Negotiating the changing NHS landscape: five critical shifts the pharma industry must embrace

Negotiating the changing NHS landscape: five critical shifts the pharma industry must embrace

As the long-awaited Health and Care Bill begins its passage through parliament, Oli Hudson looks at five critical changes resulting from these reforms that will define the way industry engages with the NHS in the future.


The new Health and Care Bill, published earlier this month, codifies much of the structural reforms taking shape over the past 18 months and fires the starting gun on a wholesale change in the way the NHS makes decisions and allocates funding.

In this article, I will explore the five critical differences you will start to see in how the NHS operates as the landscape evolves; understanding them, and adapting your strategy accordingly, will be essential to maintain competitive edge in a much-altered market environment.

  1. The shift to whole system thinking

The first fundamental change is the dissolution of the provider/commissioner split in favour of a new focus on system-based decision-making.

It will mean customer contacts within provider organisations can no longer afford to be inward-looking or insular in their decision-making: they now have an active stake and interest in saving money on behalf of the whole integrated care system (ICS) and will be weighing up a wider range of considerations than before.

Industry has much to contribute to this agenda – from knowing the profile of patients that need treating or where there may be pools of undiagnosed patients, to defining where patients are not receiving optimal care or treatment or where there may be information gaps either for staff or patients.

The key, however, will be in translating this intelligence into actionable insights that can help inform strategic decisions, at a system level, about the future of services and care pathways. Solutions like Quantis are all about deriving hard insight from real-time data – it has been developed precisely because that is where the strategic need is within the NHS customer base.

2. The shift from competition to collaboration

A second consequence of the end of the commissioner/provider split is the equivalent shift away from competition in favour of collaboration. NHS customers will be increasingly networked and incentivised to act collectively.

This will involve a significant rethink in the way industry approaches its brand planning and engagement activity. The emphasis will shift from engaging with decision-making units (DMUs) and key opinion leaders (KOLs) in individual trusts to working with clinical networks across a system or multiple systems.

The deeper significance lies in how pharma companies approach this new landscape of collective decision-making. It will no longer be enough to focus energies on a select group of favourable KOLs: you may need to engage a broader range of clinical decision-makers within a network to ensure your product or offer wins approval.

As such, drawing on a strong Strategic Account Management solution is important to help generate a broader and more multi-dimensional engagement approach than might have been considered previously.

3. A shift to neighbourhood and place-based planning

A further shift involves the gradual dissolution of the boundaries between primary and secondary care in favour of more integrated planning processes at neighbourhood and place-based levels as well as at a system level through ICSs.

The critical challenge for industry is how to reorganise field teams accordingly. Internal organisational structures based around outdated teams or territories and built around ‘hospital specialisms’ will no longer work. There is an urgent need to train and organise cohorts of pharma staff to manage engagement at system, place and neighbourhood levels.

A related issue involves the new structure and composition of formularies. Pharma will have to negotiate a more layered and complex environment for market access, with APC-ICS formularies at system level and ICP formularies making decisions at place/neighbourhood level.

In addition, Regional Medicines Optimisation Committees, which operate at a level above system, issue voluntary guidance that may be taken up by ICS and ICP local formulary bodies and are therefore another important influencer.

It’s vital that brand planning and go-to-market strategies are aligned to these new realities. Commercial optimisation support can help organisations deal with the effects of these changes on issues like CRM, how customers are grouped or segmented, what kind of targets should be expected at each of these three levels and how different elements of the salesforce should be configured accordingly.

4. The shift to population health

The penultimate shift involves the NHS moving beyond just thinking in terms of disease management and instead focusing much more on population health.

At system-level in particular, the NHS will increasingly be looking at how to support whole populations with certain health needs, particularly by improving diagnosis and intervening earlier to prevent demand on specialist services.

From being a core principle of the Long Term Plan, preventative health has now been given a structure and mechanism for delivery through the development of ICSs. It is vital that pharmaceutical companies move ‘beyond the pill’ and cultivate new ways of supporting the NHS at a population-wide level.

Aligned to this is the challenge of working with systems to monitor variation in pathways and supporting value propositions that can demonstrate clear economic value by unlocking cost-savings. Our consultancy services can help you build this into your brand and business planning.

5. The shift from face-to-face to digital

 Finally, industry faces the considerable challenge of adapting to the rapid shift in the mode of engagement with NHS customers, from face-to-face to digital.

None of us yet know whether the changes in working practices are likely to be sustained, but it is clear that as operational stresses increase pharma must make sure every touchpoint with health professionals is supportive, relevant and aligned to their priorities, relationships and organisational realities.

As my colleague Simon Grime wrote at the beginning of the pandemic, the innate conservatism within industry has made us historically reluctant to embrace digital engagement approaches over face-to-face contact, but the last 12 months have made the latter increasingly irrelevant.

Now, more than ever, it seems sensible for pharma to enhance its digital engagement capabilities and adopt a ‘digital first’ mindset in terms of how it builds and sustains relationships with its customers.

As with the other shifts, this reflects the overarching need to embrace and support the new working realities within the NHS. The urgency can’t be overstated: the changes are here, they’re happening now and they demand your attention.