16-17 - (New) terms of engagement

“How are you feeling today?” It’s a basic question that thousands of healthcare professionals have been asked as NHS organisations survey the impact of the last 12 months on the physical and mental health of its workforce.

The results, perhaps unsurprisingly, are challenging – and should give pharma companies food for thought in how they approach the tricky task of engaging clinicians during a turbulent period for the health service.

Yet as the major reforms outlined in the recent White Paper begin to take root, it’s arguably never been more important for pharmaceutical firms to work in partnership with clinicians to shape new approaches to individual care pathways and wider population health.

In this article, we’ll look at the evidence base showing how pressures are affecting the frontline mindset and how commercial firms looking to engage with healthcare professionals should adapt their approach accordingly.

Over recent weeks, there has been a jarring collision between two agendas that are extremely difficult to reconcile. On the one hand, we’ve seen ambitious plans set out in recent NHS planning guidance to encourage hospitals to ramp up activity levels as COVID rates ease off. Trusts will be incentivised to restore activity, as far as possible, to a high percentage of pre-COVID levels to access a share of a £1 billion recovery funding pot. The harsh reality is that this will strongly influence the way providers prioritise their resources over coming months, piling pressure back on clinical teams to deliver.

On the other hand, the uncomfortable truth – as told in increasingly urgent tones by membership organisations such as the British Medical Association (BMA) and the NHS Confederation – is that the workforce itself needs time to rest and recuperate after a physically and psychologically draining twelve months.

Among the hardest hit have been staff in intensive care units (ICUs), where surveys conducted last year have reported symptoms consistent with a probable diagnosis of post-traumatic stress disorder (PTSD) in 40% of respondents. A further study of 2,600 healthcare workers in the Midlands found PTSD symptoms in almost a quarter of participants, while over a third reported symptoms of anxiety and more than three in ten reported depression.

Added to this, it has been estimated that somewhere in the region of 122,000 healthcare professionals have long COVID symptoms as a result of catching the illness themselves, which is creating a long tail of sickness, fatigue and performance issues, while some will also be experiencing further uncertainty and disruption due to ongoing structural reforms set out in the government’s NHS White Paper and changes to ways of working accelerated by the pandemic.

How you reconcile this ‘ramp up now’ message with the need for a compassionate approach to staff well-being is one that I suspect will play out in workforce relations over the coming months. The more immediate concern for pharma is how best to operate in a heightened stakeholder environment where staff will continue to face significant pressures when many are physically and emotionally spent.
So what are the best approaches to take?

Firstly, any engagement needs to be acutely sensitive to the psychological effects of the pandemic and show an abundance of empathy for how customer contacts may be feeling.

Be particularly wary of going in with punchy gap analysis offering aggressive critiques of a service or pathway; this might be a legitimate approach in peacetime, but at present may feel insensitive and tin-eared at a time when clinical teams will have had many other things on their mind.

In many ways, the course of action is quite simple: be human and kind, sympathetic to what staff have been through, and use positive messaging to play up the achievements to date rather than exposing the weaknesses or describing problems yet to be solved. But there is also the need to demonstrate that there is a valid reason to call at a time when healthcare professionals will have many other claims on their time.

A good approach may involve seizing on pilot projects and exploring with key contacts how this might be scaled up at a regional level. Pharma, in this way, can act as a maven within regional systems, drawing out good practice and facilitating its spread. Done well, this can represent a win-win for all parties.

A second important requirement is to come armed with solutions that reflect upon the context people are working in and can help them answer the conundrums they face. While this isn’t a time for the full-blooded sales pitch, pharmaceutical companies can play an important role in the next stage of the NHS’ recovery.

The planning guidance, which lays out many of the priorities that NHS organisations will be working to over the next six months, should provide a good picture of the internal pressures that clinicians may be under. For example, medicines can play an important role in capacity management as hospitals grapple with operational pressures. Pharma-led solutions can also support NHS organisations meet the clear demand in the guidance for more care to be delivered remotely.

Being part of the solution means reaching beyond your own agenda and tapping into broader questions facing local systems. Often formulary issues, for example, don’t solve critical service or population issues and remember that access to a drug may be nothing to do with patient need or service design.

Oncology services, as a case in point, are currently being strongly determined by what is safe, with cancer teams frequently selecting subcutaneous methods over infusion-based drugs as they can be administered without patients being required to visit hospital for treatment. Acknowledging these realities means that, more than ever, pharma representatives need to be experts not just in their product lines but in the wider clinical and operational context within which their drugs are administered.

Above all, the most potent commercial relationships provide strategic value to customers. In the case of the NHS, this can often mean helping clinicians negotiate their way through the changes underway in the NHS’ local and regional landscape.

Pharma shouldn’t necessarily assume that clinicians have fully digested the minutiae of the government’s White Paper, and still less that they are fully cognisant of the implications and opportunities available for them to influence at place-based level or across specific pathways. So, as well as bright ideas and propositions, pharma may need to offer guidance and support to help healthcare professionals negotiate the new landscape. In times of change, it’s natural for people to retreat into their silos, seeing threats rather than opportunities and focusing on here-and-now concerns.

This is, in many ways, a uniquely difficult and delicate time for pharma to engage with its customers. The challenges posed by the psychological and operational environment are further compounded by the fact that face-to-face dialogue with customers is still extremely difficult – and likely to remain so for the foreseeable future.

Conversely though, as the NHS embarks on another major period of reform and renewal, there are tremendous opportunities for pharma to build a new, stronger relationship with the NHS – less product-based, more focused on building effective, long-term solutions for patients and populations.
Understanding and speaking the language of the reformed landscape and being able to translate this into strong, progressive solutions for healthcare professionals could do more than help build sales – it could make you an indispensable partner for health systems long into the future.