Oli Hudson, content director at Wilmington Healthcare, explores how the coronavirus pandemic is changing pharma’s relationship with the NHS
COVID-19 has redefined the rules of NHS customer engagement for pharma as face-to-face meetings have been largely abandoned; digital liaison has become the norm and collaborative working has enabled solutions to be developed at speed.
In the COVID-19 recovery phase, the NHS must tackle a fresh set of challenges, including the elective care waiting list, while continuing to work towards key Long Term Plan ambitions, particularly around integrated care.
In this article, we look at how pharma’s relationship with the NHS has been changing during the pandemic. We also explore the integration agenda, hospital capacity and what the NHS needs from pharma now.
The pandemic has not only forced the pace of digital engagement for patients, it has also put paid to regular face-to-face meetings with NHS customers for pharma. The question now is if or when industry will be able to resume this traditional method of engagement.
At the moment, NHS trusts have individual policies about social distancing and remote access. However, generally, until the pandemic is at level 1, non-essential visits to hospitals will remain difficult, owing to the safety implications for patients, NHS staff and industry representatives.
For Advanced Budgetary Notices (ABNs: used by companies to alert stakeholders with budgetary responsibility to the future intended availability of a new medicine or technology), it is possible to make appointments on the telephone with the customer and, for guidance on other urgent matters, the administrators and personal assistants who work on behalf of senior managers may be able to provide some advice remotely.
However, even when the pandemic is over, there is a sense that pharma’s style of engagement with the NHS has already changed forever, as indicated by a recent PM Society survey which showed that 26% of GPs expected regular face-to-face contact before the pandemic compared to 12% now.
Furthermore, the survey revealed that while 59% of GPs would have expected regular contact from pharma via the internet before the pandemic, the figure has now risen to 67%.
There was also a marked change among secondary care doctors, with 47% expecting to see sales representatives regularly before the pandemic compared to 22% afterwards, with the respective figures regarding contact via the internet from pharma 34% versus 42%. However, there was considerable variation between specialties.
A virtual world
While some specialties may still require regular face-to-face engagement post pandemic, industry should expect that most of its contact with the NHS will be online. So, virtual meetings are likely to permanently replace face-to-face contact in many circumstances and marcoms programmes will need to incorporate integrated digital channels in various forms.
To differentiate itself in this space and engage with the varied stakeholders who are emerging in new integrated care organisations, industry must be imaginative with its digital engagement strategy and ensure that it is tailored to different stakeholder groups.
Similar principles are likely to apply to medical conferences in future as COVID-19 has forced them to go online, and strong attendance figures have proved this is a popular format. When organising such events, it is important to consider interactive sessions, virtual breakout rooms and virtual presentations for sponsors in breakouts. These may require the use of sophisticated software; hence careful research is needed beforehand to identify the right platform.
Of course, it is not only the style of engagement that is shifting. The stakeholders themselves are changing in line with the NHS’ integration agenda. For example, in primary care, healthcare development managers or Key Account Managers (KAMs) would have previously approached commissioners in Clinical Commissioning Groups (CCGs) to make their case for a particular therapy, service or pathway. Now, however, there is confusion as to where that echelon of customers sits following speculation that CCGs will disappear in the next set of reforms and that, by April 2021, all areas will be covered by an Integrated Care System (ICS) with no CCGs at all.
In the 18 areas where ICSs are up and running, and in other places where they operate in shadow form, CCG staff, such as prescribing advisers, medicines management, clinical leads and medical directors, are already effectively working in ICSs. This transition is expected to continue apace as the ICS adoption deadline set out in the Long Term Plan looms.
Capacity in hospitals
In addition to dramatically reducing the number of patients visiting A&E departments, COVID-19 has had a devastating effect on elective care with a recent warning from the Royal College of Surgeons of a mountain of cases that will take years to resolve.
Wilmington Healthcare recently looked at the impact of COVID-19 and expected recovery in a webinar called: Activity, Uptake, Variation: The customer landscape in the COVID-19 recovery period – 21 July 2020. English Hospital Episode Statistics (HES) data shows that many areas have been hard hit including gastroenterology where, between March and May this year in England, inpatient hospital spells fell by more than 50% compared to the same period in 2019. Another area that has seen a significant drop in activity is ophthalmology where the number of inpatient spells fell by two-thirds during the same time frame compared to last year (secondary care data taken from the English Hospital Episode Statistics (HES) database produced by NHS Digital).
In terms of getting back to normal, there is likely to be significant variation between specialties. The Royal College of Physicians has made predictions as to how progress is likely to unfold in secondary care. This shows, for example, that cardiology is currently working at less than 25% capacity but within a year it is expecting to be working at between 76% to 90% capacity. This means that even in 12 months’ time they do not expect to be back to full capacity, let alone clearing the backlog, and, added to this, there is a threat of subsequent waves of COVID-19.
Coronavirus has also prompted changes in prescribing in different therapy areas. For example, in oncology, interim change recommendations from NICE have looked at reducing levels of immunosuppression, keeping patients away from hospitals and reducing pressure on resources. In line with this, NICE has been recommending the suspension of certain types of treatment or switching from intravenous to subcutaneous treatments or allowing the oral administration of some drugs for which this was not previously indicated.
One positive outcome of the pandemic is the way in which pharma and the NHS have worked together to tackle the crisis. From accelerating clinical trials to supplying essential products at speed, COVID-19 has indeed brought unprecedented changes in working practices as protocols have been set aside and life sciences companies have worked with the NHS, as well as regulatory bodies and academia.
Such partnerships were explored in a recent webinar ‘Out of adversity...rapid change, NHS and industry working together’, chaired by Health Services Journal editor Alastair McLellan and featuring a panel comprising Hugo Breda, UK & Ireland Managing director of Johnson & Johnson, Dr Rav Seeruthun, medical director, Roche UK, and Chris Hopson, chief executive at NHS Providers.
A key message from the webinar was that fighting COVID-19 was like fighting a war and in their shared determination to defeat the enemy, pharma and the NHS have formed a new bond. To achieve this, pharma has moved away from transactional relationships to value-based partnerships that are based on deeper levels of openness and transparency.
Interestingly, these relationships have not simply involved single pharma companies working with the NHS, they have seen pharma companies working with each other on vaccines and sharing both data and patients when conducting clinical trials. This has been unprecedented in terms of the scale on which it has happened, and it is really important for the future as companies can be far more persuasive and effective in delivering change when they collaborate.
Changing the landscape
Coronavirus has changed the NHS customer landscape beyond recognition and data suggests that it is going to be a long time before services get back to normal. There is also a risk that any progress could be hampered by a resurgence of COVID-19 as the NHS prepares for a possible second wave.
In the midst of such uncertainty, industry needs to be fleet of foot in monitoring and responding to change – whether that be in NHS structure, service provision or prescribing guidance – and in amending its value proposition to support the NHS.
Pharma companies have already shown how they can work in true partnership with each other and with the NHS during the pandemic. In the recovery phase, industry needs to nurture the new relationships that have been formed and keep the wartime spirit alive through the challenges that lie ahead.