Is the writing on the wall for one-to-one detailing?

GP adherence to PCT policy has occurred far faster than expected. Pharma companies need to stop paying lip service to the changes in the NHS and get a real insight into prescribing behaviour if they are to attain any value from sales and marketing activity, insists Gareth Thomas, managing director, Cegedim UK.

THE WRITING has been on the wall for the traditional representative/GP detail visit for some time, and pharma companies have begun to experiment with new forms of communication such as the practice level ‘lunch and learn’. But few pharma companies could have expected prescribing behaviour to change quite as rapidly as it has done. Despite low key efforts to communicate in different ways with prescribing influencers across the NHS, there is little evidence that these companies truly appreciate the true extent of the changes in prescribing behaviour.

Yet according to figures from Cegedim, 70% of GPs are already prescribing within the guideline of the practice. The information, compiled from InfoPharm prescription data, reveals an extraordinary shift in behaviour that seems to have taken the industry by surprise.

Given the pace of change, is there really any point in undertaking the one-to-one GP visit any more?

Changing Behaviour

Is this shift in behaviour really a surprise? PCT guidelines now provide GPs and practices with less and less opportunity for individual decision making. Since PCTs are increasingly demanding the prescription of generic rather than branded drugs – and withholding points for those who fail to adhere to specific targets – perhaps the pharma companies should have been more prepared.

At this rate, it is estimated that 99% compliance to PCT guidelines will occur within five years. While pharmaceutical companies have realised that influence networks are changing, how much radical change has really been achieved? Is the appointment of key account managers really going to be effective or is it just paying lip service to the changing prescribing behaviour across the NHS?

There is no going back. And any pharma company wanting to retain market share needs to face up to the reality of these changes and the real effect they are having on sales force effectiveness.

What Value?

There is obviously no value to be gained from targeting one-to-one visits that deliver the traditional product message to the 70% of GPs now complying with practice guidelines. There is, therefore, a pressing need to improve targeting and focus representative efforts on those 30% of GPs not adhering to PCT policy.

But it is also critical to understand the influence of each group in the core market to assess just how seriously the changes in behaviour will affect market demand. Are the 70% high or low prescribers? And the 30%? Are those following their own prescribing rules more or less likely to see representatives? Is there a correlation across specific PCTs or regional areas?

Furthermore, 70% of prescriptions are now for generic drugs. This has a serious implication for the pharmaceutical sector, which must now focus attention on making branded products the top choice should generics fail to suit a patient. Without this detailed understanding of a fast changing marketplace, pharma companies will be wasting valuable sales and marketing resource. If representatives are to be effective in the new NHS they need real time access to up to date information on local prescribing habits to ensure message relevance.

Targeting and prioritisation is essential. While the independent GPs may be in decline, they remain an important route to market in the short term. Just where are those 30% still eschewing the PCT path? Identifying and targeting these individuals remains critical. Indeed, it is possible that some of these GPs may not have previously been on the pharma company’s priority list. In this new environment, there could well be an opportunity to forge important new relationships – but only if the prescribing information confirms their potential value.

New Information

The detailed information now available to pharma companies is enabling extraordinary levels of analysis and profiling. This includes patient switching data from Talis, which demonstrates trends in support for PCT directives and is critical for any pharma company either at risk of switching or looking to maximise switching opportunities.

Combining this information with prescription data provides the detailed understanding of the local health economy that will be critical in determining the message for each representative visit – whether that is to a single GP or at practice level.

If, for example, a practice shows a high degree of compliance with PCT guidelines and a strong commitment to generic products, the message needs to focus heavily on an alternative to the traditional product sell. These can range from the role of branded products in reducing side effects in specific patients to co-promoting a product’s benefits when prescribed in conjunction with other branded or generic drugs – such as to combat nausea induced in cancer treatment.

Indeed, as prescribing compliance becomes standard behaviour, GPs and practices will increasingly expect this level of insight from pharma companies to support specific patient cases. For example, providing information to help a GP determine the best treatment for patients who either react badly to specific generic products or are struggling with the side effects of multiple drug interactions will become increasingly important.

Critically, this information provision must be delivered via multiple communication channels. Organisations can use the direct sales force to create the relationship and build the co-promotion message, for example, but back this up with online support in response to specific GP queries on demand.

Taken By Surprise

The speed of change in prescribing behaviour has undoubtedly been a surprise. It has given pharma companies little time to introduce new models for direct GP and practice based communication. But it is clear that small scale moves towards the group ‘lunch and learn’ and the occasional e-detail need to be rapidly expanded to support this extraordinary shift in attitude. The market is changing faster than most companies realise. It is those organisations that combining excellent, up to date information with a flexible multi-tiered model, that will be best placed to ensure sales and marketing spend continues to deliver value.