A whole new world

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The amendments in the Health Bill to the commissioning landscape may have
been small but they are significant for pharma. David Round (pictured) outlines the
implications of these changes to the care pathway and the new opportunities
for joint working.

The dust is beginning to settle on the amendments to the Health and Social Care Bill and it is now time to assess just what the changes in commissioning structure will mean in practice. How will the renamed Clinical Commissioning Groups (CCG) approach the creation of care pathways? Will there be much change from the model used by the previous Primary Care Trust (PCT), or will these new organisations opt for a ‘business as
usual’ approach where possible in order to simply get commissioning processes up and running in a timely fashion?

And what opportunities does the increasingly local focus on commissioning provide pharmaceutical companies to deliver added value services over and above drug products
that are increasingly viewed as a commodity across the NHS?

For pharmaceutical companies the good news is that the changes to the Bill, following the ‘pause and listen’ process, are not overwhelming. The coalition Government has accepted
many of the recommendations of the NHS Future Forum but the essence of the shift towards greater local commissioning remains the same.

The newly created GP Commissioning Consortia (GPCC) remain in place – albeit under the new name of CCG to reflect the inclusion of nursing and hospital consultants on the main board. The pressure is also off CCGs to be ready for the 2013 deadline – although those that are ready will be able to proceed with their commissioning plans sooner. In areas where CCGs are not ready to undertake commissioning duties, the National Commissioning Board will take over from the PCT Clusters for an interim period.

There is also a move towards greater local accountability, with CCGs now required to consult with a raft of new local bodies, including Clinical Senates – responsible for ensuring
CCG clinical plans are robust and meet local requirements – local NHS Commissioning Boards, and Health and Well Being Boards.

New constellations

All of these groups will have an influence on the evolution of the care pathway and must, therefore, be considered within the pharmaceutical market access strategy. Clinical Senates will work alongside the existing clinical networks – such as cancer networks – to ensure CCGs take local and disease specific requirements into consideration. If the Clinical Senate believes that care pathway plans are not good enough it can recommend the NHS Commissioning Board steps in before the CCG is authorised to act as a commissioning group.

As yet, the makeup of these Clinical Senates and local NHS Commissioning Boards is not clear. However, with the continuing exodus from PCTs, there is no doubt that some familiar names will reappear in these new roles.

It is also clear that there is a fast developing gap between the most advanced CCGs and the rest. Some, indeed, have already set their clinical priorities and are looking at care pathways. Within this process, these CCGs will have taken into account the views and concerns of local clinicians and local clinical requirements. The difference now is that there will be formal bodies in place to undertake that local clinical accountability.

For pharmaceutical companies the message remains consistent: market access strategy success will depend upon gaining an in depth insight into not only the CCGs and the speed
with which they are progressing and embarking towards clinical decision making, but also understanding the new influencers within the Clinical Senates and local NHS Commissioning
Boards.

Understanding the mission

However, there is one change to the Bill that also presents significant opportunities to pharmaceutical companies – the decision to place medical research at the centre of the
NHS mission. Under the amended proposals, ­The Secretary of State for Health will be given a statutory duty to promote research, while the new CCGs will be actively required to encourage research, innovation and the use of scientific evidence through their decisions.

This move is fundamental, and addresses criticism that the original Bill did not encourage doctors to make use of improved therapies or the latest evidence on clinical best practice.

For pharmaceutical companies, this shift in emphasis opens the door towards more innovative, cooperative working; and for embarking on joint working initiatives with CCGs. It also ensures doctors and pharmacists will continue to be involved in research projects, from clinical research to patient care, patient outcomes and procedures.

Indeed, some of the CCGs are already actively seeking more opportunities to get involved in programmes and projects that can deliver better patient outcomes by reconfiguring patient services. These leading groups want to work with pharmaceutical companies on research projects that could, if successful, be rolled out across a number of CCGs and allow them to deliver care pathways that meet budgetary constraints.

One big leap

For pharmaceutical companies this will necessitate a new approach. It may require a shift in budget towards a significant up-front investment in developing a new service within a
CCG with a view to recouping that investment further down the line when the service is successful. Fortunately, with companies no longer able or willing to spend money on certain promotional items and activities due to ABPI code changes and the new Bribery Act, there are opportunities to redirect funds towards such programmes.

Key to the success of such joint working is openness: both pharmaceutical companies and the NHS need to clearly understand the benefits to both sides of the venture. ­The  pharmaceutical company cannot simply put in a new service in order to improve product sales; that will not work in today’s NHS. The emphasis must be on implementing a service
that raises the profile of the disease area, which in turn leads to an increase in the whole market – generating additional sales – but reduces the overall burden of the disease on the
local health economy. For the NHS, there will be an investment in resource that effectively identifies certain types of disease earlier, enabling cost savings through improved preventative care.

There is a valid concern amongst smaller and medium-sized pharmaceutical companies that they simply cannot fund joint initiatives on this scale. Feedback from the NHS suggests that companies will be encouraged, even expected, to band together to create a joint working partnership.

Looking into outer space these changes are significant. But they are also taking place within an environment of increasing financial constraint. It is essential that pharmaceutical companies understand the genesis of change; to identify the changes in care pathway and patient pathway that are occurring as a result of natural budgetary restraint and those that
are a direct result of the shift in commissioning structure.

Armed with this insight, companies can ensure messaging remains valid and effectively targeted and reflects the changes that can and are being made by CCGs. Messaging must
reflect the huge pressure on CCGs to reduce costs whilst also improving patient outcomes. And it must recognise the fact that many of these organisations are and will be looking
for partners that can offer innovative solutions and services – from specific procedures to drugs or devices – proven to meet these objectives.

It is those organisations that can take that messaging, that can identify and engage with the CCG vanguard and, where appropriate, embark upon joint initiatives that can be extended over time that will be well placed to meet the needs of increasingly local
commissioning policies.

David Round is the UK General Manager of Cegedim Relationship Management.