The chief executive of the ABPI has said the industry is struggling to understand the major reform of the NHS and stressed again the need for the industry to be seen as a partner to the health service as it undergoes reform.
Speaking at the ABPI’s annual conference, titled: ‘360 degrees of health’, Stephen Whitehead, chief executive of the UK lobby group said: “I know of – and I share at times – the great frustration you have with the NHS and it seems immune, often, to the benefits we [the industry] offer - and our endless charm offensive.
“And right now, this is being compounded by the fact that the NHS is going through dramatic change. The R&D-led pharma firms in this country are struggling to understand this, and how to best develop a new strategy for this new system.”
From 1 April, the management structure of the NHS was changed dramatically as the seven-year tenure of the 151 primary care trusts and ten strategic health authorities came to an end, being replaced by 211 clinical commissioning groups, made up primarily of family doctors.
This has meant that pharma has new commissioners to engage with who have little or no experience of managing budgets and services, and it also means many long-established relationships with NHS managers must be re-built with GPs, who are less friendly with pharma than PCT leaders.
But over and above this, Whitehead said the old problems of the NHS remain. “What we as an industry get excited about – i.e., innovation – the NHS is less excited.” He gave examples of the new oral anticoagulants that had forced new pathways of care in the health service – but said many in the NHS were reluctant to make this change.
The new pills he tacitly spoke of are Boehringer’s Pradaxa, Janssen/Bayer’s Xarelto and Pfizer/BMS’s Eliquis, which are all vying to replace the 50-year old generic warfarin. Warfarin requires constant re-dosing and can cause severe bleeding and interactions with other medicines, and many patients must come into hospital or pharmacies for ‘warfarin Wednesdays’, which requires specialist staff and nurses.
The new medicines look to dramatically change this pathway as there is no need for constant re-dosing and less chance of bleeds and interactions – but many doctors have criticised NICE for allowing these medicines through, as they change the pathway so dramatically, and cost more money that warfarin, which has a price tag of less than 1p per day.
But Whitehead said patients want this type change – and they are “becoming noisier” through use of digital and patient groups, who lobby their needs to be heard and have better care with the latest innovation.
Drug spend on patientsWhitehead went on: “We all know that the medicines bill is the easiest thing in the NHS to cut, but we spend just 7p per patient, per day on medicines launched in the last five years. Compare this to Germany, where this figure is 21p.”
But Sir Andrew Dillon, chief executive of NICE, said the amount spent per patient was meaningless unless there was data to show what this meant: “Is the 7p figure the right figure? The only way you can know that is if you look at outcomes this spend achieves.
“But this is where it gets complicated,” Sir Andrew went on. “It isn’t always just about the drug and its spend and outcome – but other service areas play an important role too.
“In the end, I don’t know if the 7p figure is too much or too little,” he concluded.
Whitehead finished his speech saying that though ‘partnership’ was the “most over-used word in the industry” – it was still one of the most important.
“I don’t see us as being externalised away from the NHS as we once were, confined in large out-of-the-way R&D buildings. Now I see us working together with the NHS in laboratories and hospitals.”
He said the social contract between industry and the NHS still remained, but said: “Industry is holding up its end of the deal by creating innovative products; but the burden is on the NHS to deliver them,” implying that it was not always doing this, a major bugbear of pharma in the UK.
Talking about partnerships in the new NHS, he said: “Are we best positioned to work with the new NHS? I’d have to say yes and no. Firstly yes, because of the Innovation Health and Wealth report, which has helped increase market access through the use of the Innovation Scorecard, whilst also opening up NHS patient data and helping with research.
“But I also say no, because the NHS stills sees us as something to cut, and there are trusts issues on both sides. Sometimes, I don’t think they understand us at all.”