Sustainability and Transformation Plans (STPs) are set to create upheaval in the NHS – and in the pharma industry too

The NHS is changing again. The need to innovate is great, what with an ageing population, increased pressure on services and a bulging £22 billion budget hole to plug. Enter Sustainability and Transformation Plans (STPs). Formally introduced in April this year, these plans focus on ‘place’ – they are essentially a targeted five-year health and care strategy for a particular area in England, with 44 such areas having been designated. In a nutshell, that effectively means that much of the centrally governed giant NHS machine is out; replaced by 44 different mini health services.

Not only is this yet another upheaval to the NHS but it’s also an upheaval for the pharma industry and its future relations with the health service. Clinical Commissioning Groups (CCGs) have dominated the healthcare landscape for the past four years, and many would argue that the industry has only just got its head around how to deal with the new entrants. Now it’s forced to change tack again. And the warnings are that STPs will be even more disruptive and turbulent to pharma than the introduction of CCGs.
Mike Cooper, managing director at specialist sales organisation and outsourcing provider OUTiCO, says: “The move to STPs will be more complex than the payer/provider model” based on the diversity of stakeholders and the different priorities in each demographic and customer group.

So, what should pharma expect with the introduction of STPs? Well, each of the 44 five-year plans incorporate all aspects of NHS spending for the specific geographical footprint, with each area covering an average population of 1.2 million people. Each STP, which has been led by a particular person from a CCG, NHS Trust or local government, is tasked with improving quality and developing new models of care, improving health and wellbeing, and improving the efficiency of services.

Key priorities for each locality have been identified to meet these three challenges – such as prevention and a renewed focus on primary and community care – as well as efforts to better integrate social care and other local authority services. Changes could include, for example, how cancer or mental health services are provided, the centralisation or reduction of some acute services, fewer CCGs and even changes to IT systems. And all of this while essentially balancing the books and delivering financial sustainability to the NHS.

According to the King’s Fund, “STPs represent a shift in the way that the NHS in England plans its services”, with the new approach being called “place-based planning”. The think tank says: “While the Health and Social Care Act 2012 sought to strengthen the role of competition within the health system, NHS organisations are now being told to collaborate rather than compete to respond to the challenges facing their local services… This shift reflects a growing consensus within the NHS that more integrated models of care are required to meet the changing needs of the population… [and] also recognises that growing financial problems in different parts of the NHS can’t be addressed in isolation.”

Pharma’s role

With this in mind, there is a clear role for pharma to play – notably in working with STPs “to identify and develop improved patient pathways”, says Cooper. Indeed, the King’s Fund also alludes to this, saying that the shift to place-based planning and new way of working for the NHS, which is the “right thing to do”, “should also include collaboration with other services and sectors beyond the NHS to focus on the broader aim of improving population health and wellbeing – not just on delivering better quality and more sustainable healthcare services”.

But as with any new way of working for the NHS, it too will be a new way of working for pharma – and it will be one that touches every part of the value chain. It’s reasonable to assume that things such as the structure of the NHS, how services and drugs are commissioned, how patients journey along chronic disease pathways, as well as the local priorities, targets and efficiency plans will all change, and that each STP locality will be different from its neighbour.

The key for what this means for pharma centres on ‘value’. Says Cooper: “We will need to have a broader and deeper understanding of how our medicines can deliver benefits”, because, he says, “if we don’t make and market a medicine in a way that shows value within the more holistic setting of the STP it simply won’t be used”.

That’s not just about creative sales and marketing messages – it has to be built into the R&D fabric, he says. “From the very beginning of the product lifecycle we will need to deliver the information that will help diverse stakeholders see the position, value and benefit of our medicines,” he stresses. That means R&D will need to focus on researching and demonstrating measurable outcomes and look at the potential to use new products in different care settings. Cooper gives the example where device and delivery systems could be used in the home or community setting rather than within the hospital. In addition, knowing where exactly a product can deliver most benefit in the patient pathway will be crucial.

For sales and marketing, companies will have to develop communication channels with an even wider group of customers, some of whom pharma won’t have worked with before, such as local authorities, charities and patient groups. Pharma will have to understand the key players and objectives for each STP and show true flexibility in delivering messages to customers, Cooper says. “Many of these stakeholders will be required to look at and understand the impact of prescribing on the patient pathway. We will have to learn to deliver key messages that engage each of these stakeholders in their language. The traditional clinical sell will not be sufficient.”

The issue of market access

Ultimately, market access is at stake with the introduction of STPs, and there is an urgency now for pharma to develop new ways to engage and communicate value. “The traditional top-down model of getting a few KOLs to use a product in a specialist secondary care setting and then progress that influence to all secondary care and finally primary care will not be effective for many drugs anymore,” says Cooper. “We will need to become adept at empowering new prescriber groups to take the initiative and be the early prescribers in more diverse settings.” Cooper believes community- and GP-led services will become the innovators for many new therapies.

Even with pharma’s own transformation to align with STPs there is still the concern that it will be harder to get drugs taken up and prescribed under the new plans while funding remains an issue. There have already been several reports that some STPs are pushing medicines optimisation as a way of making savings, such as pathway reviews for high-cost drugs and reducing drug waste. And of course, there are the upcoming PPRS negotiations, which will certainly put a spotlight on drug prices. But how STPs might affect negotiations is currently unclear.

However, on the positive side, Cooper believes it might actually be easier to get secondary care drugs approved more quickly without the interventions of CCGs, while outcomes-based contracts could see more expensive, innovative drugs accepted, assuming their cost-cutting and savings potential can be proven. Indeed, Cooper believes that despite the upheaval the outlook is positive for the industry, creating a number of opportunities for pharma to identify and help plug healthcare gaps. “With correct and effective use of medicines supported by accurate and robust data we can help STPs to be innovative in the way they look at services and deliver care,” he explains.

As such, it’s also imperative for pharma to show it can provide support beyond the marketed drug – and tailored solutions will be key. “Pharma will need to demonstrate optimal pathways for their products within STPs and they will need to demonstrate the economic argument for their products way beyond product pricing,” says Cooper. Working collaboratively and innovatively with the NHS will be crucial for success.

The King’s Fund believes STPs are an opportunity for improving health and care services in England. With this in mind, Cooper says that pharma needs to win a place at the table and be seen as a valuable partner in helping to deliver the right care in the right place. “If we miss this opportunity to show how impactful we can be right at the start of this process we will find it hard to get back in and change existing structures and pathways,” he says. It’s time for pharma to step up.