Pf mag @NewPfMagWe can exclusively reveal what @

andyburnhammp would look like if he

crept up on Simon Stevens, wearing a

balaclava.

NHS Wakefi eld CCG@NHSWakefi eldCCG #Wakefi eld, it’s #WorldAidsDay -

there’re various places to go for a

#HIV test, including local

@yorkshiremesmac

Jeremy Hunt @Jeremy_HuntWhat @andyburnhammp won’t tell

you - Labour’s plans won’t raise a

penny for the NHS in 15/16.

Pf mag @NewPfMagTh e new emerging British obsession

with prefi xing every sentence with ‘so’,

is starting to freak me out. So, can

everyone stop doing it.

Andy Burnham @andyburnhammpSo @Jeremy_Hunt spoke for over an

hour but couldn’t answer a simple

question: what is he going to cut to

recycle his £700 million into #NHS?

ABPI @ABPI_UKOur Northern Ireland conference is

over. Th ank you to all our delegates and

speakers #abpiconf

Cassius Clay @ThaZenGawdI’m going back to college... probably

akron university, gonna major in

psychology and minor in sales

management, so I can be a pharma rep

NHS SW CCG @sw_ccgIf you have COPD or asthma then

protect yourself and get your seasonal

fl u vaccination as soon as possible

#fl usafe

Novartis @NovartisRetweet if you agree: we need more

support & compassion for people w/

#lungcancer. No one deserves it

Reuters Showbiz @ReutersShowbizTake Th at knock charity Ebola single

off top of UK charts

4 | Pf | DEC 2014

UK public ‘unaware’ of correct antibiotic usageA new study has discovered that many

members of the British public do not

understand how to use antibiotics responsibly,

leading to overuse of these vital drugs.

Th e fi gures from Public Health England

show that four in 10 people take antibiotics

for minor ailments such as coughs or colds,

which normally clear up on their own and do

not require antibiotic treatment.

1,625 adults were surveyed for the study,

which showed that 90% of people do not

know that bacteria that are resistant to

antibiotics are easily spread from person-to-

person. More than one in seven are unaware

that healthy people can carry these bacteria

and pass them on.

Other fi ndings suggest that many

people do not know that antibiotics are

ineff ective against fungal infections and

allergic reactions; that they work as anti-

infl ammatories, and that they can weaken the

immune system.

Overuse of antibiotics is now resulting

in the development of antibiotic-resistant

superbugs which means that current

antibiotics will become ineff ective, posing a

threat to global health.

Chief medical offi cer Dame Sally Davies

said: “We need to preserve the antibiotics

we have, otherwise we could see the end of

modern medicine as we know it. Th is is about

appropriate prescribing by GPs and patients

being aware when antibiotics are really

needed.”

New heart failure drug to get accelerated EU reviewTh e European Medicines Agency’s

Committee for Medicinal Products

for Human Use (CHMP) has granted

accelerated assessment status to Novartis’

investigational heart failure drug, LCZ696.

Th e new heart failure treatment, intended

for patients with heart failure with reduced

ejection fraction, is to benefi t from an

accelerated European review process which

will allow the CHMP to grant an opinion

after 150 days instead of the normal 210.

Accelerated review status is seldom

granted and has never before been awarded

to a cardiovascular therapy. A decision

on EU approval is now expected to arrive

during 2015.

Th e regulatory submission will be

based on results from the largest ever

landmark study conducted in heart failure,

PARADIGM-HF. Th e results showed that

LCZ696 can signifi cantly reduce the risk

of cardiovascular death or heart failure

hospitalisation compared to an established

alternative.

David Epstein, division head of Novartis

Pharmaceuticals, said: “Novartis is

committed to extending and improving

more lives sooner with LCZ696, and this

decision by the CHMP we hope will greatly

support our eff ort to do so in Europe.”

One in ten GP practices under ‘intelligent monitoring’ risk

Pf | DEC 2014 | 5

General News Personnel News NHS News Drugs News

Funding award for pioneering UK asthma research Dr. Andrew Wilson from the University of

East Anglia has been awarded £1.7million in

funding from the National Institute for Health

Research (NIHR) for research into reducing

deaths from asthma.

Th e money will enable the Asthma UK

Centre for Applied Research to identify people

most at risk of an asthma attack in order to

reduce the high number of avoidable asthma

deaths.

Th e research comes at a critical time,

following the publication in May of the

National Review of Asthma Deaths by the

Royal College of Physicians. Th e review

identifi ed that as many as two thirds of the

three deaths caused by asthma every day in the

UK could have been avoided.

In many cases the warning signs were

ignored and more than two thirds of people

hospitalised in the month before they died did

not get properly checked up afterwards.

Past asthma attacks are a clear risk factor for

future attacks and everyone who is hospitalised

due to their asthma should see their GP

within 48 hours of leaving hospital. However,

Asthma UK’s Compare Your Care report

2013 discovered that three quarters (74%) of

people with asthma did not have a follow up

appointment.

Dr. Wilson’s research will examine

whether introducing a register of people

at risk of an attack and training medical

staff to provide these patients with ongoing

specialist support will reduce their likelihood

of being hospitalised by asthma or suff ering a

potentially life threatening asthma attack.

Th e research is a key part of the Asthma UK

Centre for Applied Research, a collaborative

partnership of 13 of the UK’s leading academic

organisations. Th eir work includes halving

the time that it takes to develop new asthma

medicines and treatments through clinical

trials that lead directly to improved care.

Dr. Wilson, based at the University of East

Anglia, said: “Identifying and targeting care

to patients most at risk of asthma attacks and

developing methods to deal with the variable

standard of care in the UK are important

national treatment strategies.”

Findings gathered by a Care Quality

Commission (CQC) report have revealed that

one in ten GP practices have been assigned

the highest category of risk in an ‘intelligent

monitoring’ system.

Th e report showed that one in 10 GP

practices posed the greatest perceived risk in

an intelligent monitoring system devised by

the CQC.

Th e report used 38 diff erent indicators to

determine the perceived risk of each practice

in England, with each practice assigned one

of six risk ratings with one representing the

“greatest perceived risk” and six the lowest.

Th e 900 practices categorised as band one

will be fi rst in the queue for inspections next

year, the CQC has said.

Th e report also showed that there was

also considerable regional variation in the

proportion of practices falling into the lower

bands. At least four in fi ve practices fell into

the four lowest bands.

Only 4 per cent of practices in the North

East were rated as band one or two, while 20

per cent of London GP practices fell within

these rankings.

One of the main reasons cited for practices

being pushed into the lower bands is the

diffi culty of access to their GP or practice

nurse.

Oxfordshire commissioners have failed to

submit a realistic better care fund plan to

NHS England, which rejected their proposal

on the grounds of its incomprehensibility.

Th e proposal, submitted in September,

failed to meet NHS England’s assurance

process for the programme.

Th e county’s better care fund plan was

one of just fi ve across England which was not

approved last month. Other unapproved plans

were from Essex, Lancashire, Hillingdon,

and Northamptonshire Care Commissioning

Groups (CCGs).A statement fromOxfordshire

CCG and the county council cited a number

of reasons why the proposal was rejected,

including: “our new focus on commissioning

health and social care services via outcomes-

based commissioning, the timescale for which

crossed over with those for the submission of

initial better care fund proposals.”

Th e organisation also said that the plan

did not meet national requirements, which

expects “emergency hospitals admissions to be

reduced”, despite hospital admissions rising

locally and nationally.

Th e statement concluded: “Th e clinical

commissioning group and the county

council are working hard with Oxford

University Hospitals Trust and Oxford Health

Foundation Trust to address the challenges

and issues regarding the implementation of the

better care fund principles.”

Oxfordshire CCG has already spent the

past year redesigning its proposals to introduce

integrated outcomes-based contracts for adult

mental health and older people’s services.

Th e ambitious scheme attracted controversy

a year ago when both local trusts publicly

expressed serious concerns over its potential

impact.

Oxfordshire’s better care fund plan rejected

ABPI report shows relative lack of UK access to innovative drugsNew research published by the Association of

the British Pharmaceutical Industry (ABPI)

shows that fewer patients in the UK are

receiving new, innovative medicines than the

average in a range of comparable developed

countries.

Th e research showed that the UK uses

branded medicines less per person than many

other countries but tends to use older rather

than the latest medicines.

Th e report, International Comparison of

Medicines Usage: Quantitative Analysis was

compiled by the Offi ce of Health Economics

(OHE) and updates the 2010 Richards Report

which examined the extent and causes of

variations in international medicines use.

Despite showing an increase in usage per

person for 11 of the 16 therapy classes surveyed

from 2008/09, the report demonstrates that the

UK occupies the 9th place out of 13 countries.

France maintains its position at the top of the

rankings while New Zealand remains in

13th place.

In seven of the 11 therapy classes the UK

usage per person was below the international

average for 2012/13. Usage included the latest

cancer medicines less than fi ve years old and

those for dementia, multiple sclerosis and stroke

prevention.

In the remaining four of these 11 classes

– cancer medicines more than 10 years old

and medicines for osteoporosis, respiratory

distress syndrome and wet age-related macular

degeneration – UK use was higher than the

international average for 2012/13, highlighting

a reliance on older medicines and relatively slow

uptake since 2009 of newer, more innovative

medicines, to treat cancer in particular.

David Watson, the ABPI’s Director of

Pricing and Reimbursement, said: “We will

use the information in this report to continue

discussions between industry, the Department

of Health and the NHS on how access to

medicines can be increased through the

commitments of the PPRS (Pharmaceutical

Price Regulation Scheme) agreement.”

6 | Pf | DEC 2014

Patients ‘unaware’of GP out-of-hours facilitiesA report by the Public Accounts Committee

has revealed that people do not know where

to turn to when GP practices are closed

amid ‘unacceptable’ variations in the quality

of out-of-hours services.

Th e report has shown that “complex and

fragmented” systems mean patients are left

confused about where to get help, resulting in

higher numbers of Accident and Emergency

cases.

Health offi cials have been accused of failing

to provide the basic information necessary to

guide patients to the appropriate help for their

need.

Despite the number of services available,

including out-of-hours services, walk-in

centres, urgent care centres, or the NHS’s 111

service, patients are still not clear on what

service would be appropriate for their illness.

Th e report has also accused NHS England

of lacking the basic information necessary to

say if there will be enough GPs in the future

to deal with the growing workload expected.

Th e Committee’s Chairman, Margaret

Hodge, said, “Patients’ experience of, and

satisfaction with, the out-of-hours services

varies signifi cantly and unacceptably across

the country, as does the cost.”

She said that too many people were

unaware of the diff erent urgent care options

and how to contact them. “Th is means people

may not receive care in the most appropriate

setting. As a result of the confusion, too may

go to A&E when they do not need to.”

Th e report also found that one third of

adults in England had not heard of NHS 111

or do not know what it is for.

One quarter had not heard of out-of-hours

GP services, with a lower awareness among

certain groups including younger people

and people from black and minority ethnic

communities.

NEWSNorth Staff ordshire - CCG leaders

have said any plans to remove the

existing organisations, who treat cancer

patients in North Staff ordshire will be

carefully considered by the board, amid

growing fears from the public over the

controversial tendering out of £1.2 billion

of cancer and end-of-life care in the

county.

North Essex - Chief Clinical Offi cer of

the CCG, Dr Shane Gordon, has said

North Essex CCG is under “considerable

fi nancial and operational strain” if the

soaring population growth, which is

expected to rise to by 10,000, continues

over the next ten years.

South Devon and Torbay - South

Devon and Torbay CCG has defended

itself against the fi ndings gathered in the

GP Patient 2013-14 survey, which claim

that nearly a fi fth of local patients cannot

see their GP within a week of trying to

make an appointment.

Scarborough and Rydale - A new urgent

care centre will be integrated within

Scarborough Hospital’s A&E unit, the

CCG has announced. Th e service is

expected to replace the walk-in service at

the Castle Health Centre in York Place.

Cambridgeshire and Peterborough - A

report compiled by the CCG has revealed

that Addenbrooke and Rosie hospital has

experienced “signifi cant problems” with

its Epic eHospital system – a £200m

electronic patient record system.

Waltham Forest - Doctors are urgently

asking people to use the NHS 111 service

before visiting the hospital in order to

reduce the strain put on A&E staff during

one of the busiest times of the year. It

has been predicted that forty per cent of

visitors to Whipps Cross Hospital’s A&E

department this Christmas could be seen

by a regular GP.

Results from a survey commissioned for the 3rd annual Healthcare Meetings Forum (HCMF), aiming to defi ne the link between scientifi c information and positive patient outcomes, has shown positive trends for the future.

Th e 400+ results received so far from health care professionals (HCPs), which have been evaluated by the HCMF steering committee, off er positive views. 75% of respondents said that they preferred face-to-face meetings, as opposed to questionnaires conducted online, especially if it related to securing patient outcomes.

Th e results are encouraging and provide a strong catalyst for discussion at this year’s Forum: ‘Focus on the Patient – Driving new trends for medical meetings’.

Th e survey also showed that approximately three quarters of respondents believed that they would receive 80% of medical information virtually by 2017. Th ese results directly impact the structure of medical meetings

and in-person attendance, particularly as more research and seminars are published digitally, as well as coping with busy working schedules and diminishing budgets.

Changing the nature of information sharing is to be addressed at the Forum meeting, focusing on the quiet revolution in medical congress formats and delivery methodology. Th e meeting will also answer the question of how content is best delivered.

Other results to come out of the initial responses show the signifi cant minority of those who believe that healthcare companies can speak directly to patients about their products (19%).

Responses to the survey are still being received by the HCMF steering committee and this year’s Forum promises to reveal more insightful and signifi cant data, through leadership and a frank forum for discussion.

Healthcare Meetings Forum 2014 survey yields key trends

High blood pressure giving the NHS high billsFigures released by Public Health England (PHE) have revealed that diseases caused by high blood pressure are costing the NHS vast amounts of money.

Following data published by PHE, the organisation has announced it will partner up with the local and national government to tackle the expensive burden posed on the NHS caused by patients requiring treatment for high blood pressure.

As a result PHE has devised a plan of action, including allying with the government, as well as the health service, voluntary sector and academia to better manage spending for patients who require treatment for illnesses associated with high blood pressure.

Th e action plan will set out steps towards emulating the success of other countries, such as the US and Canada, in achieving higher levels of treatment and better control of high blood pressure, leading to lower death rates from heart disease and stroke.

Increased demand has put pressure on the NHS to cope with diseases related to high blood pressure, which has been estimated to cost the health service more than £2bn every year.

High blood pressure, also known as hypertension, can increase a person’s risk of a heart attack or stroke, and is often dubbed the ‘silent killer’. Figures continue to rise, with the condition aff ecting more than one in four adults in the UK.

Despite the heavy burden already weighing on the NHS, there are still a further fi ve million people in the UK who are unaware that they have high blood pressure.

Responding to the report and the action plan, Public Health Minister Jane Ellison said: “Any new initiative which will improve people’s health and wellbeing as well as saving the NHS money is to be applauded.”

Pf | DEC 2014 | 7

Th e Association of the British Pharmaceutical Industry (ABPI) has welcomed George Osborne’s announcement that the rate of research and development tax credits is due to increase.

ABPI Chief Executive Stephen Whitehead hailed the “benefi cial impact” of the decision, which was announced in the Chancellor’s autumn statement.

“I welcome the Chancellor’s decision to increase the rate of Research & Development (R&D) tax credits for both smaller and larger fi rms which will have a benefi cial impact on business investment in the UK. Th e pharmaceutical industry is a key contributor to the UK economy and a leading manufacturing sector.”

Mr Whitehead however expressed concerns about an additional statement from the government which may indicate changes that adversely aff ect R&D investment:

“Our industry employs 73,000 people directly in the UK and invests £11.5million per day on R&D. We are concerned however that

proposed changes to the Patent Box outlined in a written ministerial statement yesterday may aff ect incentives for investment in R&D.”

Mr Whitehead went on to underline the role that the ABPI will continue to play in facilitating access to the latest innovations in medicines, in partnership with the NHS and other stakeholders:

“I am also pleased to note that the Chancellor has allocated increased funds to the NHS at what is a challenging time. Th e ABPI is acutely aware of the funding issues facing the NHS and the pharmaceutical industry has done its part by underwriting the medicines bill within agreed boundaries under the Pharmaceutical Pricing Regulation Scheme. Th is is a platform for patients across the UK to get access to the latest innovative medicines.

“Th e ABPI is committed to working with all stakeholders to ensure that we can foster the best possible environment in the UK incorporating a holistic industrial strategy so that the pharmaceutical industry can continue to fl ourish.”

ABPI welcomes increase in rate of R&D tax credits

General News Personnel News NHS News Drugs News

10 | Pf | DEC 2014

DIAGNOSIS

T he NHS is one of the biggest

employers in the world,

rivalled only, it is said, by

Indian Railways, Wal-Mart,

and the Chinese People’s

Liberation Army. Its more than 1.7

million employees include about 370,000

nurses, 106,000 hospital and community

medical and dental staff , 40,000 general

practitioners, and 19,000 ambulance staff .

Th e NHS’s annual budget is about £110

billion, about £65,000 per employee; the

drugs budget is about £14 billion. Th ere

are about 240 million patient consultations

per year, of which 80% occur - in general

practice - at about £25 a time, and 20% in

secondary care, at about £2800.

UK universities employ under 25% of

that number: 383,000 people, of whom

186,000 are academics. Total annual

expenditure is about £28 billion, about

£73,000 per employee.

It is diffi cult to include drug companies

in such comparisons, because they

are multinational, and UK employees

contribute only part of the overall

endeavour. Furthermore, many very small

companies, including university spin-

outs, contribute to varying degrees, for

example, in early drug development - before

passing on new compounds to major drug

companies. As a touchstone, however,

Abbott Laboratories, AstraZeneca, Bayer

HealthCare, GlaxoSmithKline, Johnson &

Johnson, Merck, Novartis, Pfi zer, Hoff man

la Roche and Sanofi -Aventis together

employ about 900,000 people. Th ey spend

an estimated £33 billion each year on

research and development, and about twice

that on marketing, with total expenditure

being in excess of £110,000 per employee.

Th e interrelations in this tripartite

structure are complex. Results of research

by NHS and University academics can

be used by companies in drug discovery

and development, and can be harnessed in

spin-out companies. Recent examples of

innovations from Oxford include analytical

platforms for genomic sequence data

analysis and novel methods for synthesizing

individual isomers of chiral compounds.

Academic and NHS clinicians conduct

clinical studies of new compounds at

all phases of development and may use

the compounds as tools in their own

research. Th ey sometimes act as consultants

to companies, advising on aspects of

development. Th e same academics may

then advise regulatory agencies - such as the

MHRA and NICE - about the acceptability

of the medicines in clinical use, while also

teaching other students and doctors.

Drug discoveryErstwhile methods of drug discovery,

which focussed on biological systems, have

given way in recent years to an intensely

target-driven process, which I have called

‘targetophilia’, and others ‘targephilia’,

but which I prefer to call ‘stochophilia’

(Greek stochos = ‘target’ and ‘guess’; cf,

“stochastic”). Much of the single-target low-

hanging fruit, however, has been picked.

It is not, I believe, coincidental that

this same period has seen an increasing

number of failures in drug development,

particularly during phase II, increasing

emphasis on the marketing of stereoisomers

and novel formulations, which are not in

themselves highly innovative. Furthermore,

many companies have disinvested in areas

previously thought to be potentially fruitful.

Both pharma and the universities could

consider the potentially benefi cial eff ects

that could accrue from a return to a systems-

driven approach, and a search for innovative

medicines with multiple mechanisms of

action. Th is could be facilitated by the

establishment of Institutes of Drug Discovery

and Development, whose activities could

include development and implementation of

translational pharmacology research. Th ey

AGAINAGAIN

could also draw on the collective expertise

of academic clinicians and scientists, while

liaising with corporate partners to facilitate

collaboration, knowledge transfer and

eff ective translation.

TransparencyChanges in societal attitudes to

transparency have markedly aff ected the

relationship between big pharma and big

medicine over recent years. Companies

have, in some cases, withheld evidence

that might adversely aff ect perceptions of

the benefi t-to-harm balance of a medicine.

Th is has started to change with advance

registration of trials and declarations,

with some companies agreeing that they

will make all the evidence available and

have individual patient data srcutinised

in clinical study reports collected during

randomised studies. Th is has also been

extended to transparency in animal

experimentation by groups such as

CAMARADES.

Th e All Trials campaign, to which

over 80,000 individuals, and over 530

organisations have subscribed, has been

instrumental in pressing for increased

transparency. Another aspect of this is the

stated willingness of some companies to

declare moneys paid by them to named

healthcare professionals. All this should be

universal.

FundingFrom time to time companies have funded

training posts in universities, but these

have declined in recent years for fi nancial

reasons. Th e disparity between funding of

drug companies and universities, however, is

enormous, while the latter punch way above

their weight in contributing to drug discovery.

Major drug companies should be prepared to

fund academic posts.

Particularly pressing is the need for

basic and clinical pharmacologists, who

have in the past been instrumental in drug

discovery, facilitating decision-making

during drug development and introducing

new therapeutic applications (e.g. the use of

beta-blockers in hypertension, fi rst described

by Brian Pritchard, and of acetylcysteine

in paracetamol overdose, pioneered by

Laurie Prescott). Meanwhile, the detecting,

reporting, and interpreting of adverse drug

reactions, and the teaching of careful, safe and

eff ective use of medicines remain pivotal.

Currently in the UK there is about one

clinical pharmacologist for every million

of the population; contrast this with, for

example, Croatia, where the ratio is about

one to 150,000. Currently many of those

who hold the title of clinical pharmacologist,

within companies, are not clinically

qualifi ed, and although this is not a huge

disadvantage in the early phases of drug

development, it becomes problematic in later

phases. Companies should seek partnerships

with universities in training clinical

pharmacologists. Secondments for longer

periods than have been usual in the past -

e.g. fi ve years, rather than one year - would

be mutually benefi cial.

For their part, the universities should

seek to have the restrictive infl uence of

research assessment exercises waived for

individuals who are seconded, to encourage

fruitful academic career paths when they

return to academe. Some among those

who are seconded will choose to stay in the

companies anyway.

Th e NHS is in a fi nancial crisis and

cannot currently aff ord to take part in the

large high-quality clinical studies that are

necessary for successful drug development.

Drug company funding, aimed at training

clinical trialists in the provision of

hospital-based clinical investigation units,

could help mitigate this. Th e increasing

tendency of drug companies to fund

work of this sort abroad, more cheaply

purchased, has militated against such

developments in the NHS. More funding

of research in general practice could be

achieved by funding GP trainees to do

clinical research.

Diff erent types of clinician–researcher–

teachers, independent of drug companies,

could be funded through diff erent types

of collaborations involving corporate

partnerships.

PatientsTh e whole purpose of all this is, of course,

to serve patients and provide them with

medicines for which the benefi t-to-harm

balance is highly favourable. Patient

expectations of the benefi ts that medicines

can bring, however, have increased markedly

in recent years and adverse reactions have

become less acceptable. Nevertheless,

patients are still not well informed in this

area. Drug companies should seek to provide

clear patient information, moderated by

independent academics, rather than by

company members.

Th is also applies to the education of general

practitioners. Most teaching and training

in therapeutics and prescribing occurs in

hospitals, but 80% of all prescribing occurs

in general practice. Better education and

information should also allay the fears

recently voiced about the sharing of patient

data, through large databases, with drug

companies.

ConclusionHowever much big pharma is feeling the

fi nancial pinch, UK big medicine is much

worse off . Th e former should be giving more

unrestricted, no-strings support to the latter,

pursuing the common aim of discovering

innovative, clinically eff ective, and cost-

eff ective medicines, while also galvanising

healthcare.

Jeff Aronson is a clinical pharmacologist and honorary consultant physician in Oxford. He is a President Emeritus of the British Pharmacological Society and Editor of Meyler’s Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions.

AUTHOR

Jeffrey K Aronson

Pf | DEC 2014 | 11

“The All Trials campaign, to which over 80,000 individuals, and over 530 organisations have subscribed, has been instrumental in pressing for increased transparency”

Since 2001, Pf’s Company,

Perception, Motivation and

Satisfaction Survey for the UK

medical sales force industry has

been gathering and dispensing

information like a maniacal Amazon drone on

Black Friday.

As we prepare for another festive season

- by pulling the decorations down from the

loft, scribbling cards to our favourite second

cousins (once removed) and blowing the dust

off Grandma’s favourite sherry – questions

begin to emerge. How can I see what

professional progress I have made, am I in

the right place at the right time, or should I

be making plans for the new year? It’s funny

you should ask that, as the answers lie right

here, illuminated by a twinkling string of

fairy lights that metaphorically represent the

sparkling Pf Survey.

A festive feast of pharmaAs any good cook will tell you, the

preparations for the fi nest Christmas puddings

begin months before the big day. We’ve gone

one better than that – our pharma sales treats

have been in the making for years; 14 of

them, to be precise. We’ve gathered together

the opinions of pharma sales and marketing

professionals, mixed together the assorted

opinions, added the tastiest views, drenched it

in enlightening insights, thrown in a sixpence

for good luck, then steamed and served it

up to you with a generous deposit of brandy

butter.

Th e annual Pf survey has run every year

from 2001 to the present. A lot of data

has been crunched by our industrious and

enthusiastic band of elfs during this glorious

time. Just shy of 19,000 questionnaires

have been completed on paper and online

since the survey began in 2001. Meanwhile,

950,000 individual elements of data have been

organised and analysed; representing little

baubles of brightly shining, jewel-coloured

insight into where the pharma sales industry

has been, where it is now, and where it’s going

in the future.

Talking turkey One of the most signifi cant discoveries

unwrapped by the survey every year is the

verdict on the favoured ‘Employer of Choice’

- the category in which employees cannot vote

for their own company.

Th ere’s no better yardstick for measuring

a company’s true worth than through the

eyes of industry personnel. Th erein lies the

truth – just as Scrooge’s treatment of his

long-suff ering employees was laid bare by

those candid Christmas ghosts, so the Pf

Survey hovers over the shoulders of pharma

fi rms like a rather more benevolent, but no

less enlightening spirit, showing them exactly

what staff elsewhere think of their cultures,

products and working environments.

Every year survey respondents are asked to

score a selection of approximately 45 medical

sales companies, with regard to the perception

of how desirable they are to work for, from an

external perspective. A fi ve point scale of very

low (total turkey), low, neutral, high, very high

(golden goose) has been used every year, with

a blank score indicating no overall perception.

Time and again, three companies have

topped the list of desirable pharma fi rms.

Since 2007, Boehringer Ingelheim has

occupied the number one place in the

Company Perception results. Like a combined

Slade, Wizard and East 17 Supergroup it, once

again, stormed to the top of the Christmas

charts in 2014. Not just a crown, but the full

bird, Boehringer Ingelheim won the race to

the summit fair and square. Indeed, since

2008 the fi rm has consistently attracted the

least amount of negative perceptions and the

highest number of positive perceptions.

Speaking of second place, Roche has been

sitting pretty like a pig-in-a-blanket at the

number two spot for six years out of seven,

where it remains to this day.

SURVEYMA

KE A DIFFERENC

E

2001 - 201

SURV EY

Tear open the gift of Pf Survey 2014 results – we may not have the glamour, sequins and fallen celebrities of ‘Desperately Been Dancing’ (to save my career), but we can guarantee all the wit, saucy rhymes and cultural insight of The Two Ronnies Christmas Special.

18 | Pf | DEC 2014

SPONSORED BY

Also this year, Janssen pulled a cracker as it

nudged Lilly aside to take up third position,

showing that it is increasingly becoming

pharma’s Christmas present of choice.

Not only has Boehringer Ingelheim

consistently carved up the competition, but

prospective employees have continued to

hover longingly outside their windows like

Tiny Tim, hoping and praying that some of

the good times could one day be theirs. In

2012, 2013 and 2014, survey respondents

were asked which pharma company was their

preferred destination and the reason why.

Th e jingle bells and merriment at Boehringer

Ingelheim eff ortlessly achieved the number 1

ranking for this investigation as well, proving

that - like all good traditions - it’s all about

reputation, credability, evolution and, above

all, impressive results.

Jingle bellsIn order to ensure that its employees will

be ringing in the New Year at their usual

manger, instead of defecting to another

cordial host, pharma fi rms need to place a

number of gifts under the tree, and not just at

Christmas.

As you generously give, so shall you receive.

According to our survey, the gifts of job

security, salary, bonus, personal development,

training, belief in present products, future

product pipeline and structured appraisal

system were reported as being the most

desirable.

While everyone loves the thrill of opening

a card to fi nd a crisp note fl uttering out,

money isn’t the most important motivational

factor for our respondents. Some of the

best gifts that a successful company can

off er employees, to excitedly unwrap, are an

excellent company culture, good pension

scheme, healthy work/life balance and a

good relationship with their direct manager.

Nice stocking fi llers include a company share

scheme and good car policies.

Yule like thisTh e Motivational Values section within

the Pf Survey serves as a benchmark

for those things that keep pharma sales

professionals, all across the land, willing

to clock in promptly every day. Th e most

important motivational factor is still that

vital wedge, with salary continuing to

rock at the top of the motivational pops

in 2014.

In 2013, ‘job security’ and ‘relationship

with manager’, dived onto the sofa, beside

the dosh, slotting into second and third

positions respectively. In 2014, however,

‘relationship with manager’ has been shunted

into fourth place, as ‘work-life balance’

became employee’s third most wanted

present (not unlike socks and slippers in

that respect), proving that these days it takes

more than ‘nine-to-fi ve’ to create a happier,

more motivated employee. Interestingly,

throughout the survey’s history this factor

has consistently appeared in the top three

motivational work factors, taking the silver

position in 2003 and 2007, before this year’s

triumphant return.

It’s a wonderful lifeAs we hurtle towards the year of Our

Lord 2015 it is clear from our survey what

respondents want – in addition to peace on

earth - a superior salary, secure job future and

a healthy balance between work and home

life. All pharma companies are united in their

desire to retain their best employees, and will

be keen to deliver abundant gifts in the New

Year. In a rapidly changing environment the

need to keep staff inspired, motivated and

prepepared has, perhaps, never been greater.

Once again, the Pf Survey has provided

a great gauge with which to judge how

companies are performing in these vital

arenas. What will next year’s reveal?

AUTHOR

Pf | DEC 2014 | 19

Dear Santa,Please bestow upon me, job security, personal development, training, belief in present products, a company share scheme, a pension and a good car scheme. Yours, pharma employee.

Sorry, my relationship with you is now in fourth place.

Get over it.

ANALYSIS BY

20 | Pf | DEC 2014

Ian Munro, Industry ConsultantAnyone travelling

forward in time

from the UK

pharmaceutical

industry of 2009, to

the present day, would see a signifi cantly

changed world. Th e NHS in England

looks very diff erent compared with the

structures that existed fi ve years ago.

Scotland has new SMC processes and

a peer-approval system for individual

treatment requests, while Wales and

Northern Ireland continue on their own

evolutionary paths. With these - and

other NHS reforms - come changes in

pharma, and the focus of its daily activity.

Among the most widespread and

noticeable changes are the focus on value,

and the move to cross-functional working.

As health technology assessment has further

established itself as the gatekeeper to the

NHS market, pharma’s focus has been

driven towards proving that its products

bring considerable health benefi t for the

price charged, i.e. that the medicine is of

true value. Only then will it be accepted

and implemented. Manufacturers must now

align their operations into demonstrating

value, by producing credible evidence and

communicating it eff ectively to decision

makers. Th ere lies one of the other great

changes in the last fi ve years – we now need

to consider who the true power brokers are

within the NHS.

Th e people holding power over NHS

decisions on pharmaceuticals are certainly

fewer in number, and at higher levels of the

NHS, than before. Most have no clinical

involvement with patients, so the traditional

pharma model doesn’t fi t the modern era.

As a result, many companies have made the

move, to a greater or lesser degree, towards

a key account management-type business

approach.

Th is wider appreciation of both clinical

and payer aspects of the business brings

together offi ce departments and in-fi eld

skills in new ways. Key account managers

(KAM) and key customer managers will

now often predominate in customer-facing

roles. Th ey are eff ectively multi-skilled

professionals responsible, not just for

selling the clinical merits of their medicine

to prescribers (as in days of old), but

for the product’s place in the treatment

landscape, based on where, how and why

it delivers more to the NHS - clinically,

fi nancially and for patients - than its

competitors. In-fi eld CRM technology

arms are essentially KAMs with new levels

of information.

Th e modern UK pharmaceutical

industry is much leaner and more focused

than it was in 2009. Th e daily demand

for convincing value propositions will

continue to shape its activities and

structures, even beyond the breadth of

skills and cross-functional working we see

throughout the industry today.

Mark Struthers, National Health Economy Liaison Manager, Grünenthal Th ere are two areas

that have changed

and increased over the past fi ve years; those

of technology and compliance.

In the area of technology, SMART devices

are being used more and more by all health

care professionals (HCPs), to read about

medicines, interact online - with sales

representatives and the pharmaceutical

industry - and as tools to communicate with

their patients. Th erefore the investment

into digital communications has increased

signifi cantly. Day-to-day, across the fi eld,

selling with SMART devices has created new

The B g Quest on

Ian Munro

?

Mark Struthers

?

FEATURE

“Manufacturers must now align their operations into demonstrating value, by producing credible evidence and communicating it effectively to decision makers”

We take a reality check and ask real people, real things about real life.

“How has day-to-day life in pharma

Pf | DEC 2014 | 21

skills to learn, together with more in-depth

and interactive ways to promote medicines.

Internally, using online meeting services

through LYNC, Skype and other platfroms

has been a great, time-effi cient way for

local teams to communicate, with minimal

disruption to the working day. Although

nothing is better than a face-to-face

meeting, doing it online can cut down on

travel and nights away.

Th e speed and accessibility of Wi-Fi and

4G, provided on tablets, means that work

and admin can now be done in the fi eld (or,

in my case, a well-known burger franchise)

in between calls. Th is is something that was

mooted to me back in 2002!

In the area of compliance - on a day-

to-day basis this is woven into everything

that is created, planned and delivered

within pharma, and at every level of the

organisation, to ensure the industry works to

the highest standards. For me this has meant

more investment in training and creation of

detailed SOPs and internal working groups,

to improve transparency. On a daily basis

this aff ects every individual within the

organisation, from planning and delivering a

local education meeting, to putting materials

through approval.

Lisa Syne, National Sales Manager, Aspen Pharma UKDay-to-day

life in pharma

is determined

primarily by

three key capabilities, meeting the needs

of patients, developing relationships with

customers, and the delivering of valued

medicine and services. During the past fi ve

years, there have been signifi cant shifts in all

these areas and, as a result, day-to-day life in

pharma has changed – and is continuing to

change – at an exponential rate.

Th e provision of healthcare has rightly

become much more patient-centric. For

pharma this means becoming much more

than a medicines-provider. Collaborations

on projects that facilitate better patient care,

such as enabling better treatment closer to

home, are increasingly central to our daily

lives.

Most of all, NHS reforms have brought

about dramatic changes in terms of who

our customers are, and how and when we

engage with them. Clearly, the optimisation

of resources is a priority for everyone, but

identifying and accessing budget-holders

can be diffi cult. Whereas decision-making

previously rested with one or two clearly

defi ned individuals, these responsibilities are

now much more dispersed.

Pharma has had to restructure its

traditional selling model to refl ect these

changes. As a new entrant into the UK

market, Aspen Pharma UK has been able

to design its operating structure around the

needs of a changing NHS. Our small team

of KAMs are equipped with the expertise,

knowledge and relevant insights to engage

with customers across the whole health

economy.

Th e streamlined, agile team that we are

building is very diff erent to the sales model

that was operating in the UK fi ve years ago

and our day-to-day priorities are also quite

diff erent. As experts in key specialty areas,

such as thrombosis, we focus on working

with customers – in whichever functions

they are located – ensuring a reliable supply

of high quality, aff ordable medicines and

services that meet patient needs.

Chris Frost, Sales Director, AAH Pharmaceuticals, part of Celesio UK

Th ere are three

dominating factors

that have changed

pharmaceutical

wholesaling over the past fi ve years.

Th e fi rst is the introduction of reduced

wholesaler, DTP and agency pharmaceutical

deals, with signifi cant proliferation. In

order to secure deals with branded ethical

medicines manufacturers we now have

to be more ambidextrous, in terms of the

way we approach them, with upstream

wholesale margins squeezed. In turn, there

are reductions in pharmacy discounts

downstream as well.

Th is also initiated a complexity that

never used to exist, which is the second

dominating factor. A few years ago

pharmacies would be very loyal to one

wholesaler, and they would get the vast

majority of their business from them.

Now, pharmacies must deal with more

than one, with most dealing with two

full-line wholesalers, if not three. AAH

Pharmaceuticals, as an example, now

delivers to every single dispensing point in

the UK, rather than of half of them.

For that reason we have put signifi cant

investment in our infrastructure, in

order to supply medicines twice daily to

pharmacies across the whole of the UK. It

also means we now have a broad spread of

customers, a big chunk of whom still order

the majority products from us, and others

who order only the lines that they have to,

because we have reduced wholesale, or have

exclusive contracts with manufacturers.

Th irdly, we have seen a signifi cant

increase in the use of quotas to restrict

pharmacies from ordering large volumes of

stock, which they can therefore potentially

trade abroad to supplement their revenue.

It actually means that sometimes getting

all the stock can be quite diffi cult within

a short period of time, if they exceed their

quota. Th is can be extremely frustrating

from a pharmacy perspective, but is

something that manufacturers have to

impose on wholesaling orders, to prevent

exporting in excess.

For the foreseeable future, perhaps

the most encouraging evolutions are in

embracing technology, which will free up

pharmacists’ time to support the dispensing

process, manage prescription ordering and

help patients with long term condition

management and improve health outcomes.

Th e future challenge for wholesalers is to

diff erentiate themselves by improving the

added value services they provide, while

increasing revenue, margins and effi ciencies

for pharmacists.

?

Lisa Syne

AUTHOR

Wi-Fi AHOY!

?Chris Frost

“Collaborations on projects that facilitate better patient care are increasingly central to our daily practice”

“In order to secure deals with branded ethical medicines manufacturers we now have to be more ambidextrous”

30 | Pf | DEC 2014

Head of Regional Accounts at Boehringer Ingelheim, Nick Doe, discribes what talent means to him.

What is more important to success: ambition or talent? Probably both; Ambition without talent is unlikely to lead to very

much, and talent without ambition in one role for too long can lead

to stagnation.

How does Boehringer Ingelheim help develop employees to achieve their full potential?Employees are encouraged and supported to develop, grow and

discover new talents and strengths. We use strengths-based working

so employees can harness and develop their strengths i.e. things

they are really good at and enjoy doing. If people are energised and

focussed on the positives it helps them achieve their full potential.

How are strengths identifi ed and is this something that employees have to highlight individually?An online strengths identifi cation tool is available to all employees

to help them identify their strengths along with team development

toolkits, which help managers incorporate their team’s strengths

into day to day working. In addition employees are encouraged to

identify their own strengths and the strengths of others through

self-refl ection, day to day observation and feedback. Th e aim is to

integrate a person’s strengths into existing performance review and

talent discussions.

If someone is naturally good at something are they then developed further?Yes, it’s much more than just working with a person’s existing

strengths. Personal development and growth is very important to us.

Boehringer Ingelheim Ltd believes that in order for development to

be most impactful for both the organisation and our people, a variety

of approaches should be used. Self-development tool kits are provided

and employees are encouraged to get feedback from their manager and

peers in order to develop themselves further.

What about training, is this something that you invest heavily in?We off er a wide range of learning and development solutions to support

people with their personal development. Training is off ered, both

internally and externally, but in addition mentoring and coaching

programmes also prove invaluable. Employees often gravitate towards

an individual they both admire and click with; these colleagues can

become mentors, and off er support and guidance throughout a person’s

career development.

If an individual is interested in doing something diff erent, is this something that they are encouraged to investigate further?Employees have regular, development and career discussions with their

manager, which provide the perfect opportunity to explore future

career aspirations and identify development opportunities. Employees

are frequently off ered secondments or projects in diff erent departments

in order to stretch them and help them achieve personal growth. Th ese

can potentially lead to a new role or change in career direction and also

help increase the scope of their current role if they wish.

All these things help our people to be energised,

motivated and thriving in their roles, ultimately

driving their success and the organisation’s

success in a fast moving and highly competitive

environment.

Formal chairFormer Chair of the National Institute of Health & Clinical Excellence (NICE), Professor Sir Michael Rawlins, has

been appointed Chair of the Medicines and Healthcare Products Regulatory Agency.

Book loverSmith and Nephew has named Chief Executive Offi cer of publishing and information company, Reed Elsevier,

Erik Engstrom, as a new board member. Mr Engstrom’s former employers include General Atlantic Partners,

Random House and Bantam Doubleday Dell Publishing.

All togetherNHS England has announced plans to create a single integrated team for each of the current regions, and will be

appointing several Directors of Commissioning Operations. Each will have responsibility for their sub-regional patch.

Talent development

Ooops! When Nick recently appeared, with some excellent advice, in the ‘High Flyer’ section of these pages, we accidently included a quote – “You can’t train or develop talent – you either have it or you don’t” - that wasn’t from him and doesn’t represent his views or the company’s. Sorry about that, Nick.

Pf | MARCH 2014 | 31

Presentations are a standard element of

most interview processes. Interviewees often

assume that they will be able to tackle a

topic for a presentation with ease. Th ere

are, however, a few techniques that can help

make you stand out and secure the role you

have applied for. Presentation content will

be a key focus for the interviewing panel,

but equally as important is the structure,

layout and approach that you take.

Companies will mark candidates on all of

these factors and it should not be assumed

that your existing method of presenting will

be what every client looks for.

Topics and types of presentation can

vary widely between companies, or even

diff erent managers within an organisation.

Most recruiting managers will be looking

for a presentation which answers the

question, is laid out in an ordered format

and has a logical fl ow. Slide content needs

to be succinct with limited bullet points,

which allow you to expand further and talk

around each particular topic.

You should set a clear agenda of what

you are there to discuss and how you are

going to go about it. At the end of the

presentation, a summary of the salient

points should be covered, emphasising

what you want your audience to remember

about the presentation and about you. Th is

is a good opportunity to reiterate your

skill set and competency in explaining

why you should be the successful applicant

for a role. As a fi nal pointer; as with most

presentations that you will do in your daily

role, preparation and practice is vital to

success.

Andy Anderson Recruitment Director, Evolve Selection

| |0844 357 7332 / 0113 871 0001www.evolveselection.co.uk / recruitment@evolveselection.co.uk

Name: Reg Nathan

Job: NHS Business Manager

Time in current role: Two years

Time in pharma: 30 years

First job: GP representative for Norgine Ltd

Success is....

Being happy with what I do and who I am.

What sets you apart in the work place? It

isn’t any one thing, but I believe that being

fair, honest and working hard are values that

have helped me in my career.

What techniques have you used to ‘climb

the ladder’?

Being able to recognise an opportunity that

presents itself, making the most of it and

being able to adapt to the new challenge.

What is more important to success:

ambition or talent?

Having both is important to achieve what

you want. Ambition without talent will limit

your choices, make you feel frustrated and

lead to a lack of progression.

What drives you on?

Being able to work in an environment that

encourages innovation, entrepreneurship

and delivers the best solutions to improve

people’s lives.

What would you consider the major milestones of your professional life? Moving from Yorkshire to Scotland for an

HDM role, and taking on the management

role with RB.

What is your proudest moment so far? In work, getting the Regional Business

Manager position and being part of the best

performing NHS team at RB.

What advice would you off er an ambitious colleague? Know what you are trying to achieve, take

advice from those around you and deliver

results.

Where would you like to be fi ve years from now in terms of professional progression? I want to be the best I can be in my current

job. I still have a lot to learn and success will

bring the next opportunity.

How important is professional development to getting ahead in a work environment? Very important. It is up to you to have a plan

for developing your skills; take on projects

that introduce you to the new experiences

and ideas that will lead you to your next role.

Have you got/had a mentor?

Not formally, I have always tried to learn

from those I have worked for and with, and

incorporate learnings to fi t my style and

personality.

Why is working hard and achieving

success important to you?

Both of these elements go towards happiness

in work and life.