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Influencing the influencers: generate success by increasing your customer focus

Increasing customer focus has been identified by many pharmaceutical companies as an imperative to drive profitable uptake of their brands. Caroline Roberts demonstrates how a thorough understanding of the current NHS environment can help sales professionals to keep up with their ever-changing customer base.

Why is increasing customer focus important?

Company success in both the short and long term depends on being able to satisfy key customer needs profitably. Anticipating, identifying and satisfying these needs quicker and better than competitors will be the key to gaining the competitive advantage.

As we all know, our customers are operating in a rapidly changing environment. The key drivers within the NHS are clearly returning to financial balance (and ultimately surplus) while improving patient care. This has led to the development of new initiatives and ways of working in the NHS, a number of which will influence who prescribes, what is prescribed and how much is prescribed and taken correctly. Such initiatives, to name but a few, include:

1. Fewer referrals to secondary care (driven by Payment by Results)
2. More patients managed in primary care (driven by Practice Based Commissioning)
3. Increased prescribing rights for nurses and pharmacists
4. More products being reviewed by NICE and SMC with increased pressure on local implementation from patients and the NHS alike
5. Increased focus on delivery of priorities at a local level through changes to the GP contract
6. Disinvestment from lower priority areas
7. Increased focus on performance of NHS employees.

What do sales representatives of today need to know?

The sales representatives of today need to:

• fully understand the changes in the NHS locally that will impact uptake of their brands and how to uncover these changes as they unfold
• know how to align to and/or shape these changes
• know who the stakeholders are, how they interact and what is important to them
• know how to sell using key product messages, communicated in the context of what is important to that customer, in order to protect and grow the business profitably.

What does demonstrating good customer focus look like?

There are five essential elements to increasing customer focus in the everchanging business environment:

• Gain a higher level of knowledge and understanding of the business environment to identify business opportunities. Plan how to optimise these opportunities
• Identify and target the influencers, gatekeepers and decision-makers to make it happen
• Display deep insight into the motivations of the customer, both to gain access and within the call
• Deliver a needs-based, solution oriented sell, using brand messages in the context of the local health economy to result in clearly identified and co-ordinated actions
• Share insights and outcomes with your territory colleagues to ensure effective team working.

Knowing about your customer and the local environment in which he works is an essential step to securing more business.

Traditionally, sales representatives have focused on finding out how a GP manages a particular condition, what he currently prescribes and what he is looking to achieve with a medicine and then selling to those needs. This approach is undoubtedly effective. The NHS has changed and continues to do so. GPs these days have a lot more to think about than what they are going to prescribe for Edna when she returns for the fourth time that year with raised blood pressure. GPs are now also thinking about how to optimise their earning through the new GP contract; how to reduce their practice expenditure; how to reduce costly hospital referrals and charges made under Payment by Results (PbR); how to commission services in primary care to reduce costs and improve patient care through Practice Based Commissioning (PBC) etc. Not only are the needs and motivators of traditional customers changing within their ‘day job’, but many customers may well have a number of roles. For example, some practice nurses are now also clinical governance leads, some GPs are clinical PBC cluster leads, and so on. There are also many non-traditional customers. Influencing these influencers, decision makers and gatekeepers will make the difference between almost reaching sales targets and blowing them out of the water, as they are affecting the way whole populations of patients are managed.

Where to start

It would be very easy to be customer-focused and lose sight of the company’s objective – profitable growth. Those of you who have read Stephen Covey’s Seven Habits will be familiar with the phrase ‘start with the end in mind’. The first step, therefore, has to be identifying those business opportunities and then ensuring that these are realised through customer-focused selling. A useful checklist is to know:

• what is happening/going to happen in your local business environment that will impact uptake of your brand?
• why is it happening?
• what will be achieved?
• who is involved and what is their role?
• what is each individual trying to achieve, when and how?
• what is important to them?
• how/when do they interact?

James (a representative) is able to land a spec call with Dr. Golightly, a target doctor and the only target GP in a practice of 6 GPs. Whilst waiting to see the customer, James considers his opening and the need to be more customer-focused. Should he go for identifying what the customer is already using to treat disease X and then selling against it? Is it about finding out what Dr. Golightly is looking for in a product to treat disease X and then selling to that? Either way, James closes for the business in the next 3 patients with disease X or asks the GP to identify specific patients whom he can recall who fit a certain patient picture.

However, what James doesn’t know is that Dr. Golightly’s practice is part of a Practice Based Commissioning cluster that has recently submitted, and had approved, a proposal to redesign services around disease X. (Apologies to those of you working in Scotland who don’t have Practice Based Commissioning, but similar things are happening there around service planning).

To save hospital referrals and improve patient care, patients with this condition across the whole cluster of practices will now be referred to a Practitioner with a Specialist Interest (PwSI). This practitioner will manage a number of aspects of patient care including which patients to refer and what to prescribe for them for that particular condition. A number of areas need to be considered:

• would the approach be any different if James knew that the Practitioner with a Specialist Interest was Dr. Golightly?
• what if the PwSI was a GP who was not on the target list and was unbelievably difficult to access?
• what if the PwSI was a clinical assistant at the hospital: would James’s hospital representative have picked up their role in primary care, understood it and communicated it to James so that the customer could be managed in a joined up way?
• where else is this happening and what needs to be done?
• is the investment level in secondary care key opinion leader development still appropriate?

The Case Study demonstrates the importance of really knowing and understanding your business environment to identify business opportunities and shape the way you work to optimise those opportunities.

Who are the key customers?

The simple answer is that it really depends on what you are trying to achieve. New job titles are emerging all the time and where there is consistency in job title, the functions that person completes will vary from one local health economy to another. When being outcomes-driven, it is important to find out the name of the person who will help you achieve milestones towards your objectives, rather than focusing on job titles.

Growing the business

As described earlier, it is important to start with the end in mind. Consider prescribing guidelines as an example. The end game here isn’t to get the brand favourably positioned but to ensure that this favourable positioning results in business growth. A lot of effort is put into winning favourable prescribing guidelines for a brand, but all too often the effort is not repaid in sales due to poor implementation. With the changing influencers, there’s a lot more to excellent implementation than funding a launch meeting and ensuring territory colleagues are equipped with a copy of said guidelines. Table 1 shows what needs to be in place to make sure guidelines are implemented, who is important and what is important to them. By selling in the context of what is important to the influencers you are increasing your customer-focus and likelihood of success.

Influencing the local influencers to drive prescribing guideline implementation

What do you want to happen?What needs to be in place to make this happen?Who is important?Why is effective implementation important to them?
Ensure that local PCO prescribing guidelines favourable for your brand are implemented cost effectively• Guideline is accepted and becomes part of the PCO strategy, clinical governance programme and individual’s appraisal target
• Stakeholder team is recruited that has a vested interest in implementation and includes all relevant parties
• Cost is planned for. Any changes in treatment costs are budgeted for, funds identified and committed
• The guideline is officially launched
• Guideline is communicated to all stakeholders highlighting changes to current practice
• Guideline forms part of the clinical governance and training plan and is included in earmarked learning time
• Action plan is implemented to identify changes required during implementation with timelines/phasings. The action plan becomes part of the implementation measure
• Monitoring and reporting. Measures for effectiveness and evidence for submission are identified
The key personnel you will need to influence are those involved in the development and implementation of clinical best practice. The following job roles will encompass these responsibilities:
PCO and GP practice clinical governance leads PCO NICE implementation leads PCO Pharmaceutical Advisers Practice Based Pharmacists
PCTs in England need to demonstrate to the Healthcare Commission how they are working to implement the Core Developmental Standards in ‘Standards for Better Health’. Implementation of clinical guidelines will demonstrate achievement against Clinical and Cost Effectiveness Developmental Standard D2 and Governance Core Standard C7. This will help the organisation gain a better rating as part of the Annual Health Check review.

Implementation of clinical guidelines in areas linked to the GMS Quality and Outcomes Framework clinical domains – e.g. diabetes, hypertension, CHD, COPD – will help GP practices achieve payments by identifying and appropriately treating patients.


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