June 2022 • PharmaTimes Magazine • 10-11

// COVER STORY //


Anatomy of the new NHS

For the cogs of a cohesive healthcare ecosystem to align, understanding the key players across the modernised NHS landscape is key

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The waiting is over. What was once a theoretical set of changes will soon become the new orthodoxy in the NHS, as a wide-ranging package of reforms set out in the Health and Care Bill takes effect.

But what, in practice, will actually change for industry, and which stakeholders will be the most important commercially? Here are some of the ‘runners and riders’ who will now take centre stage throughout the reformed NHS.

Integrated Care Systems

The most immediate effect of the new legislation will be to formalise the structural changes that have already happened, and in particular reinforcing the pre-eminence of the 42 Integrated Care Systems (ICSs) within the new landscape.
  

Covering a geographical footprint of around 1 to 2 million people, ICSs will now take on official responsibility for a single budget, and will need to fulfil a ‘triple aim’ duty in the new Act requiring them to ‘consider the effects of their decisions on the health and well-being of the population, quality of care, and the sustainable use of NHS resources’.

Integrated Care Board

Each ICS will be led by an Integrated Care Board (ICB) made up of a Chief Executive, Chair, Finance Director, Medical Director and a Director of Nursing, as well as up to three non-executive directors and partner members representing local authorities, Trust providers and general practice.

These are ‘apex’ decision-makers who will shape strategy and allocate resource at a system level. The ICB will be responsible for setting the strategic priorities for its population.

Integrated Care Partnership

To help them do so, Integrated Care Partnerships (ICPs) will be responsible for developing an integrated care strategy to inform these system-level plans. ICPs are made up of organisations across local authorities, the NHS and voluntary sector.
Like the health and care partnerships that precede them, the intention is to embed a collaborative approach to system-level planning by bringing together organisations involved in health, social care and public health delivery to make shared decisions on behalf of the people they serve.

Provider Collaboratives, Primary Care Networks and Place-Based Partnerships

Beneath this, there is a fast-maturing collection of entities responsible for encouraging integration at different levels within the ICS. Provider Collaboratives, will bring provider organisations together at an operational level to develop more integrated service plans across a system footprint, drawing on the priorities and direction set by the ICB.
    

Primary Care Networks (PCNs) play a similar role, bringing together general practice and other primary care organisations to develop joined-up plans to support populations at a highly localised, ‘neighbourhood’ level.

Place-Based Partnerships (PCPs), meanwhile, are coalitions of NHS organisations, local authorities, voluntary and third sector organisations and community interest groups. They are responsible for driving integration at the intermediate ‘place’ level, which is often mapped against a local authority footprint.

Together these are the engine rooms of delivery for the new NHS, and will be encouraged to develop innovative ways of providing care to meet system-level objectives, as well the operational needs of their own organisations.

Clinical networks

The reforms should also mean NHS customers are increasingly networked and incentivised to act collectively in pursuit of system goals. Clinical networks, most typically organised by disease area of pathway, will therefore hold even greater influence.

Pharma will need to shift its focus from engaging with decision-making units and key opinion leaders (KOLs) in individual Trusts to working with clinical networks across a whole system – or sometimes across multiple systems. It demands a very different approach to what has been the traditional sales focus on agreed ‘territories’ based around specific institutions.


‘These are the opening salvos of significant change for the NHS. Pharma needs to understand the intent behind the reforms’


At this stage, there does not appear to be any consistent ‘formula’ emerging: understanding local practices will be key.

Make no mistake, there are important implications for brand planning and market access.

First – it’s inevitably going to be a complex and changeable picture. The ICS Design Framework published last year provides some of the core features expected within ICS governance, but it allows latitude for systems to evolve organically to meet local custom and practice. The same is true with provider collaboratives, where there is already a range of different models developed. Understanding local custom and practice will therefore be important.

Second – while on paper we mark out clear lines of distinction between system, place and neighbourhood, in practice individual stakeholders may actually hold influence at multiple levels within a system – that is, engaging at a strategic-ICS level and operationally at place or neighbourhood level. Unpicking their connections and interrelationships to develop a meaningful and targeted engagement approach is key so make sure you invest in your customer relations management.

Third – pharma needs to remodel its commercial pitch to the NHS. Operational and capacity pressures now make it a considerable challenge to secure market access for new drugs unless they offer a compelling proposition. Commercial suppliers will need to plead their case on multiple levels – clinical value, value to the patient, service cost value, organisational value and system value. They simply cannot do so without understanding the fundamental changes shaping the way its NHS customers think and operate.

Also – the stakeholder landscape will change, and brand planning must adapt accordingly. The typical customer profile in 2022 will look very different from what it was a few years ago. The traditional focus on acute specialists as the key decision-makers will not always apply as new care models will be placing more emphasis on care provided outside of hospital.

Similarly, as my colleague Jyotika Singh reflected in the last issue of PharmaTimes, key account management teams will need to assess how connected different institutions are into the nexus of ICS decision-making. Knowing who has presence and visibility within ICS discussions and who is therefore equipped to make change happen for their patients will be key to ensuring sales force activity is directed most effectively.

Final analysis

In short, these are the opening salvos of significant change for the NHS. A big unknown is the extent to which the principles of the Health and Care Act translate into practice on the ground. Pharma needs to understand the intent behind the reforms while continually tracking how they are actually manifesting on the ground in terms of relationships and decision-making chains. This is no small job – and it starts now.


Oli Hudson is Content Director at Wilmington Healthcare.
Go to wilmingtonhealthcare.com