As the NHS braces itself for another punishing winter, how should industry reflect on the growing crisis across the health and care system? Oli Hudson, Wilmington Healthcare’s Content Director, sets out four key processes that pharma companies can use to weather the storm.
By any measure, this is a tricky time for commercial organisations to do business with the NHS. On the one hand, the health service is currently in the thick of major reforms that are rewriting fundamental aspects of NHS organisation and delivery, and in the process significantly changing the stakeholder landscape for industry.
Meanwhile, services themselves are facing the biggest capacity challenge in their history, with acute workforce shortages reported throughout the country, referral lists approaching seven million, diagnostic services struggling to keep up with demand, social care in disarray, and hospital occupancy at dangerously high levels.
How, then, should industry best manage the risks, cut through the complexities, and develop a clear-sighted plan for their organisation? In this article, I wanted to share a few of the processes we are using to help pharmaceutical companies make sense of the implications and plot how they can best support NHS customers through this period of turbulence and change.
Step 1: Analysing change across the whole pathway
The starting point involves mapping out the opportunities and threats you’ve identified for your brand across the whole care pathway.
The aim of this analysis is to give you a full picture of how operational pressures and changes to service delivery may affect the patient’s experience and clinical outcomes at each stage – and, by extension, what this may mean in terms of your commercial offer and ways of working with the NHS.
At diagnosis, for example, there are likely to be particular issues in terms of cohorts of patients who are currently ‘lost’ to the system, as well as cases of misdiagnosis and delayed or late-stage diagnosis as a result of backlog pressures. There may also be highly localised nuances, due to demography or particular challenges with diagnostic capacity in certain parts of the country. How should you adapt your commercial approach accordingly?
At referral stage, patients may be experiencing incorrect or delayed referral due to local access challenges – do you therefore have the evidence base to pinpoint where and how your prospective patients may be affected, and how might this, in turn, affect the way you work with different NHS customers in the future?
Digital transformation can create further complexity as part of triaging processes. You may find that patients who use digital services experience a different referral journey (and/or require different information and advice) to those who use more traditional referral routes. How might this affect your commercial offer?
At point of discharge too, there may be vulnerabilities when it comes to the patient’s access to relevant aftercare packages. Does this have any implications in terms of potential administration and management of medications once the person leaves hospital – and if so, how might these risks be mitigated?
In some circumstances, pharma may also face unknowns as a result of the pathway simply being unclear about who looks after the patient after they leave hospital – again, how might this affect your approach, for example, to clinical engagement and education?
Step 2: Thinking beyond “the usual suspects” in your stakeholder mapping
Analysing these changing contours of the patient’s journey should also help to identify how your stakeholder mapping may need to adapt to these new realities.
Again, it is a useful exercise to work systematically through the pathway – through diagnosis, referral, triage, management and after care – to consider how the cast list of clinicians and other decision-makers involved in defining the patient’s care may have altered.
What most pharma companies will find is that the traditional model of engaging, say, GPs for primary care and hospital consultants for acute/tertiary settings no longer reflects the full range of professionals that now have an active stake in these altered pathways. It has never been more important to look beyond “the usual suspects”.
With more care delivered outside of hospital, there is an enhanced role for community nurses, pharmacists and other allied health professionals, as well as potentially greater involvement of patient representative groups and voluntary or charitable organisations. Do you know who they are, how to reach them and what they are looking for?
Similarly, increasing use of virtual wards and “hospital at home” models for people with long-term conditions brings further changes in the patient-clinician dynamic. Where remote monitoring is delivered at scale, it will often be done via clinical hubs with nurses responsible for supporting patients and ensuring their health is safely monitored. Are these professionals factored into your thinking?
Meanwhile, hospital-based biologics or high-cost pharmacists, specialist nurses, accident and emergency staff (where a trend for late diagnosis is present), and the relevant programme and transformation leads working within ICSs may all be increasingly important for your brand planning, depending on the specifics of the disease pathway and drug type in question.
Step 3: Developing your strategic imperatives
Next, drawing on both the pathway and stakeholder analysis, it should be possible to identify a number of “strategic imperatives” – in other words, defining what is needed for whom, when and how. These imperatives often break down into three broad groups.
The first involves data and intelligence. It is crucial to understand local realities by drawing together all available data and evidence, which our Quantis tool can help you do. This may include looking at current diagnosis and referral patterns, waiting times and other performance issues, workforce capacity challenges and development plans, relevant patient surveys and feedback, and any corporate commitments being made to improve service delivery and outcomes. Every system and locality will be different – so it pays to take the time to gather the detailed evidence to inform your approaches.
The second involves leveraging relevant policy in making your case for change. For example, it is worth looking at the growing collection of Getting It Right First Time (GIRFT) reports, which outline best practice case studies and expose variations in clinical practice across a range of disease areas and specialties. NICE guidelines, and national guidance from NHS England and other national bodies, are also clearly influential in shaping decision-making. This can help ensure your value proposition is in line with the direction of national policy.
The third is about raising awareness and building capability. For most pharma companies, it will remain vital to engage directly with the relevant clinical community to raise awareness of disease and facilitate best practice across a given pathway. Similarly, pharma is often in a unique position to be able to describe and share what works, drawing on a wealth of national and international experiences to make a compelling case for doing things differently (and better) in the future.
Step 4: Aligning your value statements with the new realities
The final stage is to assess and adapt your value statements to take account of these changing customer needs and circumstances. With the chain of decision-making for high-cost drugs becoming more nuanced and multi-faceted, pharma companies need to understand what we’ve termed “the new value proposition”.
Work systematically through the value statements for different stakeholder groupings – what is your high-level offer to the patient, the clinician, the service, and the wider system, for example? And then consider how these propositions may need to adapt in light of changes to these distinct stakeholders’ needs. Are you reflecting the strategic imperatives you’ve identified? If not, what needs to change?
The bottom line is that the pace of change within the NHS shows no sign of abating – and inertia is a dangerous commercial strategy in this environment. Taking a step back now to reset your thinking is therefore crucial for supporting your NHS customers and navigating your way through turbulent times. These four exercises can help you start that process.
Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. To find out more about how we can support your NHS partnerships, visit wilmingtonhealthcare.com.