannot be addressed completely by buying data. We also need to hone our listening skills to a new level and understand what we hear and what it means for business.

All the customers we spoke to are now more interested in well evidenced cost effective use of medicines where the business case focuses on the whole budget and not just the drug budget. However the argument must be presented in a way that is relevant to their local flow of funds and there is substantial variation.

In common with the customers, pharma has to face uncertainties and scenario plan. In particular, there is a great need to base sales performance predictions on the real world and expectations at board and senior management level needs to be managed carefully. Correctly, pharma Directors consider formularies as non strategic concern to be dealt with at a lower level, but they must remain aware of factors like the average time from application to decision and the implications on product sales.

NHS decision making is slower and more complex than ever before. Understanding and influencing the decisions needs a skill set that is not readily available in the current workforce. Formulary acceptance and turning the resulting guidelines into sales still remains fundamental for success. Some 40% of formulary status refusals are caused by preventable errors.

Finally, you are dealing with a complex organisation but you are still interacting with and selling to people. Radical new ways to achieve cost effective selling to this increasingly complex marketplace but don’t throw the baby out with the bathwater. Building relationships with key people is still at the heart of your sales strategy. Developing the right allies is a crucial step and there are interesting new ways of identifying them. If you are curious, give us a call!