16-17 - NHS - Primary goals

UK pharma knows the integration revolution in the NHS is now in full swing. For nearly 18 months now we’ve not just been talking about, but dealing with, the new landscape of 42 Integrated Care Systems in the English NHS. We’ve seen their plans, know what many of their priorities are, and stakeholder-mapped the service leads and decision-makers.

ICSs are the now the standard operating unit of the NHS. We know they will be operationally independent – as per the Hewitt review – and budgets for specialised services will be completely devolved to them and added to the system pot by April 2024.

Having said that, the actual specialised medicine cheque-signers will still be about three people monitoring pass-through payments in NHS England – so don’t worry about your rebate prices being made public any time soon.

At the HSJ Integrated Care Summit earlier this month, we learned that ICSs will from next year all have their own formularies too.

It’s also apparent that the need for a new localism is hitting home, with more and more of our clients working out routes to partnership with solutions focused on a particular locale – patient access schemes, service redesign, system costing, local patient identification and local pathway change, to name but a few possibilities. Typically, these solutions are ones that will best help the particular local circumstances.

So, three truths – ICSs are an important new customer for pharma to get their heads around; ICSs are an ideal level of customer to co-develop partnership programmes; and you’ll get a different experience of engagement around the country, depending on how well-developed, well-financed, well-governed and amenable to pharma they are.

Historically, our customers have been asking us to rank and stratify ICSs on just such metrics, to help them segment the market, look for partnership options and perhaps most important – steer the use of resources, including how to use fieldforces, MSLs, clinical specialists and digital marketing.

Now we at Wilmington Healthcare, and increasingly our clients, are asking – why not PCNs too?

It’s possible to stratify PCNs in exactly the same way – giving us the ability to assess which are the most ‘capable’ to implement new patient programmes and achieve better outcomes.

One project looks at PCNs’ ability to achieve positive diabetes outcomes, by using such datasets as QOF and performance against national targets as set out in the National Diabetes Audit.

We can assess aggregated PCN performance, but also variance across practices. And we’re finding that in situations where a PCN’s performance against data is good, and variance across practices is minimal – then that’s going to be a potentially good collaborator, with co-ordinated parties, good governance, better, quicker outcomes available and a more enthusiastic partner for Industry.

Care closer to home necessarily involves a lot of work at so-called ‘neighbourhood’ level, which is supposed to comprise population groupings of about 50,000.

Perhaps it’s unsurprising that many PCNs are getting involved in work on this kind of scale, as they are the relevant ‘neighbourhood’ stakeholder as set out in the Health and Care Act 2022.

And there are around 1,200 PCNs, as opposed to 42 ICSs, so that means many more options and ‘purchasing points’ for your ideas. Our clients are asking us more and more to help them focus comms and appropriate content for such primary care providers.

Why is this an opportunity? Well, let’s look at the fast-growing area of chronic weight management pharmaceutical intervention, which is going to provide a lot of income for certain companies in the near future.

Primary care is going to become increasingly important in this area as the distributor of these medicines, and accompanying prevention programmes and service lines – you need to understand the varying capabilities of each PCN to push this and where you might see the quickest return on investment of resources and time if you’re in this sector.

You could say the same about several clinical areas that are undergoing the transition to being predominantly primary-care managed, such as Alzheimer’s care, chronic pain, dermatology, respiratory, gastroenterology, some aspects of oncology and some aspects of cardiovascular care such as stroke.

So, it’s important to understand how care is moving closer to the patient – what exactly they are doing, who’s running it and what help do they need to get the new pathways established. For example, the rollout of mobile diagnostics is going to be a huge part of all this.

Pharma can assess what current provision is like for their disease and see what could be done – together – to speed that rollout up, make the tests more effective, and ensure that the right potential patients know about it.

It’s also going to mean focusing on a new range of customers who have a stake here – including clinical specialist nurses, clinical pharmacists and dieticians, to name but three.

In diabetes service improvement at PCN level, for example, we have found that in many cases the driving individuals are in fact clinical pharmacists, not GPs, and certainly not consultants.

One size doesn’t fit all at a local level and it’s becoming increasingly apparent that a blanket approach isn’t right. Neither, we are finding, is being led by raw population data. Several clients have asked us about a particular area as a potential lead target owing to large patient population numbers for their disease and/or big prescribing figures.

You may think there is therefore loads of opportunity for increased engagement and partnership. But here’s the rub – if the governance isn’t there in a PCN, it can be a nightmare to get anybody in the local NHS to do anything, be anywhere, decide on anything, be friendly or even be communicative.

On the other hand, in a well-governed PCN, there may be no need to see all the disparate clinicians separately and you can find individuals with delegated responsibility. Projects can be fast-tracked, obstacles can be more easily overcome, communication is less frustrating and ultimately the real-world outcomes you need to achieve for your medicine are easier to arrive at.

Primary goals

New opportunities

Closer to home

Access areas

Model professional

Final analysis