Joint Working WorkshopKevin Blakemore, National NHS Partnership Manager |ABPI

Our common goal

Win:Win:Win:Win:Win

Public

NHS

Academia

Voluntary Sector

Industry

Social

Care

Quick Start Guide – May 2012

Flow Chart

Customer Quotes on Joint Working

“The NHS is strapped for cash, the medicines are too expensive and

national therapeutic tendering is the only answer.” – Finance

Director, primary care

“JW with governance –

fantastic! This is exactly what is

needed.” – Lead Pharmacist, primary care

We want industry to get involved in the projects at the embryonic stage. We

want a long-term sustainable relationship.” - Consultant secondary

care

“I wish this JW criteria existed before. It makes

the NHS feel safer working with industry, especially as the ABPI

is endorsing it.” – Governance Manager

secondary care

“Why doesn’t pharma just provide sponsorship and let

the NHS do the rest?” – Primary

Care lead

“I’m interested in JW, but what does

industry have to offer?” –

Innovation Lead secondary care

“It’s disappointing when pharma

provides financial resources but no other resource.” –

Governance Manager secondary care

“The CCGs are gagging for JW with industry, but it has to

be open & transparent.” – Lead Pharmacist, primary

care

“NHS is wary to work with pharma, so you have to sell the concept of JW.” – Pharmaceutical Advisor primary

care

DH definition of Joint Working

“A situation where, for the benefit of patients, one or more pharmaceutical companies and the NHS 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 is n0t…….• Clinical trials• Standard product promotion• MEGS• Patient support programmes• Meetings/symposia and the like • Discounting/trading deals• Package deals• Tenders • Patient Access Schemes• Risk sharing/ Outcome agreements• Donations/grants/sponsorship• Commissioned work

Rocket science

Joint Working must…….

• benefit patients (expected to also mutually benefit the parties).

• be conducted in an ethical, open and transparent manner – overall arrangements made public.

• take place at a corporate organisational level and not with individual health professionals or reps

• be in accordance with the ABPI Code, government guidance, NHS rules and relevant professional codes, etc.

• have all materials certified in advance, including a formal signed agreement

Agreements must include…..• Name, parties, start date and term of the project.

• Expected benefits for patients, the NHS and pharmaceutical company.

• Outline of the financial (and other resource) arrangements.

• Roles each of the parties will undertake, how success will be measured.

• Contingency arrangements.

• Exit criteria.

• Summary of Joint Working agreements to be made public by the

pharmaceutical company.

• Reasonable and appropriate for both parties to consider return on investment

(ROI) before committing to any project.

• Commercial benefit to either party must not be the sole benefit.

The project may include……..

• staff training• staff and/or patient education• facilitation of pathway redesign• support for guideline implementation• funding of project staff requirements (e.g. provision of

administrative, clinical, analytical health economic and/or

management resources by either party)• secondments• audit• economic analysis• nurse services

JW using your brand

•Disease management (e.g. design and implement a disease protocol) that may increase usage of medicines in a therapeutic area can be acceptable

•Use national or local guidelines

•There must be no inducement to prescribe your product

•Beware perception of inducement if JW likely to increase use only of your medicines (rather than class/group of medicines)

Make the basis clear

For example:“On the basis that the Primary Care Trust / Health Board

has previously placed [company x’s] medicine appropriately in the treatment guidelines for the treatment of [the condition] in line with local / national guidelines, the NHS Organisation and [company x] have agreed to work together and provide funding and other support for this project.”

Be transparent about benefit

“This Joint Working project is intended to create more opportunities for the appropriate use of medicines, including [company x’s] medicines in suitable patients in line with [insert treatment guidelines, e.g. NICE/SIGN/AWMSG guidelines, National Service Framework targets, locally agreed protocol]. If this improvement occurs, we are likely to see an increase in prescriptions of [product y] roughly equal to our current proportion of prescriptions in this therapeutic area.”

Measurement is mandatory

•Patients•NHS•Company

The outcome of every project should be measured and the taking of baseline measurements at the start of a project are helpful to track success, particularly patient outcomes.

Targeting

•It is acceptable to target Joint Working geographically according to:–Identified patient need–Availability, experience and commitment of relevant

personnel to deliver the project–Areas where the NHS has expressed a need or desire to

improve benefits to patients by working together with the pharmaceutical company/ies

•Pharma ROI must not be the sole or primary criterion

Communication within Your Company

•Communication should be clear and unambiguous to ensure that the Joint Working agreement is not infringed and that the project is not used inappropriately by sales representatives to gain access to customers or to influence prescribing.

ABPI/DH Joint Working Toolkit

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082840

Or just google ABPI Joint Working toolkit

What do you think?

A Pharma company gets involved in a jointly resourced venture with

a GP practice to supply spirometry kits

A Pharma company gets involved in ajointly resourced venture with a

PCO to carry out diabetes diagnostics

A Pharma company gets involved in a jointly resourced venture with a

hospital department to redesign renal pathways

A Pharma company gets involved in a 70/30 resourced project with a PCO to

carry out angina population metrics

Ref: Wellards module NHS-Industry Joint working

Case study reviewIn your groups:

• Review the 3 case studies using the checklist

• For each discuss and agree: (Baxter/Pfizer COPD/BMS HIV)– Background/Overview/Outcomes/Services offered/Behaviours demonstrated– Is it Joint working? – yes/no/cannot say– If not, what are the reasons?– If can’t say -what extra information do you need to decide?– Prepare to share your feedback to the group

Ways of Working

PHARMA

Sponsorship

Medical Educational Goods and Services (MEGS)

Joint Working Promotion

Pharma activitiesJoint Working

• Secondments• Audit• Nurse services• Facilitation of pathway redesign• Economic analysis• Support for guideline implementation

• Staff and/or patient education• Staff training

Not Joint Working

• Clinical trials• Commercial payments for consultancy advice

• NHS tenders• Package deals (medicines & other benefits)

• Meetings and hospitality• Gifts and benefits in kind• Commercial arrangements e.g risk share, outcomes guarantee, pricing, margins, discounts

Ref: Wellards module NHS-Industry Joint working

Promotion Joint Working

MEGS Sponsorship

For patient benefit Yes Yes Yes Yes

NHS/Pharma company pool resources X Yes X X

Pharma company investment Yes Yes Yes Yes

NHS investment X Yes X O

Detailed agreement in place X Yes X X

Shared commitment to successful delivery

X Yes Yes Yes

Details of the agreement are made public

X Yes O X

Prospective ROI Yes Yes X X

Outcomes must be measured X Yes O X

4. Manage and Engagement

3. Understand

2. Analyse and Prioritise

1.Identification

Stakeholder Management: 4 Stages

Identification

Does the person:

1) Get directly/indirectly affected by the project?

2) Hold any influence over the project?

3) Have an impact on the project’s resources?

Analyse and Prioritise

INFORM MANAGE

MONITOR ENGAGE

Low Outcome Interest

HighOutcome Interest

High Process Influence

Low Process Influence

Understand, Manage & Engage• Develop a clear understanding of what the customer wants to achieve, make sure that

you spend enough time doing this to ensure that all the details are covered, make sure there are no surprises.

• Manage expectations. Do not promise what you cannot deliver.

• Engage all customers who will have a stake in the project. Identify those who will have the following roles:– The individual(s) who will be responsible for delivering the project– The individual who will be accountable for the project delivery– The individual(s) who need to be consulted on the project– The individual(s) who need to be kept informed of the project

What is a TOR?

Terms of reference (TOR) describe the:

“purpose and structure of a project, committee, meeting, negotiation, or any similar collection of people who have agreed to work together to accomplish a shared goal.”

What are we going to cover…

•What is a TOR?

•What should be included in the TOR?

•What are the benefits of agreeing a TOR in Joint Working?

•What might be the challenges for developing the TOR?

Getting it right…..•Levels the playing field

•All pharma partners understand how they will work together

•NHS partner understands what is expected of them- a “two way” relationship

•Reinforces the “code of conduct” (ABPI & NHS)

•Sets out roles of the JW committee e.g revolving Chair, minute taker etc.

Challenges….

• Legal and compliance re-drafts by each party

• A misunderstanding of the objectives of a TOR

• Lack of agreement • e.g. who will chair, how

the voting system should work

What should be included in the TOR? – (minimum)

•Name of group

•Membership and appointment

•Chairing

•Frequency of meetings and quorum

•Record of meetings

•Reporting mechanism

•Functions & delegated authority

Project Initiation Document (PID)

•What is the PID?

•What are the primary use of the PID?

•When would you complete a PID?

•Understanding the jargon of the PID?

What is the Project Initiation Document

(PID)?“The purpose of the PID is to define the project, in order to form the basis for its management and an assessment of its overall success.”

PRINCE 2

What are the primary uses of the

PID?1. Ensure the project has a sound basis before asking the JW committee to make any major commitment to the project

2. Act as a base document against which the JW committee and project manager can assess progress, issues and ongoing viability questions

3. Provide a single source of reference about the project so that people joining the “temporary organization” can quickly and easily find out what the project is about, and how its being managed

ExampleBackground

Brief statement on the explaining the context of the project, and steps taken to arrive at the current position of requiring a project

The East of England Pharmaceutical Alliance (EPA) was created to support the implementation of the National Strategy for COPD and Asthma across the East of England SHA. The EPA members consist of a number of pharmaceutical companies working jointly together with the NHS.Before the EPA can start to implement a project to support the training and education of health care professionals in line with the national strategy, it wishes to fully understand the training requirements across the locality.The EPA has identified the need to develop a project to implement a full training needs analysis (TNA) of healthcare professionals for COPD & Asthma.