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All things Pharma

Territorial advantage – Understanding Regional and Local Policy Divergence across the NHS

The NHS is a diverse and dynamic animal. As the health service moves towards a regionalised model and the industry adopts an account management approach, the question for the sales professional is simple: how well do you know your own territory? Dave Round and Duncan Alexander of Cegedim Dendrite address the need to think local. Can the industry change its spots?

As pharma companies increasingly divest large field forces and concentrate on building strong relationships at Primary Care Organisation (PCO) and Strategic Health Authority (SHA) level, there is a growing focus upon Key Account Management strategies. But far too many organisations are failing to take into consideration the very real differences that exist across the NHS – from growing national strategy divergence to individual PCO policy interpretation.

Simply focusing on the identification of Key Opinion Leaders is not enough. Pharma companies need to achieve an additional level of insight, targeting and segmentation that addresses the distinct differences in care pathways, medicine management and financial strategy at every level of the NHS.

NHS Diversity

Pharma companies have made significant changes in sales and marketing strategy in recent years to reflect the NHS’s shift in prescribing role from doctor to central bodies such as NICE, the Strategic Health Authorities (SHA) and Primary Care Organisations (PCO). But these strategies have yet to address an essential change that is also occurring: this is not one, unified NHS.

Despite sharing the same funding model, there is increasing divergence between the delivery of health services across the NHS in England, Wales, Scotland, Northern Ireland and also Southern Ireland. Furthermore, whilst national policies and procedures are increasingly being defined centrally, all are open to some level of interpretation. As a result, there is clear divergence between PCO approach to both financial and clinical management.

It is therefore essential that before pharma companies rush headlong into identifying Key Opinion Leaders (KOLs), they attain an in depth understanding of both regional and local cultural and strategic differences across the NHS. Without this insight, it will be impossible to achieve effective, tailored message creation and delivery to the KOLs, to maximise investment in sales or boost levels of engagement.

As the extraordinary level of change announced for the NHS over recent years becomes reality, pharma companies need to take into account the growing differences that will occur at both regional and local level as organisations begin to realise the implications of these new strategies.

National Devolution

Certainly, the changes at regional level are stark. Whilst five years ago NHS strategy was largely coherent and consistent, today each national service is fast evolving towards a slightly different model of care. And the results are being felt by pharma companies, not only in diverse national guidelines, but also in specific prescribing guidelines.

Continual assessment of national policy over the past two years has begun to reveal a strong divergence in cultural attitude. In England, competition between the NHS and private sector to deliver services has increased patient choice; whilst in Scotland, significantly more care is free rather than means tested as it is in other countries and in Wales prescription charges have been abolished completely. At the same time, Wales is moving towards Scotland’s model of collaboration between hospitals and commissioning, which has delivered greater harmony between clinical staff and management; while England is still looking to gain greater value for money from a competitive tendering model.

The result is a very different approach to budgeting, patient care pathways and decision making at every level.

Regional Model

As a result, pharma companies are not dealing with one NHS or with the 200 plus Primary Care Organisations (PCO) across four countries all following the same, centrally dictated policies and procedures. It is an increasingly regionalised health service.

As such, pharma companies need to adapt and tailor messaging to reflect these divergent policies and procedures. In England, for example, pharma companies need to keep a very close track on the growing influence of private sector health providers. In Scotland, in contrast, doctors have far more say in service delivery, retaining stronger roles as KOLs than their colleagues across other parts of the UK.

In Wales, meanwhile, a close working relationship with local government is boosting innovation, providing greater opportunities for pharma companies to work with Health Organisations at every level to deliver new services. In Northern Ireland Trusts are being reorganised from eighteen to five, with additional responsibility for providing social care, a move which will have a very significant impact on policy and decision making.

Local Targeting

Given the significant implications for pharma companies of these national differences, each country has to be treated discretely. Pharma companies can leverage policy, strategy and performance information that is provided on a country by country basis to ensure relevant messaging.

This information then provides important insight into the strategies adopted at SHA and PCO level. However, PCO strategic interpretation of care pathways, medicine management and financial control also varies considerably.

Those pharma companies that are hoping to maximise sales by assuming that Key Account Management will perform the same role in each and every PCO are going to be frustrated. Furthermore, a one size fits all message is not going to be relevant, even if the organisation has identified the right individuals – the message has to reflect the different operating environment and treatment approaches adopted within each PCO.

It is essential that pharma companies understand the nuances of policy interpretation within each organisation. It is only when this information is assessed that a company can create and deliver the appropriate message to the right people.

Tailored Message

In depth analysis of strategies that takes into account around 40 different factors provides a PCO sophistication rating. Updated every six months, the rating takes into account issues that include medicine management, commissioning – including proposed service delivery at primary care level – and the financial probity of the organisation.

Using this information, pharma companies can segment the PCOs into three or four different groups, and tailor several marketing messages to reflect the key cultural requirements of each PCO segment, whether that is the cost benefit of a specific drug or the improved efficacy.

Adding this insight to KOL identification has already been proved to deliver significant benefits. Pharma companies have seen approval for sales and marketing aids increase from 70% to 90%; and access to the right people from 25% to 50%.

Continual Improvement

While an initial project to improve segmentation, targeting and messaging will deliver significant value, it is also important that pharma companies recognise the implication of continuous change. Indeed, the pharma company’s own engagement may have an impact on PCO strategy, which needs to be monitored and measured to ensure the message remains on track.

Without a continual reevaluation of strategy that takes into account the regularly updated information on PCO sophistication, pharma companies are likely to see messaging slide off track in certain organisations and results begin to tail off.

Furthermore, whilst the pace of change within the NHS is slowing, 2009 will see significant consolidation, an increased focus on practice based commissioning and the fall out of policy to separate provider and commissioning within each PCO.

Therefore, whilst improving understanding of regional and local cultural and operational differences is an important starting point, to sustain results it is essential that pharma companies continue to evolve their strategy, to feedback results to drive additional insight and to ensure that any changes in either NHS strategy or regional/ local interpretation are considered.


Over the past two years, the majority of pharma companies have taken many of the tough decisions required to reduce sales and marketing spend and reduce their field forces. They have also recognised the need to undertake in-depth analysis to identify KOLs and provide Key Account Managers with the information and targeting required to improve performance.

But far too few have yet to take on board the growing regional and local differences that are emerging across the NHS. It is now essential not only to understand these differences but also to effectively segment organisations, evolve targeted messaging and put in place the tools required to enable both management and users to track every one of these new and complex decision making tiers.

With the implications of the current financial crisis due to be felt in the next round of budgeting in 2011, it will be this excellent information and analysis underpinned by a continual feedback loop that will be key to improving performance at every level to drive sales.

This is a fundamental change in the way pharma companies operate and will enable the delivery of excellent customer marketing that takes into account the growing regionalisation and diversity of the NHS.

David Round is UK General Manager at Cegedim Dendrite and Duncan Alexander the MD at Health Direction, a division of Cegedim Dendrite, where they are responsible for managing the existing client base and the co-ordination of all UK commercial activities. Cegedim Dendrite has over 35 years experience in providing value added information and CRM solutions to the pharmaceutical industry and healthcare professionals.
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