The Matrix

The CONCLUDING CHAPTER to this series of the NEW GMS CONTRACT distills key points for those representatives selling products within therapy areas

Conclusion: CONTRACT FACTS 46-50

46.Selling in Cancer: There are 2 objectives to cancer care in the new GMS – but they represent difficult tasks – produce a register of patients with cancer (noting that only skin cancers that are melanomas are to be included) and then review these patients within 6 months. The review is to include assessment, supportive patient needs and specific arrangements made with co-ordinating services with secondary care. They both provide 12 points (split equally) and it is difficult to state ‘what pharma companies’ can do for these tasks. Due to the overarching tasks for all cancers and the diverse nature for treating different cancers the actions required by GMS are generally specific! This means that pharma companies will probably focus on the cancer they are aiming to treat with marketing and subsequent energies focussing on issues such as outcomes, tolerability, quality of life and reduction in death. Broadly speaking cancer is very much in the limelight and incessant media coverage and public expectations lend this emotive disease area to significant political and documentary profile reporting. Secondary care, tertiary centres and specialist ‘beacons’ will remain the focus for pharma targeting. Of interest the concepts of ‘funding following patients’ is very important. One area pharma companies need to understand better is the approval of new cancer drugs within drugs and therapeutics remits. Bidding for new drugs will often become funding for a new business case depending on current services and new implications for the drug in question. In addition, around the country sits this dichotomy – specialist centres that patients with cancer can travel to get the best care – and the inevitability that many patients don’t want to travel and want their local consultant to provide care locally. Try moving a group of patients with cancer from a national beacon centre to their own locality where they and their families want treatment without the travel. The paperwork, funding arrangements and logistics is nothing short of verging on the impossible. Ask around…
47.Selling in Cardiovascular Medicine: Make hay. Because not only is the sun shining for those selling in this disease area, but cardiovascular disease is a priority for everyone. There are 121 points for secondary prevention alone with further points repeated for cardiovascular end-points within other diseases such as diabetes, hypertension, stroke and TIA. So with all these companies talking about the how their drug will help their GPs achieve their points – is anyone really offering anything original?
48.THINK POINT PF: Interesting in that it is very difficult to get all 121 points for cardiovascular disease but makes more sense in concentrating say on blood pressure – CHD 26 points + diabetes 20 points + stroke 7 points and hypertension 76 points !! By tar getting across diseases rather than down them, service investment pays off rather than trying to ‘tick all the boxes’ on a single disease (note BP target 150/90 except for diabetes which is 145/85 and also note that current payments for BP is capped at 70% – no doubt to be increased later.. The same principal could be said for cholesterol management – CHD 23 points + diabetes 9 points + stroke 7 points (note cholesterol targets of 5mmol/l and capped payments is again at 70% except for diabetes which is only 60% !! Few thoughts emerge – firstly capped payments means that the GP need not treat any more patients to target. If they do, they certainly don’t get more points or prizes. I have companies say to me that using their statin will get more patients to target. Interestingly the GP contract (at the moment) allows GPs to leave over 1/3 patients cholesterol levels uncontrolled and still achieve maximum points! The blood pressure caps are the same – 70%. It’s a bit like when pharma company representatives have their bonus capped at say 120%. Why try and achieve more sales if payments are capped? So has the government overlooked this? No. This is how they will turn the screws into general practice (see point 50)
49.The Prescribing Advisers: The pharmaceutical companies have finally realised that marketing their products to GPs whist essential requires additional attention to other professionals involved Conclusion: CONTRACT FACTS 46-50 OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com’ with prescribing. What has become an interesting dynamic is the relationship between the pharmaceutical industry, prescribing doctors and pharmaceutical/prescribing advisers. This has been covered in previous issues of PF but how does the new GMS relate to prescribing advisers? Much of the key lies in medicines management. Without a doubt the prescribing advisers will be involved in directive patient medication reviews, formulary and prescribing guidelines and new drug usage and restriction. There are even points for GPs to see us now! (A total of 42 points under medicines management covering activities such as meeting with the prescribing adviser at least annually, recording and documenting medication reviews, providing evidence of agreeing to and producing change in prescribing as agreed with the prescribing adviser and repeat prescribing). Many companies are struggling with a mismatch of ‘aiming for 1st line in the market and formulary inclusions’ and the subsequent ‘restrictions’ or even ‘blacklisting’ of certain products within individual PCOs by way of newsletters, incentives or simple control at the prescribing level. The way forward is a teetering balance for pharma companies. Try to liaise, involve and get on board the powers at be – or, at some point, plough ahead with a vigorous marketing campaign regardless of what may be coming from prescribing advisers per se. Either way, unless pharma companies have flexibility in their launch direction (remember there will always be a NICE guidance or an NSF or some directive) they will remain always trying to react to the climate/customer base and never feeling they are controlling it. This is the key to the future of pharmaceutical companies in today’s NHS.
50.Epilogue GMS contract: One of the most fascinating aspects of the GMS contract is not what is in the contract, but what is not in the contract! No dermatology! No gastroenterology? Why? What about those selling in these areas. Not easy. In fact the danger with GMS (or NICE or NSFs) is that it creates ‘trendy’ diseases which means there will always be non trendy ones. So if you suffer from reflux or eczema – there are no points in the GMS – there are no NSFs – will we be too busy to take these diseases seriously? Will there be reluctance to fund or prioritise these conditions compared to say heart disease or diabetes? Interesting questions. Furthermore – I made reference to the capping % – at first sight it seems ludicrous. It can’t be acceptable to just control the blood pressure of 70% of your patients and leave the rest! Well here’s the twist – quite literally… Follow this. Start the GMS idea of points means prizes. Give the carrot MPIG so no-one loses out and they all play ball. Set the minimum targets of 25% (to get the ball rolling). Leave capping at 60%-90% to allow for slack in the system. Then – as time goes by – turn the screws…. Minimum becomes 30%, then 35%. Maximum becomes 80%-100%. The goalposts move – but the money doesn’t change. Hence to get minimum payment this year needs 25%. Next year it may need 35%. Extra work. For the same payment. It’s a very clever way of how the government pushes the NHS to do more for less. Nothing new there then… That’s the Matrix for you.

 

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com