It is interesting to
watch the hesitance of pharmaceutical and equipment companies now, as they are
pursued by PCO and SHA leadership for partnership ventures. The trend used to
be the other way around just six months ago. Equally suddenly, the partnership
concepts have grown from what was essentially sponsorship of training, audits
etc, to involvement in service delivery.
This certainly raises many
questions:
- What is causing the change?
- Can the supplier
company trust the NHS to deliver?
- Can the supplier company offer long
term support (the NHS does not want a 'pilot' that will run out of funds as
soon as it is up and running)?
How can the supplier company ensure that
the partnership is profitable?
All of these are crucial questions in
the current business environment.
There has been a recent sudden
growth in PCO interest at directorate level in developing partnerships with
pharmaceutical and equipment companies, in particular for cost effective
delivery of the priority targets, such as chronic disease management. Senior
PCO leaders recognise that it makes good sense not only to utilise just the
medicines provided by the pharmaceutical companies but to avail themselves also
of their training and support of healthcare professionals in making best use of
those medicines. Equally keen are the Hospital Trusts, who will look to balance
the trend against referrals, as they are paid on a cost per patient basis.
The prospect of payment by results, and the hunger to achieve targets,
is helping to overcome the barriers of scepticism. Directors are often more
visionary than middle management and prescribing advisory teams, who are more
sceptical of the pharmaceutical industry.
Therefore it will take a
skilled partnership facilitator, with well-tested abilities in change
management, to implement any partnership ventures with the full cooperation of
all concerned. Many partnership agreements get drawn up and fail to be
implemented. Stated reasons include lack of human resourcing and pressures of
other work, but there is frequently an unstated reluctance to bridge the gap
and work with the partnership team. The partnership facilitation is often best
carried out by an external consultant, who initially represents a firewall and
an impartial project manager.
An accomplished partnership facilitator
will explicitly examine organisational values and the values of other
non-industry partner organisations. They are usually fluent in facilitating
recognition of the common values required to underpin the partnership.
Frequently cited values include honesty, transparency, respect for the
contribution and the privacy of the individual partners and their clients.
Gaining agreement on these values is a key step towards joint working to
achieve the partnership outcomes.
Firstly the change facilitator gains
agreed definition of partnership: typically, "a pooling of skills and resources
for joint development and implementation of specific projects; all partners
have equal ownership and shared commitment in successful delivery".
The partnership facilitator will ensure that the project is jointly designed by
the partners and will have common objectives shared by the partners. The
partners will be encouraged to have equal say in decision-making relating to
the project. Partnership is only possible if all parties feel they have a
legitimate role to play and that their contribution is of equal value to that
of the other partners.
Thus this is clearly different from the
traditional sponsorship, where pharmaceutical companies provided funds for
specific activities. However, much of the current literature about such
partnerships shows that this distinction is not always clear in the minds of
the NHS customers. Trust Guidelines for interaction with suppliers frequently
use both words to mean the same thing. It may take time for some NHS personnel
to really change the way they work with pharmaceutical companies. While some
sources quote that around 50% of NHS organisations are working in partnership
with pharmaceutical companies, only a few are really implementing the large
scale partnership ventures that have recently become so enticing.
Those clients for whom we have provided consultancy support in partnerships
found it helpful to consider the following questions when forming partnerships:
- Is the initiative clearly for the benefit of patients?
Agreement on this gives the individual partners a common focus, as all are
quick to agree that the patient comes first. If there is consensus on this, it
provides leverage for overcoming the challenges of a new partnership venture.
- Will the initiative promote and enhance equality of access to evidence-based health care? This again brings benefit to the patient, the supplier and the Trust.
- If guidelines and protocols are to be produced, will there be a mechanism for local and/or national NHS scrutiny? This will help to ensure transparency and probity.
- Will the partners agree that a work programme will not be seen as an endorsement or promotion of a specific medicine or technology?
- Will the patient information be handled in line with the Data Protection Act, Caldicott Guardianship standards and the Freedom of Information Act? Will all partners give explicit permission if reports or information pertaining to the partnership are published or otherwise distributed?
- Will full consideration be given to any possible conflict with the ethical requirements of any healthcare professional, including the duty of clinicians to provide whatever treatment they consider clinically appropriate?
- Will industry partners comply with the relevant industry codes of practice, such as the ABPI Code of Practice?
- Will all NHS staff involved comply with relevant professional codes of conduct and local governance?
- If the partnership project involves research, are there plans to fully consult with, and seek approval from, the Local Research Ethics Committee?
A key role of the
facilitator is to ensure that the supplier partner can clearly benefit from the
partnership, within the legal and ethical framework which is there primarily to
protect the Trust. It is often a paradigm shift when the NHS partner recognises
that ethical pharmaceutical and devices companies hold a clear desire to
improve health and healthcare, whilst maintaining profitability. Many Trust
staff still see profitability from healthcare as immoral, while the government
is sending out a clear message that the NHS must become more
commercially-minded.
The help of the specialist solicitor in our team
is always welcome when we facilitate drafting of a partnership agreement.
Drawing up a secure contract with clear criteria, including an exit clause,
helps to overcome the uncertainties of these new ventures.
At its
best, and within its true definition, partnership is a welcome development,
bringing equity and respect for suppliers. It brings substantial improvement
when compared with sponsorship. Client confidentiality prevents mention of
specific examples, but the benefits are clear, even though the challenges are
great.
