Barriers to partnership working are breaking, it’s time for pharma to build on its differences to be more than a supplier. James Roach and Johnny Skillicorn-Aston explain more.
Top 5 Takeaways
- Pharma’s relationship with the NHS goes beyond supply and demand.
- Partnership working requires a redefining of the relationship.
- Pharma needs to take a stakeholder approach and engage with partners.
- Pharma should sit at the centre of the patient experience.
- Ultimately, pharma should be more than a supplier.
It might be argued that 2020 could be one of those milestone years, which occur every now and then, when two agents of change realise they can walk side by side, speak multi-intelligible languages and have more to gain than fear in developing an ever-closer relationship.
Pharma and the NHS are, in the simplest of terms, co-dependent entities. Pharma has a market in the NHS and the NHS has a supplier in pharma, however, it is a relationship that goes beyond the basic supply and demand dynamic.
Through technical, device and drug innovation, the pharmaceutical industry has made a major contribution to disease eradication, cure, management and modification of symptoms. By creating a climate and framework for the development and uptake of the most innovative and life-changing medicines, the NHS has set the ground for collaboration and cooperation. Unfortunately, the relationship has all too often run along conventional lines of purchaser/supplier.
“Marking out a point of difference is no longer about the what, it is now about the how and the what else”
The partnership pivot
Across the purchaser/supplier landscape, there have been some oases of change. Yet, while pharma and the NHS have been gathered around the same watering holes for many years, each has watched the other drink but has often taken flight when the other raises its head or makes a move. That is changing; conversations are being had more freely about opportunities that once would not have been contemplated. One word has been the pivot for this; partnership, a hackneyed phrase but one that resonates now with more than the buzz of management-speak.
Both NHS and pharma alike are getting to grips with redefining their relationship. Factors illustrating this in the NHS include the expanded remit of the Accelerated Access Collaborative (AAC); the 2018 re-licencing of the Academic Health Science Networks as the key NHS transformation arm and the creation of NHS England’s Commercial Medicines Directorate. Likewise, pharma is making its moves and recalibrating its relationship with the NHS through collaboration on risk-sharing and co-production of solutions in partnership with both competitors and the NHS. At the same time, it is focusing on resetting the thinking of NHS staff and patients toward viewing the industry as a contributing partner to, rather than a contractor within, a sustainable world-class health system.
Partnership working breakthrough
A breakthrough example of this can be found in the 2017 Memorandum of Understanding1 between pharma and the Greater Manchester Health and Social Care Strategic Partnership Board, which created a partnership that would seek to:
- Transform the health, wellbeing and wealth of the people of Greater Manchester
- Optimise care
- Develop and adopt innovation at pace and scale
- Create an environment for flexibility and opportunity to develop outcomes-based pricing methods.
Playing into the changing NHS landscape, its aims neatly connect what once might have been viewed as separate agenda:
- Health and wealth
- Optimal care and innovation through commercially focused, financial modelling.
A package that includes both a return on investment (RoI) and a social return on investment (SRoI).
Health commissioners are accountable for effective patient outcomes and experience through delivering sustainable and affordable service pathways that give a good RoI. With the advent of Integrated Care Systems, there has been a shift to including a SRoI factor in the commissioning dynamics.
Pharma’s role in supporting the NHS
There is no question over the place of pharma in providing the chemical and organic inputs to the NHS that deliver remedy, nor the scale of its operations in so doing. A quick look at the facts shows:
- In 2017, pharmaceuticals contributed £12.6bn to the UK economy
- UK is a major centre, and key player, in the production of pharmaceuticals2
- 41% of the sector’s demand is generated from overseas sales, making the sector the third most export intensive in UK manufacturing3.
However, the pharma industry’s place in the hearts and minds of patients and the NHS workforce is less certain. Increasing its approval rating as a trustworthy partner means strengthening how it demonstrates its significant contribution to patient wellbeing through prevention, disease modification and cure, and measuring value beyond what can be captured in financial terms. Resetting the concept of value by measuring the wellbeing, social, environmental and economic outcomes of a therapy, drug or device is an ideal place from which to build a new partnership model between pharma and NHS commissioners and providers.
Stakeholder approach to partnership
Taking a stakeholder approach and engaging with all those who might experience change, whether positive or negative, will help those who wish to work in partnership to arrive at a set of common values. This helps with the transition from the conventional purchaser/supplier model, largely because this approach focuses on what social value has been created rather than the financial return for the investor (health commissioner). The relationship is less characterised by ‘He who pays the piper’ and more by ‘Share and share alike’.
Manchester’s example reflects that approach and now dovetails into the ambitions of the NHS Long Term Plan. It is also a model that can be easily embedded within an Integrated Care System and supports measures aimed at addressing the wider determinants of health.
Returning to the AAC, it serves to localise its aims and objectives by:
- unlocking the potential that rests in strength of local system relationships and partnerships
- drawing on the widest base of experience, knowledge, research and data to develop a cutting-edge pop-health model – analysing from the bottom up to identify where impacts can have greatest effect
- evidencing cure – the rate at which morbidity and disability are reduced or constrained.
Moreover, it places pharma at the centre of the patient experience. It makes it an equal partner in a common endeavour to translate innovation and transformation into benefits that can be felt by local people; fires up the entire supply chain by putting patients at its start, not just at its end, and faces up to the significant challenges posed by demographic, procurement and workforce factors.
“The point is not to supply more for less, it is to be more than a supplier; that is the difference”
Influencing change in how services are planned and delivered; collaborating in developing optimal therapies that modify disease, manage symptoms and help patients normalise their lives, is a role that pharma can embrace now more fully than ever before. This opportunity demands more than being able to demonstrate clinical efficacy, that is a given, the old-fashioned approach of ‘marking out’ is the key. Demonstrating the point of difference pharma makes rests in assimilating the new doctrines in healthcare, adjusting to its demands and focusing on the wider benefits associated with the product.
But in order to achieve this, pharma needs to ask itself:
- Does it support a more integrated, value-based, patient-centric and integrated model of care?
- Is it a good fit with the nascent delegated specialised commissioning and transfer of responsibility to sustainability and transformation partnership level?
- Does it provide an innovative medicine to patients at the point of need?
- Can it demonstrate delivery of the national AAC ambition at a local level?
- Is it an opportunity to provide specialist care in community settings and/or in the patient’s own home?
- Does it improve clinical workforce capacity through the use of an innovative medicine, reducing the need for in-patient/clinic and specialist healthcare professional time?
- Does it come with lower monitoring and administration requirements?
- Does it satisfy the ‘asks’ of the NHS Long Term Plan?
– Out-of-hospital model
– Preventative health and opportunities to reduce inequality
– Improves quality
– Enabling workforce to operate at the top of their licence
– Digital applications
– Sustainable, affordable and tangible RoI and SroI
– Reduce unwarranted variation
– Reduce demand
– Support ‘Getting it Right First Time’ and ‘RightCare’.
Marking out a point of difference is no longer about the what, it is now about the how and the what else. What, besides the therapeutic target, can be achieved through the take-up of a drug or device within a mixed economy healthcare partnership that delivers national health ambitions for local people? The point is not to supply more for less, it is to be more than a supplier; that is the difference.
James Roach is Managing Director and Johnny Skillicorn-Aston is Communications and Engagement Director at Conclusio Ltd. Go to www.conclusio.org.uk
1 Greater Manchester Health and Social Care Strategic Partnership Board www.gmhsc.org.uk/wp-content/uploads/2018/05/05-Pharma-Industry-MoU-Cover-Sheet-FINAL.pdf
2 HM Government: Invest in Great www.great.gov.uk/international/invest
3 The Manufacturers Organisation: Pharmaceutical Sector Bulletin www.makeuk.org/-/media/eef/files/reports/industry-reports/sector-bulletin-pharmaceutical.pdf