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All things Pharma

Going independent?

The changing provision of NHS care

Regular Pf contributor Thoreya Swage examines the benefits of independent sector involvement in healthcare and what opportunities it presents for the pharma industry.

If you were to ask a member of the public about independent sector involvement in the NHS and its role in providing NHS care, you would probably get complaints about creeping privatisation of the health service, a focus on profits and an inevitable fall in the quality of clinical care. The fact is the private sector has been around for a long time and certainly since the inception of the NHS.

Sixty years ago, the only way Aneurin Bevan could persuade GPs to get involved in the NHS was through a nationally agreed contract guaranteeing that they could retain their status as independent contractors and have their own businesses, and so the scene was set for the continuing the participation of the independent sector in the UK health system.

“There is nothing like a threat to your business, i.e. patients being referred elsewhere, to make you smarten up your act and, for example, show that you can reduce waiting times just as well as the ISTC down the road”

The NHS landscape has grown and diversified since those early days and if you were to examine the kinds of providers currently providing health services in the UK, you would find that the independent sector is involved in many aspects of healthcare. This has been reinforced by central policy in that the Government has made it clear that the independent sector has a vital role within the NHS and is here to stay. You only need to peruse the interim Darzi report, where there are references to discovering and fast-tracking different categories of innovation including pharmaceuticals, new medical technologies and other innovative models of care overseen by a Health Innovations Council. This is supported by the operating framework for 2008/09 – the document that sets the priorities and guides the business process for the NHS – where PCTs are expected to widen patient choice, increase competition and stimulate the marketplace for healthcare.

What services are offered by the independent sector?

There is a multiplicity of independent sector organisations providing healthcare in most settings, ranging from support services such as pathology to clinical services such as primary care walk-in centres and independent sector treatment centres.

What are the benefits?

There are a number of benefits of widening the healthcare market. One of the most dramatic has been the general improvement of healthcare services in local health economies; there is nothing like a threat to your business, i.e. patients being referred elsewhere, to make you smarten up your act and, for example, show that you can reduce waiting times just as well as the ISTC down the road. Hip and knee replacement and cataract waiting times have gone down dramatically since the central ISTC programme started due to this effect, as have waiting times for audiology.

There are scattered examples all over the country where the independent sector, in its different approach to providing healthcare, has had a ripple effect and has influenced improvements in care. These include:
• The management of deep vein thrombosis post-operatively, where ISTCs have encouraged local clinicians, through working with NHS partner organisations, to continue the anti-coagulation of patients post-discharge with low molecular weight heparin.
• An impact on waiting times for elective surgery through greater and more efficient throughput in theatres – for example, having patients ready and anaesthetised for surgery in a timely fashion and setting the order of cases in such a way that the work flow runs smoothly.
• Influencing good practice – in some ISTCs, consultants work in both the NHS and the independent sector; this has encouraged a cross-fertilisation of ideas and good practice between the two sets of organisations.
• Access to fast-track diagnostic services is helping the NHS achieve the 18-week waiting time target from GP referral to first treatment; diagnostic services have been identified as a bottleneck to reaching this target.
• The idea of new types of healthcare professionals not considered before in the NHS, such as non-medical anaesthetists.
• Good practice in the area of infection control, as pioneered by the independent sector. Well before screening for MRSA was decreed by the operating framework, this was a requirement for patients before they had their routine surgery done at the ISTCs.
• The provision of scarce commissioning skills such as contracting, procurement and contract management to PCTs is the aim of the FESC programme.
• Having commercially robust contracts with the independent sector – meaning that poor performance is rewarded with penalties. The prospect of docking one’s pay has resulted in rapid improvements in services.
• Increased patient choice – patients have voted with their feet for the independent sector in preference to the NHS.

Range of independent sector organisations providing healthcare in England

• Independent sector treatment centres (ISTCs) – for elective surgical procedures, e.g. total hip and knee replacements and cataract surgery. A few ISTCs are also involved in providing chemotherapy services.
• Primary care walk-in centres – for treatment of minor illnesses and injuries.
• Home care delivery services – for example, services to support renal dialysis, enteral feeds, total parenteral nutrition, stoma care and administration of HIV and rheumatology (e.g. anti-tumour necrosis factor [TNF]) drugs at home, as well as the delivery of oxygen to patients.
• Diagnostic services – e.g. MRI, echocardiography, PET-CT and Chlamydia testing and advice.
• Primary care services – Fairness in Primary Care programme – independent sector alternatives to the traditional GP practices
• Support services – e.g. pathology and decontamination services.
• Services provided by the pharma industry, e.g. asthma and epilepsy nurses
• Commissioning services – Framework for Securing External Support for Commissioners (FESC) programme.

What does this mean for pharma?

Clearly, independent sector organisations now have a greater share of the healthcare market and this will continue to grow.

With the shift from central to local procurements, the time is ripe for the pharma industry to get involved.

The greatest opportunity is to get to know the different facets of the independent sector organisations engaged in healthcare and identify potential strategic partnerships the industry may wish to develop with these potentially new customers.

The independent sector is keen to demonstrate innovation and evidence-based practice to NHS commissioners, and the industry can facilitate this through the use of its own products in collaborative working. As the independent sector is generally more flexible in achieving change, it will be more willing to consider new clinically and cost-effective products as part of the service it offers.

Through this flexibility it is possible to achieve a change in practice much faster than has been the case with the NHS. This characteristic will be attractive to NHS commissioners when they come to procure services.

It is also possible to exploit positively the synergy between the independent sector and the NHS, particularly in situations where staff work for both organisations in a locality. By demonstrating an effective drug in the independent sector setting, consultants can see how well this works and can influence practice at their home NHS trust. By this means it is possible to get new and more effective products in two different types of organisation.

Working with the independent sector to question current service provision and to produce innovative solutions could potentially yield dividends in increasing the market share of your products. The key challenge is whether this opportunity will be taken up to improve healthcare services.

 Dr Thoreya Swage is the Clinical Lead for new projects at the Commercial Directorate at the DH, responsible for transfering the clinical knowledge and experience acquired from the Independent Sector Treatment Programme to the wider NHS. She has worked as both clinician (psychiatry) and senior manager in various NHS organisations. She can be contacted at t.swage@btinternet.com.

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