Thoreya Swage takes a predictive look at the NHS environment in 2008 and explains how the introduction of new players in the areas of healthcare commissioning and provision could open up new opportunities for the pharma industry.

The NHS Reform Agenda continues apace and this year will see many of the ideas and concepts mentioned previously become reality.

The biggest driver is the need to produce something eye-catching and highlight achievements of an NHS that will be 60 years old in 2008, particularly in the context of emerging from a difficult year in which many organisations have had to focus on reducing financial deficits. The main item fitting this bill is Lord Darzi’s final report on the state of the NHS, due out in June.

“Many of these potential providers may need help in familiarising themselves with a new market, require help with understanding local relationships and care pathways and need advice on effective evidence-based drugs and treatments”

Lord Darzi’s review

Lord Darzi’s interim report, produced in October 2007, identified the need to invest in primary care, specifically to establish new GP practices in twenty-five per cent of the most poorly provided Primary Care Trusts in England. In addition, a local health centre in every PCT is to be set up to offer a wide range of primary care/walk-in services to the population, whether registered or not. Extending opening hours for GP services and improving urgent care are high on the agenda for improving access for the general public.

The final report will set out how the NHS can deliver the ‘vision for a world class service’ for the next ten years, focusing on:

• primary and community services
• maternity and newborn baby services
• maintaining good health
• child health
• planned care
• acute services
• mental health
• care of people with long-term conditions
• end-of-life (palliative) care.

In the meantime, the NHS operating framework for 2008/09 concentrates on priority areas that need to be achieved for this year.

Operating Framework for 2008/09

This operating framework, unlike its predecessors, only concentrates on the next financial year ahead. Although there is a commitment to a three-year contractual cycle, decisions about the following two years will be difficult as the allocations for 2009/10 and 2010/11 will only be made in the summer of 2008 – a few months into the next planning cycle. This does present a level of uncertainty concerning future spending plans for the NHS.

Having said that, the priority areas are very clear and there is an expectation that investment will occur in key services to achieve the identified targets.

The approach to service planning, delivery and performance is as follows:

• national requirements that must be achieved
• national priorities that must be achieved, but can be delivered according to local needs
• areas for local action as determined by local needs.

The national requirements include healthcare acquired infections (HCAIs) and improving cleanliness, improving access, improving the health of adults and children, patient views and preparing to respond to a state of emergency.

Improving hospital cleanliness and HCAIs

All NHS organisations are expected to tackle HCAIs in a systematic way including screening for MRSA and reducing Clostidium difficile infection rates. This involves a huge effort to improve infection prevention and control processes by staff led by hospital matrons. This will be backed up by inspections and fines for failing to meet hygiene standards by the new health and social care regulator (successor to the Healthcare Commission).

Improving access to healthcare

The biggest challenge for the NHS is to achieve a maximum wait of eighteen weeks from referral by the GP to the date of first treatment, whatever the medical condition, by December 2008.

Ensuring more efficient access to treatment means a redesign of patient pathways, services and current clinical practice. Here is an opportunity to highlight effective treatments and innovative care in different settings.

The target for improving access in primary care is equally stretching, with PCTs being required to ensure that at least 50% of GP practices in their area offer extended opening hours to their patients.

PCTs are also required to have completed procurements for the health centres and new GP practices by the end of March 2009.

Cancer Reform Strategy

A fresh impetus on cancer was provided in December 2007 with the Cancer Reform Strategy, which includes much activity around prevention, earlier diagnosis, extended screening, fast-track drug approval and development of radiotherapy and ambulatory care. This is backed up with £370 million over the next two years. The waiting time (from decision to treat to start of first treatment) for all cancer treatments has been reduced to a challenging 31 days.

The main implications of the Cancer Reform Strategy include more patients being diagnosed and treated, and a shorter time for chemotherapeutic drugs to reach the market, both of which will mean a greater demand for pharmaceutical products in this arena.

National Stroke Strategy

This document, published in December 2007, sets out a ten-year strategy for stroke services in England. One of the first actions for 2008 is the improvement of stroke services through the development of stroke care networks. This means a redesign of services to ensure appropriate access to urgent treatment for stroke and Transient Ischaemic Attacks (TIA) and long-term care.

Better identification of TIAs and prompt access to stroke care will mean a greater demand for cardiovascular drugs.

Emergency preparedness

Planning for major emergency incidents is a high priority. With each passing year there is an increasing need for the country to be prepared and to be able to respond to an ever more likely outbreak of pandemic flu. The pharma industry will play an important role here in ensuring adequate supplies of vaccines in the right locations.

National priorities for local action

On a local level, there are two main issues to highlight; the need for earlier intervention and care for people with dementia and the improvement of end of life care services.

PCTs will be required to develop local dementia services, taking into account the need for earlier intervention, and to review their services for people with terminal conditions. This may mean a revisiting of drugs to treat dementia in the early stages and better control of terminal conditions.

A new NHS Landscapez

This year is the year when the NHS develops its business and commercial acumen in procuring effective healthcare.

A key component is the development of ‘world class commissioning’, whereby commissioning organisations hone their skills in assessing health needs, developing strategy and procuring from a market that is comprised of all of kinds of providers including NHS Trusts, Foundation Trusts and the independent sector.

NHS commissioners will be helped in this process by other organisations which have these skills identified through FESC (Framework for Procuring External Support for Commissioning).

In order to ensure a fair playing field for all potential providers, a new NHS standard contract has been developed to clarify the NHS terms and conditions and bring some commercial rigour to healthcare contracting mechanisms.

Opportunities for the pharmaceutical industry

Despite the reduction in investment as compared to previous years, there are potentially many opportunities for the pharma industry to consider.

The setting up of new services in primary care and cancer care provides an opportunity to develop relationships with new and different organisations. This plurality of provision broadens the potential customer base. Many of these potential providers may need help in familiarising themselves with a new market, require help with understanding local relationships and care pathways and need advice on effective evidence-based drugs and treatments – a role that the industry can perform whilst developing new customers.

“The main implications of the Cancer Reform Strategy include more patients being diagnosed and treated, and a shorter time for chemotherapeutic drugs to reach the market, both of which will mean a greater demand for pharmaceutical products in this arena”

The increase in cancer screening activity will yield more presentations to GPs, identify more new patients and require more referrals for treatment. This rise in activity will, of necessity, require more and better drug treatment regimens to improve outcomes and survival. The fast-tracking of new cancer drugs through the NICE approval process will speed up access to new treatments for chemotherapeutic agents.

The development of ambulatory care, whilst still in its infancy, could potentially increase the throughput of patients treated with chemotherapy on an outpatient basis and stimulate drug sales and development.

The targets for healthcare acquired infections and MRSA screening will increase the demand for products supporting these processes.

Commissioners including PCTs, PBC Groups, clinical networks or providers wishing to subcontract services will be grappling with commercial approaches and may not have the necessary skills and knowledge to tender and procure services. The industry can help by offering help and support to improve business and contracting skills, explaining the evidence base for interventions and help develop patient pathways.

This year presents a double opportunity for the pharma industry; increasing product sales and a unique chance to nurture new customers. With many new players entering the healthcare arena (both as commissioners and providers) the market is wide open for development.