The White Paper Equity and Excellence: Liberating the NHS sets out the new Government’s strategy for the Health Service. The intention is to create an NHS which is more responsive to patients, and achieves better outcomes, with increased autonomy and clear accountability.
One of the central features of the proposals in Liberating the NHS is to devolve commissioning responsibilities and budgets as far as possible to those who are considered best placed to act as patients’ advocates and support them in their healthcare choices. The aim is to empower GP practices to come together in wider groupings or ‘consortia’ to commission care on their patients’ behalf and manage NHS resources.
PAMMtrak is a bi-annual survey that gathers the views of, and highlights the key issues facing, pharmaceutical advisers and senior medicines management pharmacists. In October 2010, healthcare publisher MGP and specialist market research company Brainsell carried out a specific survey of this PAMMtrak audience to assess how they see the future in the light of the Government’s White Paper.
The results of this online survey are based upon the first 100 responses and make very interesting reading for those working in the pharmaceutical industry.
The new NHS
Only 17% of pharmaceutical advisers and senior medicines management pharmacists who responded to the questionnaire are positive about the future under the new commissioning arrangements; whilst 58% are either quite or extremely negative. Indeed, more than 80% believe that their colleagues feel either quite or extremely negative about the proposed changes.
When asked about their greatest concerns over the new arrangements, typical comments included:
“The destruction of the PCT and SHA organisation and expertise, the loss of their functions particularly in regard to quality and patient safety.”
“The proposals to completely remove PCTs. I agree there is potential opportunity to make some savings in management costs but the many functions and benefits that PCTs bring to the NHS are I’m afraid going to be thrown out with the bath water and we will have a system in total chaos.”
“The disintegration of medicine management services and rising prescribing costs.”
“Fragmentation, particularly with respect to medicines management.”
“Medicines management teams can be quite large in some areas, if we are to be directly employed by GP consortia, how are they expected to pay for the whole team? Will they want to? Therefore, jobs may be lost.”
“The lack of pharmacy networks if pharmacy moves to consortiums.”
“That GPs will not sufficiently comprehend the value of our offering and choose not to use our medicines management services but go elsewhere for them.”
“Uncertainty as to where we will be. Will there be a role for us and will this be within the NHS umbrella?”
“Losing my job.”
Respondents were also asked: “What do you consider will be the major changes to medicines management under the proposed new NHS commissioning arrangements?” Typical responses included:
“The drug budget being passed to GP consortiums.”
“It may become fragmented with individual consortia each taking their own focus. This may have benefits if benchmarking and sharing across consortia are developed.”
“Prescribing teams having to create their own limited companies and therefore not being NHS staff. Working for GP consortia and, again, not being an NHS employee.”
“Loss of capacity, expertise and leadership within medicines management, particularly in primary care, where the majority of the QIPP changes (major cost savings) will be delivered.”
“Greater focus on direct work for GP practices, budget management, formulary management, working on GP agenda rather than PCT agenda. Employed directly by consortia? More outsourcing/industry involvement.”
“It will be positive as working with doctors more closely.”
When asked to think about which organisations under the proposed new NHS commissioning arrangements will have prescribing formularies, clinical guidelines/care pathways, and provide medicines management advice the results point largely to foundation trusts and GP consortia/consortia federations.
It is interesting to see that under the new arrangements roughly 50% of pharmaceutical advisers and senior medicines management pharmacists consider that they will be employed directly by GP consortia and 28% by GP consortia federations. Additionally, roughly a fifth considers that they will be employed by either a social enterprise spun out from a PCT or a private provider company.
The majority of respondents consider that they will be working in a salaried post. Although interestingly over 16% think that they will be working on a ‘fee per project’ basis, over 10% on a fee related to target achievement and over 8% on a percentage of drug savings basis.
From the list of medicines management activities that they consider that they will be involved in it would seem that these will be in managing the prescribing budget, formulary management, cost minimisation, prescribing reviews and formulary development. More than half also consider that they will be involved in care pathway design and implementing national guidance.
The link with pharma
The respondents were also asked how likely they would be under the new commissioning arrangements to engage in joint working with the pharmaceutical industry in a range of activities.
The responses were largely positive with the leading areas where they would be likely or very likely to engage with the industry being training, patient education, project staff support, economic analysis and guideline implementation. Roughly a third stated that they would be unlikely to engage with pharma in this way, meaning that two thirds may be happy to do so.
With the emphasis for commissioning shifting to GP consortia it seems that those involved in delivering medicines management have an uncertain future. However, this survey suggests that it is important that companies build strong relationships with the emerging GP commissioners and their medicines management teams and that there is a strong opportunity to do so.