A new report into how the pharmaceutical industry and Government can work together to improve healthcare has called for a ‘more mature’ relationship between the industry and the NHS. Pf looks at how previous penchants for ‘partnership’ are being replaced by a move towards ‘joint working’.
LAST MONTH, the Long-term Leadership Strategy, a collaborative work proposed by the Ministerial Industry Strategy Group (MISG) – an advisory body comprising the ABPI and the Department of Health – suggested that successful ‘joint working’ between the industry and NHS can propel healthcare in the UK and help eradicate variances in the use of medicines across the country. Recent analysis from the MISG has revealed that, while medicines uptake across England has increased, the rate of increase varies substantially geographically, particularly in hospitals, and also with new drugs in primary care. As such, the Long-term Leadership Strategy has identified NHS/industry joint working as a means to improve patient access to cost-effective new medicines.
Building trust through a shared goal
Critics have dismissed the report’s findings as rhetoric, claiming it simply rebadges the old term of ‘partnership’ under the new guise of ‘joint working’, and that it will suffer the same lip-service that has blighted previous attempts to improve communication and co-operation between the NHS and the industry. However, the report argues that its market research uncovered an environment that was positive towards joint working, but that increased trust is required on both sides for collaborative working to succeed. An historical mistrust of the commercial motives of pharmaceutical companies seeking to work with the NHS appears to be a primary reason for the apparent failures of previous attempts to partner. The Long-term Leadership Strategy suggests that if a ‘maturing’ of the relationship between the NHS and the industry can be achieved, the goal to move more care to the community will become easier and, in turn, patients will see an overall improvement in healthcare. In this sense, the report implies that the historical NHS mistrust of the commercial motives of pharma companies can be overcome by a shared goal: “The NHS and industry has to realise that while their priorities might be different, the ultimate aim of getting cost-effective medicines to patients is the same.”
Defining joint working
So what is joint working, and how does it differ from partnerships? The MISG describes partnership as a narrow term and claims that joint working is broader and therefore more appropriate. It provides the following definition: “Joint working between the pharmaceutical industry and the NHS refers to situations where, for the benefit of patients, organisations pool skills, experience and/or resources for the joint development and implementation of patient-centred projects, and share a commitment to successful delivery. Joint working agreements and management arrangements are conducted in an open and transparent manner. Joint working differs from sponsorship, where pharmaceutical companies provide funds for a specific event or work programme.”
| East Lincolnshire PCT Chronic Obstructive Pulmonary Disease (COPD) Programme incollaboration with GlaxoSmithKline, Boehringer Ingelheim and Pfizer* |
| East Lincolnshire PCT developed a locally enhanced service, three-phase programme to target suspected COPD. Phase 1 identified patients and screened them for COPD within spirometry clinics; phase 2 involved training clinicians to manage these patients and establishing specific COPD clinics within the practices; and in phase 3 a primary care-based respiratory service was set up which integrated primary and secondary care. Patients previously referred to secondary care for treatments such as pulmonary rehabilitation or long-term oxygen assessment are now seen in primary care and the hospital manages the most complex patients and other specialist services, such as lung volume reduction surgery. Additional support was provided by an educational pathway available to all clinicians in primary care. The programme recorded a 23 per cent fall in admission rates in COPD (neighbouring PCTs’ reductions were in single figures). Over a fivemonth period, 78 out of 215 case-managed patients had acute episodes that were successfully managed at home. Only one resulted in hospital admission. All 37 practices in the PCT area signed up for the enhanced service. Funding was shared between the PCT and the three companies. Industry was also able to provide essential project management support and communications and marketing expertise. * Source: MISG Long-term Leadership Strategy, February 2007 |
The report cites three examples where joint working between the NHS and pharmaceutical companies is currently taking place that have led to significant health and health-economic outcomes. Figure 1 shows an example of how one PCT worked in collaboration with GSK, Pfizer and Boehringer Ingelheim to improve COPD treatment. The project won the Health Service Journal’s Chronic Disease Management Award and the overall Secretary of State’s Health Management Award in 2005.
Changing the NHS mindset
The East Lincolnshire PCT example demonstrates that joint working is actually already taking place within the UK. However, independent research published within the MISG report, showed that the NHS has mixed views on collaboration; some participants are willing to embrace the concept, others claim they would never consider it. Consequently the Leadership Strategy outlined an objective to change the view of those who would not consider such an approach and underline that collaboration can take place within an appropriate governance framework. As such, the Department of Health is to develop specific guidelines on joint working for NHS organisations which endorse joint working. The DH and the industry will also develop and pilot a best-practice toolkit for the NHS and the industry to support joint working. An outline of the common characteristics of successful joint working has already been published in the report (Figure 2).
| Common characteristics of successful joint working* |
| Set-up: • Shared vision – benefit for patients Running/managing projects: • Good project management Attitudes and people issues: • Shared attitudes to risk and levels of urgency * Source: MISG Long-term Leadership Strategy, February 2007. |
Trust me – I’m in pharma
There is undoubtedly much to be gained from a more co-operative and collaborative approach between the NHS and the pharmaceutical industry. However, previous attempts to build stronger ties between the two have brought about lukewarm results and led to allegations that the Government and the NHS have paid lip-service to the idea of partnerships. Whether a move towards joint working proves to be little more than semantics, it is clear that the environment for collaboration is improving. The NHS is beginning to recognise that, beyond its commercialised drugs, the pharmaceutical industry contains skills and resources from which it can benefit. The key to success depends upon a shared and mutual goal to improve patient healthcare. Recognition of this can only help eradicate a lack of trust in the pharmaceutical industry that has plagued previous attempts at partnership. And, as the industry’s largest customer-facing body, medical representatives have a major part to play in building that trust.
