Mission possible

How pharma can help the NHS deliver personalised care

Conversation around healthcare is still dominated by NHS waiting lists and challenges with workforce capacity. Indeed, both those in the NHS and the healthcare industry are scouring for strategies that not only maximise resources but also improve patient outcomes.

Now, more than ever, long-term conditions demand our focus in order to generate the innovations that can, in turn, help the NHS.

In the recent National GP Patient Survey, 56% of patients have a long-term condition – the highest level for six years, with more than one in five not feeling confident enough to manage their condition. Meanwhile, Age UK’s recent figures suggest that by 2040 in England, we will have over nine million people with a major illness.

While it is clear that many integrated solutions will be needed, one key concept touted by the NHS Long Term Plan is moving to a personalised care approach.

Consequently, individuals are encouraged to be involved in the management of their health and care pathways are tailored to their specific needs. While not new, the concept has recently benefitted from further expansion of its scope and detail.

Under the NHS’ new personalised care team, there are six key elements to personalised care – patient choice, shared decision-making, patient activation and supported self-management, social prescribing and community-based support, personalised care and support planning, and personal health budgets.

Implemented together, these measures are expected to become business as usual across the health and care system, aiming to benefit 2.5 million people by 2024.

While many have heard of and incorporated programmes to support social prescribing and shared decision-making, one of the key areas in the personalised care model that is yet to see the same traction – especially in planned care services – is supported self-management (SSM).

This focuses on supporting patients in managing their long-term health conditions by providing them with the knowledge, resources and support they need from their clinical team.

For example, this could be about providing them with digital tools to monitor their own condition, educating them about their condition and where to seek support, or enrolling them onto a support programme.

Most importantly, SSM has been shown to enhance patient outcomes and quality of life while also promoting health equity, but according to the Health Foundation, it can lead to 38% fewer emergency admissions and 18% fewer GP appointments.

SSM is gaining traction, with clear benefits and emerging examples of best practice in disease areas such as irritable bowel disease, multiple sclerosis (MS) and oncology.  Implementation, however, has not been consistent and it is not yet considered business as usual in planned care services across the board.

Lack of resources and supporting infrastructure, as well as problems with time constraints in clinic and patient safety, are barriers that have been cited by clinicians.

There are also patient barriers to overcome to encourage uptake of SSM. Patient activation is a key measure for healthcare professionals to consider when using SSM; it is a measure of the patients’ ability and willingness to learn, understand and participate in their care.

Reluctance can stem from many individual and nuanced places, from cultural ideas, confidence barriers, digital or health literacy, among others.

Digital tools and face-to-face support groups are central to many self-management initiatives, but these are not always accessible for everyone, especially elderly patients.

This may pose a risk of widening the health gap based on geographic locations, disabilities and language barriers, which are factors that must be considered when trying to implement this care model and improve uptake across the board.

One of the ways to overcome some of the challenges to implementation, and encourage equitable delivery of SSM, is through a continued commitment to educating and supporting healthcare professionals (HCPs).

As an example of where this has worked in practice, Merck partnered with the Neurology Academy to develop an SSM educational series for HCPs working with MS.

This explores sharing best practice, real-world ideas and solutions to help implement SSM in MS, and importantly considers how to engage with patients who are underserved or marginalised.

Other examples of projects to help further integrate SSM into practice may include improving service design and patient pathways, and developing resources to empower patients. It could also involve conducting research to demonstrate the value of SSM, as well as creating awareness campaigns to drive uptake.

One of the most significant learnings for Merck in SSM has been the value of collaborative working with the NHS and Neurology Academy.

The benefits of approaching a problem together, harnessing joint resources and innovation and sharing resources across networks, by far outweighed that which can be achieved alone.

Making SSM a reality for all will require a collaborative approach between public and private sectors, bringing together different perspectives and experiences from across the care pathway to maximise success.

Surprisingly, there is limited evidence of partnerships between industry and the NHS or private healthcare providers on SSM initiatives, beyond the development of digital tools and apps by health technology companies. These of course play an important role in self-management for many, but a more systemic, structured and collaborative approach is needed to drive meaningful change.

We have also seen some examples of successful collaborations between the NHS, patient organisations and academia, notably the TrueNTH SSM follow-up pathway in prostate cancer, between the Movember Foundation, Prostate Cancer UK and the University of Southampton.

While collaboration is happening in personalised care, there is a clear gap for pharma to add significant value in implementing SSM through partnerships with the NHS. As an industry, our access to insights, resources and an extensive network of connections can clearly be leveraged for success.

Doina Ionescu, General Manager, Merck UK and RoI.
Go to merckgroup.com/uk-en