Dr Hamzah Baig

Pharmaceuticals in the new era: is Joint Working delivering results?

Dr Hamzah Baig MRCP

Senior Medical Advisor

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• What is Joint Working? Background

• Physicians in industry

• Case Studies

• My tips for success

• Q&A

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Background

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The evolving environment

Ministerial Industry Strategy Group Partnership Working Group

‘There are a number of areas where increased dialogue and partnership between the NHS and

industry would deliver significant benefits for Governments, patients, industry and research’

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But first…

Why does industry and the NHS need

to build a new relationship?

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The environmental challenges for the NHS

Ageing demographic

Increasing demand on healthcare resources

Economic pressure

New technologies

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R&Dproductivity

Increasing payor powerRegulatory

conservatism

Patent cliffs

Decentralisationof healthcare

Changing customer and societalexpectations

A multi-dimensional storm for Pharma…

Implicationsfor Pharma:

GrowthRisk

+ Excess global capacity

= New business model needed

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Different approaches and behaviours

All parties need to adapt and engage with each other differently

A more strategic relationship is required

ProcurerProcurer

SupplierSupplierCo-dependent partnersCo-dependent partners

Short-term focusShort-term focus Long-term strategic focusLong-term strategic focus

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Achieving long-term conditions targets by:

•Improved management of long-term conditions through:

•Reducing unscheduled consultation/admissions which will lead to.…

More, appropriate use of medicines:

•More proactive management and treatment of patients which will lead to.…

Improving patient outcomes in specific long-term conditions through:

• Identification of patients• Optimisation of treatment

and management of patients• Measuring outcomes• Medicines expertise

and information

NHS Our Shared Vision

Pharma

Helping to improve outcomes for patients

Improved NHS achievements – both clinical and financial targets

More appropriate use of medicines

The Shared Agenda

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February 2008

• DoH best practice guidance informs the NHS it can enter into JW with pharma

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February 2008


March 2008

• DoH/ABPI Joint Working toolkit

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February 2008


March 2008


June 2008

• ‘We want to foster a pioneering health service that makes best use of the talents of NHS staff, the higher education sector and industry’

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February 2008


March 2008


June 2008

• ‘We want to foster a pioneering health service that makes best use of the talents of NHS staff, the higher education sector and industry’

March 2009

• Guidance seeks to provide a framework and greater clarity about JW

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February 2008• DoH best practice guidance informs the

NHS it can enter into JW with pharmaMarch 2008• DoH/ABPI Joint Working toolkitJune 2008• ‘We want to foster a pioneering health

service that makes best use of the talents of NHS staff, the higher education sector and industry’

March 2009• Guidance seeks to provide a framework

and greater clarity about JWJuly 2010• Liberating the NHS White Paper &

Consultation Documents• “We expect consortia to involve relevant

health and social care professionals from all sectors in helping design care pathways or care packages that achieve the integrated delivery of care, higher quality, better patient experience and more efficient use of NHS”

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The framework for the Industry and the NHS to work together is now in place

• Guidance from the Department of Health

• Joint Working toolkit produced by Department of Health and ABPI - March 2008

• Practical guidance to help establish Joint Working projects• Template agreement and governance documents

• ABPI Guidance - March 2009• Joint Working between Pharmaceutical Companies and the

NHS for the benefit of patients

• Liberating the NHS White Paper & Consultation Documents – July 2010

“We expect consortia to involve relevant health and social care professionals from all sectors in helping design care pathways or care packages that achieve the integrated delivery of care, higher quality, better patient experience and more efficient use of NHS”

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DoH defined Joint Working

Defined as situations 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-centered projects and share a commitment to successful delivery

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Joint Working is

• Clear articulation of patient benefit

• POOLING of resources between company(ies) and NHS organisation

• Publication of the overall arrangements

• Significant contribution by each party (people, expertise, equipment, communication channels, IT, finance) clearly documented before project starts

• Significant size and duration (manpower, funding, materials >£15,000; >6 months)

• Arrangements conducted in open and transparent manner • Clear statement of mutual benefit up-front (including company ROI)

• Must be made public

• Clear, measurable outcomes regularly evaluated (6-monthly for projects of >1 year)

• Clearly defined, mutually agreed exit criteria

• Managed by a Steering Group of NHS and company personnel

• Engagement with stakeholders

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Joint Working isn’t

• Provision of Medical and/or Educational Goods and Services (MEGS) which enhance/maintain patient care or benefit NHS

• Clinical trials, support for investigator or institution-initiated/sponsored studies

• Gifts, benefits in kind, pecuniary advantages

• Commercial payments for consultancy/advice

• Educational grants

• Meetings and hospitality

• Package deals (medicine + other associated benefits)

• Pricing, margins, discount arrangements

• NHS tenders

• Commercial arrangements, e.g. risk share, outcome guarantee schemes

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Other Considerations

• Market share vs Market growth

• One or more pharma companies

• Budget holders – New NHS environment

• Any willing provider

• HCP Private providers

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Pharmaceutical Physician

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Medical Affairs Physician

• Evolving role in bridging R&D

• Pills to Pathways

• Value to patients and society

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• Material prepared in relation to joint working between the NHS and the pharmaceutical industry must be certified as per the requirements of the ABPI Code of Practice.

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Training

• Sales to Account Manager

• Ethics & Governance

• Unmet clinical need

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Improving quality and productivity in the management of COPD

Developing Joined-up ways of working to improve COPD

An ABPI/DH defined Joint Working project between

StHealth PBC Consortium and GlaxoSmithKline (GSK).

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COPD exerts a significant burden in the St Helens locality

1. NHS Comparators admissions data provided by StHealth PBC, March 2010.2. Modelled projections of PCT COPD prevalence in England in 2020, Eastern Region Public Health Observatory.

http://www.erpho.org.uk/Download/Public/18025/1/Modelled%20COPD%20by%20PCT%20v4.xls, Accessed December 2010. Current COPD prevalence from QoF data 2008/09 http://www.ic.nhs.uk/statistics-and-data-collections/supporting-information/audits-and-performance/the-

quality-and-outcomes-framework/qof-2008/09/data-tables/prevalence-data-tables Accessed December 2010.

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The StHealth / GSK COPD Project

• Education and mentoring• Early detection of COPD• Complex patient reviews

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Implementation started with business case

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Objectives follow principles of QIPP

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Excellent outcomes emerging….

1. GSK POINTS data from sample of 923 patients. Collected and supplied by Quintiles. March 2010.2. Ipsos MORI. COPD Patient Experience Survey. May 2010.

3. StHealth PBC SUS data based on ICD10 primary diagnosis codes J40 – J44. July 2010.4. StHealth PBC Consortia. Analysis of COPD6 Screening. December 2010.

5. StHealth PBC Consortia. Internal Survey of 20 practice nurses. December 2009.

Improving Quality and Productivity in COPD Management in line with NICE guidelines

Wearside PBC Consortium and GlaxoSmithKline UK (GSK)

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Project Team

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COPD exerts a significant burden on the Wearside locality

1. British Lung Foundation, “Invisible lives. Chronic Obstructive Pulmonary Disease (COPD) finding the missing million.” November 2007.2. Wearside Hospital Episodes Statistics Report 2007/2008, prepared by GSK October 2008. HCM/MAM/08/38502/1.

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Clear objectives from the beginning

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A stepwise – replicable - approach

Share tangible project results

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Joint Working means pooling resourcesWearside Consortium GSK

• PBC Business Manager & Clinical Lead – project management and practice engagement

• Development of COPD treatment protocol

• Locum cover for healthcare professionals to attend training sessions

• Provision of training facilities

• Incentive scheme

- 50p per COPD patient

• 50% of the cost of the Patient Experience Survey

• Project management resource

• POINTS Patient audit tool to measure adherence to NICE guidance

• Dedicated resource to develop bespoke training and action plans

• 50% of the cost of the patient experience survey

• Health Outcomes Consultant to set project measures, interpret and analyse locality data, and evaluate results

Value of Total Contribution = £162,300 Value of Total Contribution = £91,000

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Excellent outcomes emerging….

3. POINTS data reports for 17 practices, 2,836 patients. Collected and supplied by Quintiles, data analysis by GSK, September 2010.4. COPD Patient Experience Survey. Data collected from 216 patients and analysed by Ipsos MORI, September 2010.

5. SUS data based on HRG DZ21. Data provided by NHS Sunderland PCT and analysed by GSK, August 2010.6. Stakeholder Survey, data collected and analysed by Ipsos MORI, March 2010.

Tips for Success

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Top 10 tips

1. Read the guidance

2. Spend time engaging with stakeholders

3. Give account managers appropriate training and support

4. Do your homework

5. Don’t PROMISE anything!

6. Remember Competition Law

7. Be open and honest

8. Try to avoid turning it into something it is not

9. Build expertise

10. Pay attention to Exit Strategies

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• If you have any examples of similar partnership working elsewhere in Europe or would like to discuss possible partnership working with GSK please feel free to contact me on:

»[email protected]

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QUESTIONS?

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Health & Medicine

Dr Hamzah Baig