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Issue 3. March 2002.
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NHS News Review by Alan Jones of ajc
healthcare
Analysis of the NHS changes that are likely to have an
impact on your business. This issue: The Volcanic NHS - shifting the
balance of power, NICE submits - Health Select Committee begins its scrutiny of
the Institute....
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Product Review, by Matthew Pitt of Isis Research
plc
An up-to-date review of recent UK pharmaceutical product launches
and new licences. This issue: Pfizer: Relpax - more effective than
Sumatriptan, Lundbeck: Almogran - Over 60% GP awareness, Aventis Pasteur MSD:
Stamaril - Yellowfever...
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This page is an 'unframed' version of
Pharmceutical Review (March 2002) and is for printing purposes only. To view an
'easier to navigate' version of the same newsletter,
please click here. |
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What a busy month in the 'NHS World' last
month! First of all you should be excited by the fact that the NHS
Modernisation Board, set up to oversee the implementation of the NHS Plan, has
published its first annual report. You won't be surprised to learn that little
headway seems to have been made in reaching many of the targets set out in the
Plan. "Modernisation is patchy and there is still clearly a long way to go",
says the report. This is relevant to companies since knowing which areas are
moving faster than others (e.g. NSFs) is pertinent to determining appropriate
and timely responses at both national and local levels. Rhetoric v
reality!….. See
www.doh.gov.uk/modernisationboardreport.
…..And
Shifting the Balance of Power: the next steps finally saw the light of day as
final countdown to the arrival of the StHAs begins. The new STBOP paper sets
out the framework for the forthcoming changes but, in line with its own
philosophy, it leaves the practical arrangements, the how, when and where of
working arrangements and service delivery to be decided locally! As companies
will need to have an interface with these brand new organisations, there is a
need to find out exactly what is going on here. There is also stuff in the
paper about, not only devolving management authority to organisations, but of
devolution within organisations. Further, the changes are not just about
structure, but about behaviour with a shift from a more hierarchical approach
to a more networked approach, putting greater emphasis on team-work and on
patient and staff involvement. The new Chief Executives have started to appoint
their teams of Directors. So watch out for announcements soon on a new customer
base.......
…And the Department's response to the Bristol Royal
Infirmary Kennedy Report, 'Learning the Lessons', was also published last
month. Professor Sir Ian Kennedy was asked to inquire into the management of
paediatric, cardiac services in Bristol between 1984 and 1995 and his analysis
demonstrated a need for a fundamental reform of the relationship between
government, the healthcare profession and the public. The central message of
the Kennedy Report was the need to change the culture of the NHS so that
patients are able to become active partners in care - so that's the stuff about
'behaviour' highlighted above. Of course any changes in behaviour of
traditional industry customers is of direct relevance to companies! Bottom
line, the Government has largely accepted the broad approach set out in the
Kennedy Report but a lot was also rejected, although you wouldn't think so from
the spin! See
www.doh.gov.uk/bristolinquiryresponse/index.htm.
As
the National Health Service gets ready to face its biggest upheaval for almost
20 years, last month we also had an unexpectedly radical speech from Alan
Milburn on further 'redefining' the NHS! What is particularly interesting is
that the policy ideas Mr. M. revealed at a New Health Network seminar seem to
have emerged from backroom discussions, developed without consultation and yet
again sprung on the service through the media. So now the health service has to
grapple with the concepts of foundation hospitals, public interest companies,
mutuals, 'public service entrepreneurs' and the thought that management at
failing trusts could be franchised out to not-for-profit organisations. I
wonder if Mr. Milburn has focused on the fact that the foundation school
experiments do not seem to have had a noticeable effect on the education system
and that franchising has done little for the rail network!…… It is as
if Mr. Milburn feels he has to put one last stamp of his authority on the NHS
before he 'lets go of the reins' as promised. It does seem as if the Government
is panicking again over the lack of NHS modernisation and this is probably the
reason for more change on its way. For a full transcript of the speech so that
you can extract every little nuance (!), please see
www.doh.gov.uk/speeches/jan2002milburnnhn.htm.
The
policy bombshell actually has echoes of the Conservative reforms - working for
patients, self-governing Trusts etc, and one could almost have heard all of
this from former Health Secretary Kenneth Clarke, who pushed through the Tory
changes! So, a strong sense of déjà vu then. Of course the devil
would be in the detail and there is currently none! So what some people are now
asking is - are we beginning to move down a long road at the end of which all
health service provision rests in private hands and that this road begins with
the first step to allow private sector managers to run NHS hospitals under
franchise. In this scenario, while healthcare would remain free at the point of
use for all, according to need and regardless of means, the state would no
longer own or operate the facilities in which it was provided…. The answer
here must be that we don't know yet, but, for sure, this will be a major
talking point amongst your customers!!…
Lots of NICE things have also happened this
month….. First of all the Health Select Committee began its scrutiny of
the Institute and just about everybody who is anybody has been invited in to
give 'evidence'. In their evidence, both the Drug and Therapeutics Bulletin and
the British National Formulary, arguably the UK's two most influential clinical
publications, suggested that the process of appraisal of drugs by NICE was
flawed, that a number of significant decisions had been based on dubious
evidence and particularly criticised NICE's lack of willingness to discuss
their concerns. "The kind of flaws we have found on NICE guidance are far
ranging….sometimes NICE says things that we find difficult to put in the
BNF because they are not quite true."!! Other groups have also weighed in with
some criticism over something or other - certainly everyone seems to have been
showing off their own particular vested interests! Indeed from the documents
submitted and presentations made so far, it is pretty clear that nobody seems
best pleased with NICE. But, just maybe, by displeasing everybody, NICE has got
it just about right?!….
Actually, the most interesting submission so
far has to be one by NICE itself. In its 'memorandum of evidence' (see
www.nice.org.uk) you can read the most extraordinary self
congratulatory 'essay', as if none of this criticism existed at all. There is a
particularly impressive long list of all the things it has done since start up
and it goes on (and on….), "There is overwhelming national and
international (!) opinion that NICE guidance is credible, appropriate and
produced to an exacting standard. There is no other body in England and Wales
capable of producing clinical practice guidance of the quality and range
achieved by NICE. No other body producing clinical advice operates in a manner
that is as inclusive and transparent. Although it is not the only source of
guidance, NICE is now the only body with the credibility, resources,
professional networks, and robust methodologies to provide a single national
focus for developing clinical standards for the NHS." Interestingly, the
authors of the document do admit that inevitably its advice will not always be
received with universal approval as many of the topics referred to NICE
represent areas of genuine uncertainty or disagreement. "The decisions NICE
makes are sometimes difficult, and the Institute will seldom satisfy every
possible interest. But they are keen to point out that its guidance is
independent of any vested interests…
The document also says that the Board would
like the work programme to be constructed in a more inclusive manner and so
expect in 2002 then, that NHS staff will be increasingly asked to propose
either appraisal or clinical guideline topics and also that PCTs (and Acute
Trusts) will have an opportunity to become involved with the actual appraisals
themselves as consultees. Certainly this paper is of direct relevance to
companies, as it re-emphasises the need for earlier referral of new
technologies to ensure faster access (or not). "NICE is anxious to publish
appraisals of significant, novel health technologies as soon as possible after
licensing" - e.g. within 3 months. For new drugs this would involve starting
the appraisal process around the time of submissions for marketing
authorisation. The document refutes ABPI concerns that appraisal should wait
until the drug has been marketed for 2-3 years as it says that this would deny
NHS patients access, create confusion and its experience thus far suggests that
Industry's fears are unfounded. A useful document overall to look through.
If folk are into clinical audit then note
that Principles of Best Practice in Clinical Audit will be launched at the
Conference Clinical Audit 2002 on 12/13th February at Church House,
Westminister, organised by HealthCare Events. The book will be distributed to
NHS from early March. Finally and by no surprise, NICE has announced that the
appeals against the Institute's Final Appraisal Determination (FAD) on the MS
drugs have not been upheld. In other words, beta interferon and glatiramer for
MS will not be recommended to the NHS in Technology Appraisal Guidance issued
on Monday 4th February. So, it is up to the direct discussions still going on
between the manufacturers and the DoH to see if the drugs are going to be
available at another price!
Do you read Bandolier? In January's issue,
you will actually find quite a lot on medicines - particularly on 'class
effects'. A study on statins is outlined where decisions were being taken by
clinicians and policy-makers between older, more expensive statins, and newer,
cheaper statins. "….assumption of a class effect is usually done to
justify choosing the cheapest drug in terms of acquisition costs. One group
chose the cheaper statin with less information, and the other the older and
more expensive statin with masses of patient experience. Can you guess who
choose what?…… So this is about the weight of evidence versus
acquisition costs…. Remember Bandolier has a wide NHS readership and is
well respected, so these kinds of comments are important. Negative quotes will
need to be countered but positive quotes could also be used by marketing! See
www.ebandolier.com.
In a Health Service Journal
article last month on PCTs and the fact that they will now be taking on 75% of
NHS funding, the author had to have a go at prescribing costs. "Prescribing
costs are another concern as PCTs are responsible for managing GP prescribing.
Our national database on spending in this area calculates that over £130m
could be saved in prescribing costs. To achieve this, the prescribing of
premium priced drugs needs to be more economical….although most PCTs are
taking on their own prescribing expert, there is little experience in the
strategic management of prescribing, which is what PCTs need…." So, expect
continued downward pressure on prescribing costs in 2002. The first,
centrally-funded training courses for the extension of nurse prescribing
started on 7 January. Further courses will begin in February and March and
continue throughout the year. See
www.doh.gov.uk/nurseprescribing. And finally, following the
allocation of £1 million to HAs last September to support clinical
governance in community pharmacy, Guidelines on Good Practice has now been
disseminated. See
www.doh.gov.uk/clinicalgovernance/communitypharmacy.htm.
The DoH, in conjunction with the Sowerby
Centre for Health Informatics at Newcastle (SCHIN), has produced an 'on-line'
resource for appraising and appraisee GPs. See
www.appraisals.nhs.uk. SCHIN is also, of course, the home
of PRODIGY, whose winter 2001/2002 newsletter has just been mailed out. A new
CD Using the Computer in the Consulting Room has also just being issued. Email:
prodigy-enquiries@schin.ncl.ac.uk
for copies of either. The role of GPs with a Special Interest (GPSIs) is being
developed and a national network of GPSIs is now being established. Questions
currently being asked about what this role brings are - can patients access
GPSIs without adding new steps to their journey? How can a GPSI provide systems
of 'advanced access' without detriment to patients or their general practice?
What is the role of GPSIs in training and dissemination of knowledge to other
GP colleagues? What is the impact on waiting times for secondary care within
the PCT? It will be important for companies to track this development in their
relevant therapy areas. And finally, Solihull PCT have been the first to
advertise for a Director of Public Health in the HSJ. It would seem these folk
do not necessarily need to be doctor trained and that epidemiological skills
will be OK!
Prof. Malcolm Johnson, Prof. of Health
& Social Policy at Bristol University, has warned that only 50% of the key
targets of the NSF for Older People are deliverable. Prof. Johnson, who is also
Director of the International Institute on Health & Aging, has said that
standards for mental health, for instance, were unachievable. Prof. Alan
Maynard has also pointed out that as the NSFs have not been properly costed,
they will "require determined management if rhetoric is to be translated into
practice. They could be nothing more than a public declaration of intent: an
empty policy wheeze". Alan's comments coincide with the publication of the
latest issue of York University's Health Policy Matters. See
www.york.ac.uk/healthsciences/pubs/hpmindex.htm.
The NHS Cancer Plan continues to be
implemented. Each of the 34 Cancer Networks is to be given £10K to spend
on tapping into the knowledge and experience of people with cancer - and to
ensure that the results are fed back into service development. Also a new
network of cancer research centres is being set up (see
www.ntrac.org.uk). The January 2002 Newsletter (Edition 5)
from the Cancer Action Team is now available for all the latest cancer news.
See www.doh.gov.uk/cancer to download a pdf copy.
Therapy specific, corporate newsletters,
written by Alan Jones of AJC Healthcare, are employed within many
Sales Teams throughout the UK Pharmaceutical Industry, as a source of crucial
NHS intelligence.
To discuss how your team could benefit from
regular up-to-date analysis of the NHS changes and issues that directly impact
on your business, please contact
Alan Jones
of ajc healthcare (alan.jones28@virgin.net)
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Four Countries - NHS Update
By Duncan Alexander of Health
Direction.
Reviewing key NHS developments within
England, Scotland, Ireland and Wales |
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England | Scotland |
Wales | Northern
Ireland
PCT name Changes
We have
been notified of a number of recent name changes for April 2002:
- Lowestoft PCT- will become Waveney PCT when it
merges with South Waveney PCG in April 2002.
- Dales PCG will become Durham Dales PCT and not
Dales PCT as originally suggested.
- Middlesbrough and Eston PCG will become
Middlesbrough PCT, not Middlesbrough and Eston PCT.
- Sunderland PCT - this merger of the three
Sunderland PCOs will be known as Sunderland Teaching PCT.
Teaching PCTs (tPCT)
We
now have confirmation of the eight new Teaching PCTs from April 2002:
- North Tees PCT
- Bristol North PCT, Bristol South West PCT (joint
application)
- Slough PCT
- Luton PCT
- Lincolnshire South West PCT (leading for joint
application from all PCOs in Lincolnshire HA)
- Heart of Birmingham PCT
- Haringey PCT
- Blackburn with Darwen PCT.
This is in addition to the three existing tPCTs:
- Bradford City PCT
- Salford PCT
- Sunderland West PCT (Sunderland PCT will be
'teaching' when they all merge)
Personal Medical Service Pilots
(PMS Pilots)
The 1st and 2nd wave Pilots are now well established.
Response has been positive, with most practices embracing PMS and enjoying the
benefits of improved patient care and more flexible working. It has, however,
highlighted areas of concern around the support given to PMS Pilots from higher
up the NHS chain of command, but many of the Pilot practices are expanding
their services and are wholeheartedly committed to this way of working.
2002 Charter Marks
More
than 60 NHS organisations have won recognition for providing high quality
services in the form of a charter mark. Three of these are Primary Care
Trusts:Dereham Hospital - Norwich PCT, Bridport Community Hospital - South west
Dorset PCT and West Dorset Wheelchairs Service - North Dorset PCT
Doncaster Central
PCT
Doncaster Central PCT, in the first national pilot, is
pioneering the use of the NHS Clinical Assessment System, staffed by nurses, to
get patients faster and more appropriate access to primary care. Nurses have
also been trained to provide clinics that treat minor illnesses.
South Peterborough
PCT
South Peterborough PCT has issued a leaflet to staff to prepare
them for a CHI clinical governance review as one of eight pilot sites. The
pilots have submitted clinical governance policy information to CHI, which will
be used to identify areas for attention. The 17-week programme starts this
week, with action plans published around June. A full roll-out to all PCTs will
start in the autumn.
South Manchester PCT
The
plan to develop a £20 million community hospital in Withington has been
given the go ahead by both South Manchester PCT and Manchester HA. It will
include the first Diagnostic and treatment Centre (DTC) in the North West.
These centres are part of the national policy of providing a range of
non-urgent, day case treatment away from main hospital sites.
Pioneering GP
Education
GPs in Barking and Dagenham are taking part in a
pioneering educational programme which brings GPs together in one place at the
same time for group learning. The Protected Time Initiative is a new idea in
the NHS.
Local Improvement Finance Trust
Blackburn with
Darwen PCT, in conjunction with the rest of East Lancashire, has bid for the
next wave of LIFT (Local Improvement Finance Trust) funding. This is the public
Private Partnership introduced by the Government to fund the modernisation of
the Primary Care estate. Their bid was successful which will attract
substantial funding into the area for improvements to the premises and enable
more joint working with other agencies "under one roof".
Bedford PCT
implements 'Action on ENT'
Bedford PCT has been successful in its
bid for funding both for capital funding to improve ENT and Audiology Services
and to run a national communications pilot (jointly with the Queen's Medical
University Hospital, Nottingham) to implement the Action on ENT programme.
New Cancer Centre
A new
multi-million pound cancer centre for the West of Scotland will be up and
running by 2007. Health Minister Malcolm Chisholm announced his formal approval
for the second phase of the replacement of Glasgow's Beatson Oncology Centre
with a state-of-the-art facility at Gartnavel that will be one of the finest
cancer treatment centres in Europe
Cancer services receive additional
£10 million
Cancer services in Scotland are to be given an
extra £10 million of new investment over the next two years to step up
the drive to reduce waiting times, it was announced on the 21
February.
Health Bulletin to be discontinued
The Health
Bulletin, which is on the HSP, and provides a comprehensive summary of news and
articles relevant to all Scottish doctors is to be discontinued at the end of
January 2002. The Scottish Executive are not sure at the moment what, if
anything wil,l replace it.
Pharmacy Plan
Improved
access to pharmacies, safer use of medicines, and maximising the expertise of
Scotland's 4000 NHS pharmacists are three key features of Scotland's first
Strategy for Pharmaceutical Care. Produced in consultation with patients,
pharmacists and other healthcare professionals, it was launched on the 4th Feb
and highlights steps to be taken so that patients can get the best and safest
use of their medicines. It includes plans for pharmacists to be given
responsibility for writing prescriptions and changing dosages without having to
consult a GP. Flexible arrangements are envisaged, including home visits for
certain patients.
Bridging fund announced for Cancer
Care Society
A one-off bridging fund to allow the services provided
by the Cancer Care Society to continue after they withdraw from Wales at the
end of February, has been announced by Welsh Minister for Health and Social
Services Jane Hutt.
Making a statement on 29 January 2002 Jane Hutt
said: "I was deeply concerned to hear the news that the Cancer Care Society is
to close its operations in Wales. I know that the services they provide, both
the transport and befriending service and the drop in centres, are highly
valued by people in Merthyr, Mountain Ash and the surrounding areas".
Award for Pembrokeshire GP
Practice
Winch Lane Practice based in Haverfordwest have been
successful in achieving the Royal College General Practitioners Quality Award.
As the first practice in Wales to achieve this prestigious award, the Winch
Lane Primary Care Team have worked extremely hard to implement the standards
required. QPA is a process which allows every member of the practice team the
opportunity to become involved in improving the quality of both practice
systems and clinical care. The Quality Practice Award is awarded to practices
that can produce written evidence documenting their ability to meet high
quality criteria, which is verified by a multi-disciplinary team visit.
Drugs Prevention web-site
launched
The first, regional, comprehensive website addressing all
issues relating to drug misuse and prevention was launched on 15 January 2002
at the Health Promotion Agency by the Northern Ireland Drug and Alcohol
Co-ordinator, Jo Daykin -
http://www.drugsprevention.net
2002/2003
Budget
The budget for 2002 to 2003 is £2,528m. The HPSS
spending will be £72m higher than planned in June 2001. This includes
£41m for new service developments. |
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Understanding Cultures (Part. 1)
Sally Fagan, JS
Training.
An essential guide to doing business
in multi-racial communities. |
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When I am talking to export executives
about cultural awareness I will often ask 'How many contracts have you lost
through lack of skill in another language?' The answer may be difficult to
quantify for them even if they know that they have lost some. I then go on to
ask 'How many contracts have you lost through lack of cultural awareness?' Now
this question poses a bit of a conundrum. If you are not aware of subtle
cultural differences, how can you possibly know if you have lost business
because of it? It would be easy to blame the lost contract on market
conditions, price or not quite meeting the specification when in fact the
underlying cause may have been a cultural blunder.
Most sales people in the healthcare
industry in the UK are not dealing with export, but we do have an increasing
number of people working in primary and secondary healthcare who are of
overseas origin. Yes, they may be second generation and have been to school in
this country, but for many their cultural traditions and ties to their country
of origin still influence their behaviours in various ways. Many of us of UK
origin are not sensitised to these influences and may be making false
assumptions that can affect our business. We may easily fall into the trap of
assuming that just because a doctor, for example, speaks English without an
accent and was educated in this country, he or she has accepted all our values
and way of thinking, and that culture difference doesn't enter the
equation.
I was lucky enough to spend nearly
four years living and working in Singapore. It is a modern metropolis with more
MacDonalds per head of population than anywhere else in the world. English is
one of the official languages and is the one most used for government and
commerce. Western influences are everywhere, and it was easy to be lulled into
a false sense of security that to do business, all you had to do was assume our
normal Western values. The longer I was there however, the more I realised that
their value system was very much less Western than outward appearances would
suggest, and for the Chinese population at least, their Chinese value system
ran much deeper than anything Western that they had taken on at a superficial
level. In this country too, we are on dangerous ground if we ignore ethnic
origin, since outward appearances may be deceiving.
It may even be that the person him or
herself does not realise what makes them accept or not accept the sales person
in front of them. Someone of Arab origin may have been brought up with the
belief that the left hand is only used for cleansing, and whilst long years in
the Western world will have taught them that no such difference exists in the
Western culture, they may still feel uneasy at being handed something from a
salesman's left hand. If it doesn't register in their conscious mind, deep down
the sub-conscious mind might be saying 'This salesman has just insulted me,
there's something about him that I don't like and therefore if I have a choice,
I will use another company's products.'
A good salesperson aims to overcome
objections and lead the client logically to a sale, whether that sale is to try
the product in the first instance or buy a large quantity. A pharmaceutical
representative does not normally have the facility to walk out of the door with
a signed order in the hand, which gives the doctor far more scope to choose to
use an equivalent product from a competitor if they feel more at ease with the
competitor's representative.
In the next issue, I shall explore in
greater detail how we can sensitise ourselves more easily to our client's
culture, but in the meantime I shall leave you with a definition of the word
ASSUME, in case you don't know it. Splitting it into its component parts,
making assumptions can make an ASS of U and ME.
Sally Fagan
Associate of JS
Training.
admin@jstraining.co.uk
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Product Review
By Matthew Pitt of Isis Research
plc.
An up-to-date review of recent UK
pharmaceutical product launches and new licences. |
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Pfizer: Relpax - Relpax more effective than
Sumatriptan
Lundbeck: Almogran - Over
60% of GPs aware
Abbott Laboratories:
Ketek - Will Ketek have an impact on the respiratory infection
market?
Aventis Pasteur MSD: Stamaril
- Another potential blockbuster?
February has seen the arrival of
Relpax / Eletriptan from the pharmaceutical giant Pfizer. In trials, Relpax was
seen to be more effective than Sumatriptan at combating migraine. It is
unclear, however, as to what impact this product will have on the UK migraine
market. Big players dominating the market at the moment are GSK, Astra-Zeneca
and MSD, all with well-established products making the market a difficult one
to join. Imigran leads the way, followed by Naramig and Zomig.
Over the past year we have seen the
CNS Specialist Company, Lundbeck, gain a firm footing into the market. Almogran
was launched in February 2001 and if we look at the Launch Essential panel,
over 60% of GPs were aware of the product and over 50% had been detailed. That
they have achieved these results in such a short space of time is a true
testimony to the effort of the Lundbeck sales force. If Almogran performs to
the current trends seen on Launch Essential, in another year we may see similar
results as with the more established products.
Abbott Laboratories have introduced
Ketek/Telithromycin, which is an erthyromycin derivative, bacteriastatic
Ketolide antibiotic with a 400mg bd dosage. Will Ketek have an impact on the
respiratory infection market? With the patent expiry of Ciproxin becoming a
potential problem, will physicians choose Ketek over this more superior, gold
standard for chest infections? Abbott also own a powerful antibiotic in the
shape of Klaricid - which is generally an alternative to Ciproxin in most
respiratory infections.
Aventis Pasteur MSD have launched
another potential blockbuster - Stamaril for yellow fever. This is a single
dose, licensed vaccine that is delivered in an extremely convenient
presentation. The closest competitor is a product developed by Evans, but this
has now encountered licensing problems, leaving a largely unprotected market
for Aventis to exploit. Patients will benefit from the new vaccine as they will
no longer have to attend satellite travel clinics but will eventually, and more
conveniently, be able to receive the immunisation at their local, GP
surgery.
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