16 - Service reboot

It might be comforting to think that the National Health Service is returning to where it was before the COVID-19 pandemic struck, but for a whole tier of senior decision makers this would represent a tragic waste of opportunity.

As a result, there is now a drive to build on the positive changes that COVID-19 has brought to the NHS, and to ensure that all pathways and services are reformed with a focus on innovation and system-wide change.

Known as the ‘NHS Reset’, these changes are being spearheaded by the Royal College of Physicians (RCP), the Academic Health Sciences Network (AHSN) and the NHS Confederation. They have significant implications for pharma’s brand strategy and the way it should engage with its NHS customers.

The RCP has issued nine key points about resetting services, while AHSNs – charged with leading on the adoption and diffusion of new technologies and techniques in the NHS – have launched their own Health and Care Reset programme.

Speaking of the reset on its campaign website, the NHS Confederation says: “NHS Reset will seek to influence upcoming national strategies, including from NHS England and NHS Improvement, and their priorities for a reset with services, as well as looking to guide local systems through their own planning processes to ensure they can maintain the beneficial changes they’ve already realised.”

Essentially, the NHS Reset seeks to drive improvements in treatments and care that will help the NHS to become sustainable and enable it to withstand another wave of coronavirus. Many of the primary objectives of the Reset align with the NHS Long Term Plan. For example, keeping patients out of hospital, where possible, and enabling them to be treated in the community or at home, underpin both of these initiatives.

Managing early discharge and risk monitoring will be essential to preventing hospital admissions. It will also be important to empower patients to take greater control over their health if more care is to be managed in the community or at home. Patients will need to be better informed about their condition, more confident about self-managing it and motivated to take preventative measures.

Under the NHS Reset, triage will become as remote, efficient and safe as possible, with reductions in hand offs and appointments to maximise capacity. Digital innovation will be key to driving these changes including artificial intelligence (AI) and products that support community and home-based care by, for example, enabling patients to be monitored remotely.

The rise of remote patient management and monitoring will be accompanied by changes in the way key stakeholders work and also where they work. Rather than seeing patients in hospitals, specialists will aim to manage them digitally or virtually with support from multidisciplinary teams in primary care and in the community, who will monitor patients and determine how drugs are performing.

This is all part of the move to integrated care which is seeing stakeholders from different parts of the NHS and social care work together as a joined-up system with all resources available to them. Major structural changes are required to enable this change, including the creation of Integrated Care Systems (ICSs), which are expected to take on an increasingly prominent role. There is speculation that Clinical Commissioning Groups (CCGs) will disappear in the next set of reforms and that, by April 2021, they will have been entirely replaced by ICSs. If this happens, ICSs will become the statutory bodies responsible for commissioning, working alongside wider system partners such as Social Care and housing.

Many of pharma’s traditional brand activities, such as promotional calls, conferences, events and education have all been compromised in some way by coronavirus. For example, telephone calls have become difficult because clinicians are too busy, or they have been seconded to another area, while face-to-face meetings have been widely abandoned.

Over the past few months, digital engagement has become the norm and evidence suggests that in the main, it is here to stay. For example, a recent PM Society survey showed that 26% of GPs expected regular face-to-face contact before the pandemic, compared to 12% afterwards, and more GPs now expect regular contact from pharma via the internet.

There was a similar shift among specialists, although the research indicated some differences among them. For example, cardiology was one area in which it seemed that face-to-face engagement would remain important.

Overall, pharma needs to be imaginative and responsive in its brand strategy and ensure that its marcoms programmes incorporate integrated digital channels in various forms and are tailored to meet the needs of different stakeholder groups, and allow for face-to-face activity if or when it is needed.

It is also vital to understand how patient pathways have changed as a result of COVID-19 and the NHS’ priorities now as it moves on to ‘Phase 3’ of the pandemic, and plans to make a gradual return to pre-COVID-19 service levels.

In the past, cost-effectiveness was the key priority for the NHS when buying drugs. But now it is patient safety and whether a particular drug can fit into the new COVID-friendly pathways that have emerged. Such changes might mean that a particular drug is now considered unsafe because of its effect on immunocompromised patients or because it does not fit in with a new patient pathway because it needs to be administered intravenously in hospital.

This situation has created a new series of threats and opportunities for pharma. So, for example, companies with drugs that can be administered only by infusion will struggle as the NHS aims to take more care out of hospitals, while those with similar drugs that can be given via oral or subcutaneous methods could have an advantage.

Similarly, companies with large field forces that previously relied heavily on face-to-face engagement will find the new restrictions difficult, but those already doing much of their engagement digitally will have the edge on competitors who are not working in this way, and now is the time to expand on these activities.

Changes to the NHS stakeholder map are key to the NHS Reset because they will accelerate closer working and integration. In line with this, we will see ICSs, Integrated Care Partnerships/Providers and Primary Care Networks (PCNs) take on more prominent roles, while many CCG staff are already effectively working in ICSs.

These changes are bringing a wealth of new contacts for pharma. So, as part of their brand strategy, companies need to re-evaluate who they should be targeting, where these people are now working and what their roles encompass.

One likely change is that the customer base will shift out of the traditional comfort zone of senior stakeholders to encompass a much wider range of customers and influencers, including those working in multidisciplinary teams as well as the wider health and social care related organisations that will work alongside the ICSs.

These stakeholders will be looking to deliver more holistic care services and become more financially efficient by working in a joined-up way. So, pharma needs to think about how its products and services can deliver benefits across the whole system.

Furthermore, with integrated care evolving at a different pace in different regions, there is no one-size-fits-all approach. Pharma needs to map each region individually and tailor its approach to that region’s unique challenges and needs as well as the overarching constraints and implications of national policies.

As the NHS aims to return to pre-COVID service levels, it has a unique opportunity to deliver service transformation at a much faster pace than anyone would have believed possible just a few months ago. The NHS Reset will be key to making this happen.

The changes most likely to affect industry will be around integration, whole system thinking, clinical practice and innovation. It will be important to look out for these in future recovery plans appearing in local systems, and to ensure that brand strategies are aligned with these new ways of thinking and working.

The NHS is entering a new era and there has never been a more opportune time for pharma to support its customers. With the right brand strategy and approach some promising new partnerships can be formed that will help the NHS to overcome the challenges that lie ahead and achieve its service transformation goals.

To find out more about the changes that are occurring in the NHS, register to download a free copy of Wilmington Healthcare’s new white paper, entitled Covid-19: Roadmap to Recovery (http://ow.ly/yY3C30r5auA).